Computer aided skeletal reconstruction with use of Bone Morphogenetic Protein -Experimental study of new method for skeletal reconstructive surgery-

临床上经常遇到因骨切除、软组织肿瘤或高能量损伤而造成的不同部位、不同大小和形状的大面积骨缺损的重建。然而，目前的方法来修复大骨缺损是不够的，临床结果通常是不令人满意的，即使使用自体骨移植。迫切需要在短时间内高效准确地修复这种大面积骨缺损的新方法。本研究旨在开发一种新的骨修复技术，将DNA重组技术产生的生物活性蛋白（骨形态发生蛋白-2，BMP-2）、人工合成生物材料（HA，羟基磷灰石）、人工合成聚合物（聚乳酸-聚乙二醇嵌段共聚物，PLA-PEG）和生物可降解的β-磷酸三钙（β-TCP）粉末联合应用，促进骨修复。作为一项临床前研究，我们建立了一个狗的骨盆骨缺损模型， ...更多信息 生成髂骨，并通过从镜像的对侧正常髂骨中减去受影响髂骨的三维图像，基于计算机断层扫描数据确定真实尺寸和形状的骨缺损。利用骨缺损的三维CT数据，通过计算机辅助设计（CAD）系统Tb联合收割机将CAD制作的HA种植体与BMP、PLA-PEG聚合物和βTCP粉末结合，将小剂量BMP-2（~ 100 μg）混入糊状的PLA-PEG聚合物/ βTCP粉末中。（分别为100 mg），并涂覆HA植入物表面，通过外科手术植入骨缺损中。术后每周通过骨盆常规和CT扫描X线片对骨形成反应进行随访。术后3周，种植体表面开始出现新骨，9周时新骨完全覆盖整个种植体。术后9周，髂骨大体观察，原有骨缺损完全修复，新骨形成，髂骨解剖结构恢复正常。结果表明，使用合成材料（重组BMP-2、PLA-PGE聚合物βTCP和Hablock）在短时间内不使用骨移植物的情况下具有修复大骨缺损的潜力。少

Reconstruction of large bone defects at various site with various size and shape are often encountered in clinical practice as results from surgical resection of bone and for soft tissue tumors or from the high energy injury. However, current modalities to repair the large bone defects are not enough and clinical outcomes are usually not satisfactory, even if with use of autogenous bone grafting. And novel methods to repair such large bone defects with high efficacy and accuracy in short periods are urged. This study is aiming at development of such a new technology to promote bone repair with combined use of a bioactive protein (bone morphogenetic protein-2, BMP-2) produced by DNA recombination technology, synthetic biomaterial (HA, hydroxyapatite) a synthetic polymer (polylactic acid-polyethylene glycol block co-polymer, PLA-PEG) and a biodegradable β tricalcium phosphate (βTCP) powder. As a preclinical study, we generated a pelvic bone defect model in dog, where optional defect in t … More he iliac bone was generated and the real-sized and shaped bone defect was determined based on computer tomography scanning data by subtracting the three-dimensional image of the affected iliac bone from mirror-imaged contralateral normal ilium. The 3-dimensional CT data of the bone defect was utilized to fabricate HA implant correctively identical to the bone defect by a computer aided designing (CAD) system Tb combine the CAD fabricated HA implant with BMP, PLA-PEG polymer and βTCP powder, small dose of BMP-2 (-100 μg) was mixed into paste-natured PLA-PEG polymer/ βTCP powder. (〜100mg respectively) and coated the HA implant surface and placed into the bone defect by surgical procedures. After surgery, the bone forming reactions were followed weekly by routine and CT scanning radiographyof the pelvis. New bone covering the implant started to appear in 3 weeks after surgery and completely covered whole implant in 9 weeks, On gross appearance of the retreaved ilium at 9 weeks after surgery, the original bone defect was completely repaired with new bone formation and restored normal anatomy of the ilium. The results indicated potential repair of large bone defects with use of synthetic materials (recombinant BMP-2, PLA-PGE polymer βTCP and Hablock) without use of bone grafting in short periods of time. Less