Elsalanty Mohammed E, Por Yong-Chen, Genecov David G, Salyer Kenneth E, Wang Qian, Barcelo C R, Troxler Karen, Gendler El, Opperman Lynne A
Department of Oral Biology and Maxillofacial Pathology, School of Dentistry, Medical School of Georgia, Augusta, GA, USA.
J Oral Maxillofac Surg. 2008 Feb;66(2):277-85. doi: 10.1016/j.joms.2007.06.626.
Cranial defect reconstruction presents 2 challenges: induction of new bone formation, and providing structural support during the healing process. This study compares quantity and quality of new bone formation based on various materials and support frameworks.
Eighteen dogs underwent surgical removal of a significant portion of their cranial vault. Demineralized bone matrix was used to fill the defect in all animals. In 9 dogs, recombinant human bone morphogenetic protein-2 (rhBMP-2) was added, while the other 9 served as the non-rhBMP-2 group. In each group, 3 animals were fixed with cobalt chrome plates, 3 with adding platelet-rich plasma, and 3 fixed with a Lactosorb (Walter Lorenz Surgical, Inc, Jacksonville, FL) resorbable mesh. Necropsy was done at 12 weeks postoperative. Histomorphometry, density, and mechanical properties of the regenerate were analyzed.
The non-rhBMP-2 groups showed minimal substitution of demineralized bone matrix with new bone, while only sporadic remnants of demineralized bone matrix were present in the rhBMP-2 groups. The defect showed more new bone formation (P < .001) and density (P < .001) in the rhBMP-2 groups by Kruskal-Wallis test. The area of new bone was not significantly different among the rhBMP-2 subgroups. The resorbable mesh struts showed no sign of bone invasion or substitution. In the non-rhBMP-2 resorbable mesh group, demineralized bone matrix almost totally disintegrated without replacement by new bone.
The addition of rhBMP-2 to demineralized bone matrix accelerated new bone formation in large cranial defects, regardless of the supporting framework or the addition of platelet-rich plasma. The use of a resorbable mesh in such defects is advisable only if rhBMP-2 is added.
颅骨缺损修复面临两个挑战：诱导新骨形成，以及在愈合过程中提供结构支撑。本研究比较了基于各种材料和支撑框架的新骨形成的数量和质量。
18只犬接受手术切除大部分颅顶骨。所有动物均使用脱矿骨基质填充缺损。9只犬添加重组人骨形态发生蛋白-2（rhBMP-2），另外9只作为非rhBMP-2组。每组中，3只动物用钴铬板固定，3只添加富血小板血浆，3只用Lactosorb（Walter Lorenz Surgical, Inc, Jacksonville, FL）可吸收网片固定。术后12周进行尸检。分析再生组织的组织形态计量学、密度和力学性能。
非rhBMP-2组显示脱矿骨基质被新骨替代的程度极小，而rhBMP-2组仅存在散在的脱矿骨基质残余。通过Kruskal-Wallis检验，rhBMP-2组的缺损显示出更多的新骨形成（P <.001）和密度（P <.001）。rhBMP-2亚组之间的新骨面积无显著差异。可吸收网片支柱未显示骨侵入或替代的迹象。在非rhBMP-2可吸收网片组中，脱矿骨基质几乎完全分解，没有被新骨替代。
在脱矿骨基质中添加rhBMP-2可加速大型颅骨缺损的新骨形成，无论支撑框架如何或是否添加富血小板血浆。仅在添加rhBMP-2时，才建议在这类缺损中使用可吸收网片。
