Wiltfang Jörg, Rohnen Michael, Egberts Jan-Hendrik, Lützen Ulf, Wieker Henning, Açil Yahya, Naujokat Hendrik
1 Department of Oral and Maxillofacial Surgery, University Hospital of Schleswig-Holstein , Kiel, Germany .
2 Department of General, Visceral, Thoracic, Transplantation, and Paediatric Surgery, University Hospital of Schleswig-Holstein , Kiel, Germany .
Tissue Eng Part C Methods. 2016 Aug;22(8):740-6. doi: 10.1089/ten.TEC.2015.0501. Epub 2016 Jul 13.
Reconstruction of critical-size jaw defects still remains challenging. The standard treatment today is transplantation of autologous bone grafts, which is associated with high donor-site morbidity and unsatisfactory outcomes. We aimed to reconstruct a mandibular discontinuity defect after ablative surgery using the gastrocolic omentum as a bioreactor for heterotopic ossification. Three-dimensional computed tomography data were used to produce an ideal virtual replacement for the mandibular defect. A titanium mesh cage was filled with bone mineral blocks, infiltrated with 12 mg of recombinant human bone morphogenetic protein 2, and enriched with bone marrow aspirate. The scaffold was implanted into the gastrocolic omentum, and 3 months later, a free flap was harvested to reconstruct the mandibular defect. In vivo single photon emission computed tomography/computed tomography revealed bone remodeling and mineralization inside the mandibular transplant during prefabrication and after transplantation. Reconstruction was possible without any further modifications of the graft. A histological evaluation revealed that large sections of the Bio-Oss material were covered with osteoid matrix 3 months after transplantation. The quality of life of the patient significantly increased with acquisition of the ability to masticate and the improvement in pronunciation and aesthetics. Heterotopic bone induction to form a mandibular replacement inside the gastrocolic omentum is possible in human subjects. Heterotopic prefabrication is associated with many advantages, like allowing a reduced operative burden compared with conventional techniques and good three-dimensional outcomes.
临界尺寸颌骨缺损的重建仍然具有挑战性。目前的标准治疗方法是自体骨移植，但这种方法会带来较高的供区并发症，且效果不尽人意。我们旨在利用胃结肠网膜作为异位骨化的生物反应器，在切除术后重建下颌骨连续性缺损。使用三维计算机断层扫描数据制作下颌骨缺损的理想虚拟替代物。用骨矿物质块填充钛网笼，注入12毫克重组人骨形态发生蛋白2，并加入骨髓抽吸物。将支架植入胃结肠网膜，3个月后，切取游离皮瓣重建下颌骨缺损。体内单光子发射计算机断层扫描/计算机断层扫描显示，在预制过程中和移植后，下颌骨移植物内部有骨重塑和矿化。无需对移植物进行任何进一步修改即可实现重建。组织学评估显示，移植3个月后，大部分Bio - Oss材料被类骨质基质覆盖。随着咀嚼能力的获得以及发音和美观度的改善，患者的生活质量显著提高。在人体中，在胃结肠网膜内异位诱导骨形成下颌替代物是可行的。异位预制有许多优点，比如与传统技术相比，可减轻手术负担，并能获得良好的三维效果。
