Pluhar G E, Manley P A, Heiner J P, Vanderby R, Seeherman H J, Markel M D
Comnparative Orthopaedic Research Laboratory, School of Veterinary Medicine, University of Wisconsin-Madison, 53706, USA.
J Orthop Res. 2001 Mar;19(2):308-17. doi: 10.1016/S0736-0266(00)90002-0.
This study compared the effect of augmentation of allograft host bone junctions with recombinant human bone morphogenetic protein-2 (rhBMP-2) on an absorbable collagen sponge (ACS), autogenous cancellous bone graft (CBG), and a collagen sponge alone in a canine intercalary femoral defect model repaired with a frozen allograft. Outcome assessment included serial radiographs, dual energy X-ray absorptiometry scans, and gait analyses, and mechanical testing and histology of post-mortem specimens. The distal junction healed more quickly and completely with rhBMP-2 than ACS alone based on qualitative radiography and histologic evaluations. The primary tissue in the unhealed gaps in the ACS group was fibrous connective tissue. The proximal allograft host bone junction had complete bone union in the three treatment groups. There was significantly greater new bone callus formation at both junctions with rhBMP-2 than with CBG or ACS alone that resulted in increased bone density around the allograft host bone junctions. All dogs shifted their weight from the treated leg to the contralateral pelvic limb immediately after surgery. Weight bearing forces were redistributed equally between the pelvic limbs at 12 weeks after surgery with rhBMP-2, at 16 weeks after surgery with CBG, and at 24 weeks after surgery with ACS alone. Bending and compressive stiffnesses of the whole treated femora were equal to the contralateral control femora in all treatment groups, whereas torsional rigidities of the whole treated femora for the CBG and ACS groups were significantly less than the control. Both the proximal and distal junctions the treated with rhBMP-2 had torsional stiffnesses and strengths equal to intact control bones. Ultimate failure torques of the proximal junctions of the CBG group and of both junctions of the ACS group were significantly less than the BMP-treated bones. Augmentation of the allograft host bone junctions with rhBMP-2 on an ACS gave results for all parameters measured that equaled or exceeded autogenous graft in this canine intercalary femoral defect model.
本研究比较了在冷冻同种异体骨修复的犬股骨节段性缺损模型中，重组人骨形态发生蛋白-2（rhBMP-2）增强同种异体骨与宿主骨结合处对可吸收胶原海绵（ACS）、自体松质骨移植（CBG）以及单独使用胶原海绵的效果。结果评估包括系列X线片、双能X线吸收法扫描、步态分析，以及死后标本的力学测试和组织学检查。基于定性X线摄影和组织学评估，与单独使用ACS相比，rhBMP-2使远端结合处愈合更快且更完全。ACS组未愈合间隙中的主要组织为纤维结缔组织。三个治疗组的近端同种异体骨与宿主骨结合处均实现了完全骨愈合。与单独使用CBG或ACS相比，rhBMP-2在两个结合处均有显著更多的新骨痂形成，导致同种异体骨与宿主骨结合处周围的骨密度增加。所有犬在术后立即将体重从治疗侧腿转移至对侧骨盆肢。在术后12周使用rhBMP-2、术后16周使用CBG以及术后24周单独使用ACS时，负重力量在骨盆肢之间平均重新分布。所有治疗组中，整个治疗股骨的弯曲和压缩刚度与对侧对照股骨相等，而CBG组和ACS组整个治疗股骨的扭转刚度显著低于对照组。rhBMP-2治疗的近端和远端结合处的扭转刚度和强度均与完整对照骨相等。CBG组近端结合处以及ACS组两个结合处的最终破坏扭矩均显著低于rhBMP-2治疗的骨。在该犬股骨节段性缺损模型中，在ACS上使用rhBMP-2增强同种异体骨与宿主骨结合处，所测所有参数的结果均等于或超过自体移植。
