free vascularized bone grafting formed by stimulation of the periosteum with the BM (Bone Morphogenetic Protein)

大鼠胫骨内侧骨膜由隐动静脉营养。人们试图通过骨形态发生蛋白(BMP)刺激骨膜产生一种新骨，然后将其作为骨移植进行移植。在手术显微镜下，用微血管细微器械在胫骨上隆起骨膜。将20只Wistar系大鼠随机分为4组。第1组从胫骨上提骨膜，单纯闭合皮肤，第2组仅在抬高的骨膜下放置骨形态发生蛋白载体，第3组将含10μg骨形态发生蛋白的25 mg载体放置在骨膜上，第4组将骨形态发生蛋白及其载体放置在骨膜下。术后3周取大鼠胫骨，摄片测量新生骨量。组1和组2仅有少量骨形成，组3基本无骨形成，组4有大量骨形成，提示骨膜下可在BMP刺激下产生大量骨，并可移植到其他部位作为活骨移植。通过插入腹主动脉的导管进行的血管造影清楚地显示了股动脉及其分支。在手术的胫骨股骨远端1/3处形成了一块骨缺损。解剖隐动脉和股动静脉，在胫骨内侧形成新骨，并将骨转移到股骨的缺损处，作为带血管的骨移植。股骨的可靠愈合尚未达到，可能是由于移植骨固定不良所致。然而，移植的骨被发现长时间保持在股骨远端而不被吸收，与BMP刺激下肌肉中异位形成的新骨相反。

The medial periosteum of the rat tibia is nourished by the saphenous artery and vein. An attempt was made to produce by stimulating this periosteum by the bone morphogenetic protein (BMP) a new bone that could then be transferred as a bone graft. The periosteum was raised on the tibia using microvascular fine instruments under operating microscope. Twenty Wistar strain rats were divided in 4 groups. The periosteum was raised from the tibia and the skin was simply closed in Group 1. Only a carrier of the BMP was placed under the raised periosteum in Group 2. The 25 mg carrier containing 10 μg BMP was placed on the periosteum in Group 3. The BMP and its carrier was placed under the periosteum in Group 4. The operated rat tibia was taken three weeks postoperatively and amount of the newly-formed bone was measured radiographically. Only a small amount of bone was formed in Group 1 and 2. While there was virtually no bone formation in Group 3, a good amount of bone was seen in Group 4. It was thus found that the undersurface of the periosteum could produce by stimulation of the BMP a good amount of bone that could be transferred to another place as a living bone graft. Angiography performed through a catheter introduced in the abdominal aorta depicted the femoral artery and its branches clearly.A bone defect was created in the distal one third of the femur of the operated tibia. The saphenous as well as the femoral artery and vein were dissected with the new bone formed on the medial aspect of the tibia and the bone was transferred to the defect created in the femur as a vascularized bone graft. A reliable union of the femur has not been yet attained due to, probably, a poor fixation of the grafted bone. The transferred bone was, however, found to remain at the distal femur without absorption for a long time, contrary to a new bone formed ectopically in muscles with stimulation of the BMP.