Pittsburgh, Pa. From the Division of Plastic Surgery and the Departments of Oral Biology, Bioengineering, Anthropology, and Orthodontics, University of Pittsburgh.
Plast Reconstr Surg. 2011 Feb;127(2):588-594. doi: 10.1097/PRS.0b013e3181fed5c5.
Recombinant human bone morphogenetic protein-2 (rhBMP-2) delivered on an absorbable collagen sponge has been shown to induce the healing of acute, primary, large-scale calvarial defects in rabbits. However, clinical circumstances often require the reconstruction of a previously infected and chronically scarred wound. This study was designed to evaluate the efficacy of rhBMP-2/absorbable collagen sponge to improve healing in the previously infected, unfavorable calvarial defect model.
Subtotal defects were made in the calvariae of 15 adult New Zealand White rabbits. The bone flap was inoculated with Staphylococcus aureus and replaced in situ. After a 2-week infection period, animals underwent bone flap removal and a 10-day course of antibiotic therapy. On postoperative day 42, the defect was exposed and treated with (1) no intervention/control (group 1; n = 5), or (2) absorbable collagen sponge with 0.43 mg/ml of rhBMP-2 (group 2; n = 10). Bone growth was analyzed with serial computed tomographic imaging and postmortem histology. Percentage bone healing was compared between groups using the t test.
The treatment group (group 2) demonstrated statistically more healing (55.6 percent) compared with the control group (group 1) (29 percent; p < 0.01). However, rhBMP-2-induced bone was not histologically or radiographically similar to native bone, lacking both continuity and a well-defined diploic space.
These data suggest that rhBMP-2-treated collagen sponges may be useful for the repair of calvarial defects following infection. However, the osseous healing observed in this study was significantly less than previous reports in acute, noninfected models and was dissimilar to native bone. Further work is needed to optimize treatment of the previously infected calvarial wound with rhBMP-2.
已证实，可吸收胶原海绵负载的重组人骨形态发生蛋白-2（rhBMP-2）可诱导兔急性、原发性、大面积颅骨缺损愈合。然而，临床情况常需要重建先前感染和慢性瘢痕化的创面。本研究旨在评估 rhBMP-2/可吸收胶原海绵在改善先前感染的不利颅骨缺损模型愈合方面的疗效。
在 15 只成年新西兰白兔颅骨上造成部分颅骨缺损。骨瓣接种金黄色葡萄球菌，原位替换。感染 2 周后，动物行骨瓣切除和 10 天抗生素治疗。术后第 42 天，暴露缺损部位，分别给予（1）无干预/对照（第 1 组，n = 5），或（2）负载 0.43mg/ml rhBMP-2 的可吸收胶原海绵（第 2 组，n = 10）。通过连续 CT 成像和尸检组织学分析骨生长情况。使用 t 检验比较两组间的骨愈合率。
治疗组（第 2 组）的愈合率（55.6%）明显高于对照组（第 1 组）（29%；p < 0.01）。然而，rhBMP-2 诱导的骨在组织学和影像学上与正常骨均不同，缺乏连续性和明确的板障空间。
这些数据表明，rhBMP-2 处理的胶原海绵可能有助于修复感染后的颅骨缺损。然而，本研究中观察到的骨愈合率明显低于急性、非感染模型的先前报告，且与正常骨不同。需要进一步的工作来优化 rhBMP-2 治疗先前感染的颅骨创面。
