Maus Uwe, Andereya Stefan, Gravius Sascha, Siebert Christian H, Ohnsorge Jörg A K, Niedhart Christopher
Department of Orthopaedic Surgery, University Hospital of the RWTH Aachen, Pauwelsstr. 30, 52074 Aachen, Germany.
Arch Orthop Trauma Surg. 2008 Dec;128(12):1461-6. doi: 10.1007/s00402-008-0608-8. Epub 2008 Mar 11.
Autologous bone graft is the gold standard for the filling of large osseous defects. Because of its limited supply and complications such as pain, bleeding or infection, the development of alternative bone substitutes has been the subject of several studies. In clinical practice, the most commonly used bone substitutes are calcium phosphates like hydroxyapatite or tricalcium phosphate. With the aim to improve the osseointegration of these materials, growth factors such as bone morphogenetic protein-2 (BMP-2) have been added. Preferably, an injectable bone substitute should be made available. Hyaluronic acid is a component of the extracellular matrix of many tissues, including bone. We examined the bone regenerative effect of commercially available, injectable hyaluronic acid (Hyalart) with and without addition of bone morphogenetic protein-2 (BMP-2).
Trepanation defects of 9.4 mm diameter in the intercondylar groove of sheep femora were filled with pure and augmented (200 microg BMP-2) hyaluronic acid. As controls, empty defects and defects treated with autologous bone graft harvested from the contralateral side were used. After 3 months, the defects were analysed by fluorescence microscopy after intravital fluorescence staining, contact microradiography, histology and histomorphometry.
Treatment of the defects with loaded and unloaded hyaluronic acid resulted in a significant lack of bone formation inside the defects. Untreated defects showed an amount of 5.1% newly formed bone, and defects treated with autologous bone graft revealed a bone content of 20%. The difference between both groups was statistically significant (P < 0.05). Furthermore, there was neither a remarkable effect in the periphery of the defects nor ectopic bone formation.
The application of the used injectable hyaluronic acid (Hyalart) with and without BMP-2 is not advantageous as sole bone substitute for the filling of osseous defects.
自体骨移植是填充大的骨缺损的金标准。由于其供应有限以及诸如疼痛、出血或感染等并发症，替代骨替代物的开发一直是多项研究的主题。在临床实践中，最常用的骨替代物是磷酸钙，如羟基磷灰石或磷酸三钙。为了改善这些材料的骨整合，已添加了诸如骨形态发生蛋白-2（BMP-2）等生长因子。优选地，应提供可注射的骨替代物。透明质酸是包括骨在内的许多组织的细胞外基质的一种成分。我们研究了市售的可注射透明质酸（Hyalart）在添加和不添加骨形态发生蛋白-2（BMP-2）的情况下的骨再生效果。
用纯的和添加了（200微克BMP-2）的透明质酸填充绵羊股骨髁间沟直径为9.4毫米的环锯缺损。作为对照，使用了空缺损以及用从对侧采集的自体骨移植治疗的缺损。3个月后，通过活体荧光染色后的荧光显微镜检查、接触式微放射摄影、组织学和组织形态计量学对缺损进行分析。
用负载和未负载透明质酸治疗缺损导致缺损内部明显缺乏骨形成。未治疗的缺损显示新形成骨量为5.1%，用自体骨移植治疗的缺损显示骨含量为20%。两组之间的差异具有统计学意义（P<0.05）。此外，在缺损周边既没有显著效果，也没有异位骨形成。
所使用的可注射透明质酸（Hyalart）在添加和不添加BMP-2的情况下作为填充骨缺损的唯一骨替代物均无优势。
