Peterson Brett, Whang Peter G, Iglesias Roberto, Wang Jeff C, Lieberman Jay R
Department of Orthopaedic Surgery, David Geffen School of Medicine at UCLA, Center for Health Sciences 76-134, 10833 Le Conte Avenue, Los Angeles, CA 90095, USA.
J Bone Joint Surg Am. 2004 Oct;86(10):2243-50. doi: 10.2106/00004623-200410000-00016.
Although autogenous bone is the most widely used graft material for spinal fusion, demineralized bone matrix preparations are available as alternatives or supplements to autograft. They are prepared by acid extraction of most of the mineralized component, with retention of the collagen and noncollagenous proteins, including growth factors. Differences in allograft processing methods among suppliers might yield products with different osteoinductive activities. The purpose of this study was to compare the efficacy of three different commercially available demineralized bone matrix products for inducing spinal fusion in an athymic rat model.
Sixty male athymic rats underwent spinal fusion and were divided into three groups of eighteen animals each. Group I received Grafton Putty; Group II, DBX Putty; and Group III, AlloMatrix Injectable Putty. A control group of six animals (Group IV) underwent decortication alone. Six animals from each of the three experimental groups were killed at each of three intervals (two, four, and eight weeks), and the six animals from the control group were killed at eight weeks. At each of the time-points, radiographic and histologic analysis and manual testing of the explanted spines were performed.
The spines in Group I demonstrated higher rates of radiographically evident fusion at eight weeks than did the spines in Group III or Group IV (p < 0.05). Manual testing of the spines at four weeks revealed variable fusion rates (five of six in Group I, two of six in Group II, and none of six in Group III). At eight weeks, all six spines in Group I, three of the six in Group II, and no spine in Group III or IV had fused. Histologic analysis of the spines in Groups I, II, and III demonstrated varying amounts of residual demineralized bone matrix and new bone formation. Group-I spines demonstrated the most new bone formation.
This study demonstrated differences in the osteoinductive potentials of commercially available demineralized bone matrices in this animal model.
尽管自体骨是脊柱融合术中应用最广泛的移植材料，但脱矿骨基质制剂可作为自体移植的替代物或补充物。它们是通过酸提取大部分矿化成分而制备的，保留了胶原蛋白和非胶原蛋白，包括生长因子。供应商之间同种异体移植物处理方法的差异可能会产生具有不同骨诱导活性的产品。本研究的目的是比较三种不同市售脱矿骨基质产品在无胸腺大鼠模型中诱导脊柱融合的疗效。
60只雄性无胸腺大鼠接受脊柱融合术，并分为三组，每组18只动物。第一组接受Grafton Putty；第二组接受DBX Putty；第三组接受AlloMatrix可注射腻子。一个由6只动物组成的对照组（第四组）仅接受去皮质术。三个实验组中的每组6只动物在三个时间间隔（两周、四周和八周）的每个时间点处死，对照组的6只动物在八周时处死。在每个时间点，对外植脊柱进行影像学和组织学分析以及手动测试。
第一组的脊柱在八周时影像学上明显融合的发生率高于第三组或第四组（p < 0.05）。四周时对脊柱进行手动测试发现融合率各不相同（第一组6只中有5只，第二组6只中有2只，第三组6只中无融合）。八周时，第一组的所有6只脊柱、第二组的6只中有3只、第三组或第四组中无脊柱融合。对第一组、第二组和第三组的脊柱进行组织学分析显示，残留的脱矿骨基质和新骨形成的量各不相同。第一组的脊柱显示出新骨形成最多。
本研究证明了在该动物模型中，市售脱矿骨基质的骨诱导潜力存在差异。
