Koch Felix P, Yuhasz Mikell M, Travieso Rob, Wong Kenneth, Clune James, Zhuang Zhen W, Van Houten Joshua, Steinbacher Derek M
From the *Oral and Maxillofacial Surgery, University Medical Centre Mainz and Yale School of Medicine, New Haven; †Section of Plastic and Reconstructive Surgery, Yale School of Medicine, New Haven; ‡Bioimaging Science, Yale University, New Haven; and §Yale Core Center for Musculoskeletal Disorders, New Haven, Connecticut.
J Craniofac Surg. 2014 May;25(3):766-71. doi: 10.1097/SCS.0000000000000769.
Transport distraction osteogenesis (DO) can be used to autologously reconstitute calvarial defects. The purpose of this study is to histomorphologically interrogate osteogenic formation during cranial transport distraction using a novel device. We also evaluate the effect of fat grafting on the regenerate and soft-tissue stability during distraction. This study was approved by Yale IACUC. Ten male New Zealand white rabbits (3 mo; 3.5 kg) were used (8 treatment, 2 control). A 16 × 16 mm defect was created abutted by a 10 × 16 mm transport disc. The device was fixated anterioposteriorly. Four animals were fat-grafted using 2 mL of subdermal intrascapular fat deposited along the distraction site. Latency (1 d), active distraction (12-14 d) (1.5 mm/d), and consolidation (4 wk) followed. Calcein and xylene orange fluorochromes were injected subcutaneously during and post-distraction to mark sites of bone formation. Following sacrifice, osteogenesis was assessed using microCT, histology, and fluorescence. Treatment animals demonstrated regenerate bone between distracted segments on microCT. MicroCT analysis of non-fat-grafted and fat-grafted animals revealed a mean density of 2271.95 mgHA/ccm and 2254.27 mgHA/ccm (P = 0.967), respectively, and defect bone versus total volume (BV/TV) of 0.0999 and 0.0766 (P = 0.5979), respectively. Controls had minimal reossification. Histologically, mean densities measured 43.63% and 8.19%, respectively. Fluorescence revealed ossification from the callus as well as from dura and periosteum in the cranial defect. Transport distraction is effective to reconstruct critically sized rabbit calvarial defects. Regenerate bone arises predominantly from the callus with contribution from surrounding dura and periosteum. Adipose grafting is well tolerated but does not enhance osseous regeneration.
运输性牵张成骨术（DO）可用于自体修复颅骨缺损。本研究的目的是使用一种新型装置，从组织形态学角度探究颅骨运输牵张过程中的成骨形成。我们还评估了脂肪移植对牵张过程中再生组织和软组织稳定性的影响。本研究经耶鲁大学实验动物管理与使用委员会（IACUC）批准。使用了10只雄性新西兰白兔（3个月大；3.5千克）（8只用于治疗，2只作为对照）。制造了一个16×16毫米的缺损，旁边是一个10×16毫米的运输盘。该装置从前向后固定。4只动物沿牵张部位皮下注射2毫升肩胛下脂肪进行脂肪移植。随后依次经历延迟期（1天）、主动牵张期（12 - 14天）（每天1.5毫米）和巩固期（4周）。在牵张期间和牵张后皮下注射钙黄绿素和二甲苯橙荧光染料以标记骨形成部位。处死后，使用微型计算机断层扫描（microCT）、组织学和荧光技术评估成骨情况。治疗组动物在microCT上显示出牵张节段之间有再生骨。对未进行脂肪移植和进行了脂肪移植的动物的microCT分析显示，平均密度分别为2271.95毫克羟基磷灰石/立方厘米和2254.27毫克羟基磷灰石/立方厘米（P = 0.967），缺损骨与总体积之比（BV/TV）分别为(0.0999)和(0.0766)（P = 0.5979）。对照组的骨再化极少。组织学上，平均密度分别为(43.63%)和(8.19%)。荧光显示骨痂以及颅骨缺损处的硬脑膜和骨膜均有骨化。运输性牵张对于重建兔临界大小的颅骨缺损是有效的。再生骨主要源自骨痂，并伴有周围硬脑膜和骨膜的贡献。脂肪移植耐受性良好，但不会增强骨再生。
