Center for Musculoskeletal Surgery, Charité Universitätsmedizin Berlin, Berlin, Germany.
Injury. 2009 Dec;40 Suppl 3:S39-43. doi: 10.1016/S0020-1383(09)70010-5.
The recent development of new orthopaedic devices and advanced techniques for soft-tissue reconstruction have clearly improved the outcome in trauma and orthopaedic surgery. Nevertheless, large bone defects are still difficult to treat and require a careful analysis of the situation. Individual planning of the reconstructive strategy is desirable. Bone morphogenetic proteins (BMPs) have successfully been applied in the clinical setting for the treatment of spinal fusion, fracture healing and delayed and non-unions. Following the 'diamond concept', surgeons have begun using BMPs for treatment of critical-size defects also--in most cases, 'off label'; different treatment strategies are currently being evaluated. BMPs are often used in combination with autogenic, allogenic, xenogenic or synthetic grafting materials and even with mesenchymal stem cells. In addition, gene therapy approaches present an attractive option. Experimental studies and first clinical results are promising in the use of BMPs for treatment of critical-size defects; however, there is obvious need for further controlled studies to define strategies.
近年来，新型骨科设备和软组织重建的先进技术的发展显然改善了创伤和骨科手术的结果。然而，大的骨缺损仍然难以治疗，需要对情况进行仔细分析。理想情况下，应制定个体化的重建策略。骨形态发生蛋白（BMPs）已成功应用于临床，用于治疗脊柱融合、骨折愈合以及延迟愈合和不愈合。根据“钻石概念”，外科医生已开始将 BMP 用于治疗临界尺寸的缺陷——在大多数情况下是“超适应证”；目前正在评估不同的治疗策略。BMP 通常与自体、同种异体、异种或合成移植物材料联合使用，甚至与间充质干细胞联合使用。此外，基因治疗方法也具有吸引力。在使用 BMP 治疗临界尺寸缺陷方面，实验研究和初步临床结果很有前景；然而，显然需要进一步的对照研究来确定策略。
