Canter Halil Ibrahim, Vargel Ibrahim, Korkusuz Petek, Oner Filiz, Gungorduk Dilsad B, Cil Barbaros, Karabulut Erdem, Sargon Mustafa F, Erk Yucel
Acibadem University Faculty of Medicine, Department of Plastic, Reconstructive and Aesthetic Surgery, Acibadem Health Group, Acibadem Bakirkoy Hospital, Plastic, Reconstructive & Aesthetic Surgery/Craniomaxillofacial Surgery, Halit Ziya Usakligil Cad. No: 1 Bakirkoy, 34140 Istanbul, Turkey.
Ann Plast Surg. 2010 Mar;64(3):342-50. doi: 10.1097/SAP.0b013e3181a73045.
Bone grafts, used for providing structural integrity of cranial vault remodeling, could not always integrate with the remaining bone structures. All efforts are focused on increasing incorporation of the applied bone grafts. Allografts were covered by chitosan so that slow release of bone morphogenetic protein-2 (BMP-2) and Transforming growth factor-beta-2 (TGF-beta-2) was achieved. Two hundred forty Wistar-Albino rats were distributed equally in 8 study groups. Study groups were designed as; defect group, autograft group, allograft group, chitosan group, allograft + chitosan, TGF-beta-2 group, BMP-2 group, and TGF-Beta-2 +BMP-2 group. Bone biopsies were obtained at second, eight, and 14th weeks. Bone regeneration was evaluated by morphologic studies detecting histologic bone healing and radiologic studies detecting bone density. Histologic findings were evaluated in 2 categories; tissue response to the implant and defect healing. Additionally, scanning electron microscopy for detailed morphologic evaluation was done. Bone density of the applied scaffold and the parietal bone at the same computed tomography section were measured in Hounsfield scale and this ratio was used for densitometry evaluations. Kruskal-Wallis test was used to analyze difference among groups according to the histologic and radiologic data. Pairwise comparisons were done using Mann-Whitney U test with Bonferroni correction. P < 0.05 was considered significant. In the morphologic studies, bone regeneration in BMP-2 group was found to be compatible with bone regeneration in gold standard autograft group and even better than it within 15 days. Chitosan is a biocompatible material. TGF-Beta-2 alone is not effective enough in bone regeneration; BMP-2 alone has a positive effect in every step of bone regeneration. Combining TGF-Beta-2 with BMP-2 does not lead to a better bone regeneration than using BMP-2 alone. A synergistic effect is not obtained by using these 2 factors together.
用于提供颅顶重塑结构完整性的骨移植材料，并不总能与剩余的骨结构整合。所有努力都集中在提高应用骨移植材料的融合率上。同种异体骨用壳聚糖覆盖，以实现骨形态发生蛋白-2（BMP-2）和转化生长因子-β-2（TGF-β-2）的缓慢释放。将240只Wistar-白化大鼠平均分配到8个研究组。研究组设计如下：缺损组、自体移植组、同种异体移植组、壳聚糖组、同种异体移植+壳聚糖组、TGF-β-2组、BMP-2组和TGF-β-2 + BMP-2组。在第2周、第8周和第14周获取骨活检样本。通过检测组织学骨愈合的形态学研究和检测骨密度的放射学研究来评估骨再生情况。组织学结果分为两类进行评估：组织对植入物的反应和缺损愈合情况。此外，还进行了扫描电子显微镜检查以进行详细的形态学评估。在同一计算机断层扫描切片上，以亨氏单位测量应用支架和顶骨的骨密度，并将该比值用于密度测定评估。采用Kruskal-Wallis检验根据组织学和放射学数据分析组间差异。使用经Bonferroni校正的Mann-Whitney U检验进行两两比较。P < 0.05被认为具有统计学意义。在形态学研究中，发现BMP-2组的骨再生在15天内与金标准自体移植组的骨再生情况相当，甚至优于自体移植组。壳聚糖是一种生物相容性材料。单独的TGF-β-2在骨再生中效果不够显著；单独的BMP-2在骨再生的每个阶段都有积极作用。将TGF-β-2与BMP-2联合使用并不会比单独使用BMP-2产生更好的骨再生效果。同时使用这两种因子未获得协同效应。
