Marcacci Maurilio, Kon Elizaveta, Moukhachev Vladimir, Lavroukov Andrei, Kutepov Sergej, Quarto Rodolfo, Mastrogiacomo Maddalena, Cancedda Ranieri
Laboratorio di Biomeccanica, Istituti Ortopedici Rizzoli, Bologna, Italy.
Tissue Eng. 2007 May;13(5):947-55. doi: 10.1089/ten.2006.0271.
Extensive bone loss is still a major problem in orthopedics. A number of different therapeutic approaches have been developed and proposed, but so far none have proven to be fully satisfactory. We used a new tissue engineering approach to treat four patients with large bone diaphysis defects and poor therapeutic alternatives. To obtain implantable three-dimensional (3D) living constructs, cells isolated from the patients' bone marrow stroma were expanded in culture and seeded onto porous hydroxyapatite (HA) ceramic scaffolds designed to match the bone deficit in terms of size and shape. During the surgical session, an Ilizarov apparatus or a monoaxial external fixator was positioned on the patient's affected limb and the ceramic cylinder seeded with cells was placed in the bone defect. Patients were evaluated at different postsurgery time intervals by conventional radiographs and computed tomography (CT) scans. In one patient, an angiographic evaluation was performed at 6.5 years follow-up. In this study we analyze the long-term outcome of these patients following therapy. No major complications occurred in the early or late postoperative periods, nor were major complaints reported by the patients. No signs of pain, swelling, or infection were observed at the implantation site. Complete fusion between the implant and the host bone occurred 5 to 7 months after surgery. In all patients at the last follow-up (6 to 7 years postsurgery in patients 1 to 3), a good integration of the implants was maintained. No late fractures in the implant zone were observed. The present study shows the long-term durability of bone regeneration achieved by a bone engineering approach. We consider the obtained results very promising and propose the use of culture-expanded osteoprogenitor cells in conjunction with porous bioceramics as a real and significant improvement in the repair of critical-sized long bone defects.
广泛的骨质流失仍是骨科领域的一个主要问题。人们已经开发并提出了多种不同的治疗方法，但迄今为止，尚无一种方法被证明是完全令人满意的。我们采用一种新的组织工程方法治疗了4例患有大段骨干缺损且治疗选择有限的患者。为了获得可植入的三维（3D）活体构建物，从患者骨髓基质中分离出的细胞在培养中进行扩增，然后接种到设计成在尺寸和形状上与骨缺损相匹配的多孔羟基磷灰石（HA）陶瓷支架上。在手术过程中，将伊利扎罗夫器械或单轴外固定器放置在患者的患肢上，并将接种了细胞的陶瓷圆柱体置于骨缺损处。通过传统X线片和计算机断层扫描（CT）对患者在不同的术后时间间隔进行评估。在1例患者中，在随访6.5年时进行了血管造影评估。在本研究中，我们分析了这些患者治疗后的长期结果。术后早期或晚期均未发生重大并发症，患者也未报告重大不适。在植入部位未观察到疼痛、肿胀或感染迹象。术后5至7个月，植入物与宿主骨完全融合。在最后一次随访时（患者1至3术后6至7年），所有患者的植入物均保持良好的整合状态。在植入区域未观察到晚期骨折。本研究显示了通过骨工程方法实现的骨再生的长期耐久性。我们认为所获得的结果非常有前景，并建议将培养扩增的骨祖细胞与多孔生物陶瓷联合使用，作为对临界尺寸长骨缺损修复的一项切实且重大的改进。
