Oppenheimer Adam J, Mesa John, Buchman Steven R
Division of Plastic Surgery, University of Michigan Hospitals, Ann Arbor, Michigan 48109-0340, USA.
J Craniofac Surg. 2012 Jan;23(1):30-6. doi: 10.1097/SCS.0b013e318240c6d9.
Ongoing research in bone biology has brought cutting-edge technologies into everyday use in craniofacial surgery. Nonetheless, when osseous defects of the craniomaxillofacial skeleton are encountered, autogenous bone grafting remains the criterion standard for reconstruction. Accordingly, the core principles of bone graft physiology continue to be of paramount importance. Bone grafts, however, are not a panacea; donor site morbidity and operative risk are among the limitations of autologous bone graft harvest. Bone graft survival is impaired when irradiation, contamination, and impaired vascularity are encountered. Although the dura can induce calvarial ossification in children younger than 2 years, the repair of critical-size defects in the pediatric population may be hindered by inadequate bone graft donor volume. The novel and emerging field of bone tissue engineering holds great promise as a limitless source of autogenous bone. Three core constituents of bone tissue engineering have been established: scaffolds, signals, and cells. Blood supply is the sine qua non of these components, which are used both individually and concertedly in regenerative craniofacial surgery. The discerning craniofacial surgeon must determine the proper use for these bone graft alternatives, while understanding their concomitant risks. This article presents a review of contemporary and emerging concepts in bone biology and their implications in craniofacial surgery. Current practices, areas of controversy, and near-term future applications are emphasized.
骨生物学领域正在进行的研究已将前沿技术应用于颅面外科的日常实践中。尽管如此，当遇到颅颌面骨骼的骨缺损时，自体骨移植仍然是重建的标准方法。因此，骨移植生理学的核心原则仍然至关重要。然而，骨移植并非万灵药；供区并发症和手术风险是自体骨移植获取的局限性之一。当受到辐射、污染和血管受损时，骨移植的存活会受到影响。虽然硬脑膜可诱导2岁以下儿童的颅骨骨化，但小儿群体中临界尺寸缺损的修复可能会因骨移植供体体积不足而受阻。骨组织工程这一新兴领域作为自体骨的无限来源具有巨大潜力。骨组织工程的三个核心要素已确立：支架、信号和细胞。血液供应是这些要素的必要条件，它们在颅面再生手术中既单独使用，也协同使用。有见识的颅面外科医生必须确定这些骨移植替代方法的正确用途，同时了解其伴随风险。本文综述了骨生物学的当代和新兴概念及其在颅面外科中的意义。重点介绍了当前的实践、争议领域和近期的未来应用。
