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改变间隔材料会影响大鼠股骨缺损的Masquelet技术中的骨再生。

Altering spacer material affects bone regeneration in the Masquelet technique in a rat femoral defect.

作者信息

McBride-Gagyi Sarah, Toth Zacharie, Kim Daniel, Ip Victoria, Evans Emily, Watson John Tracy, Nicolaou Daemeon

机构信息

Department of Orthopaedic Surgery, Saint Louis University School of Medicine, St. Louis, MO.

出版信息

J Orthop Res. 2018 Feb 9. doi: 10.1002/jor.23866.

Abstract

The Masquelet technique depends on pre-development of a foreign-body membrane to support bone regeneration with grafts over three times larger than the traditional maximum. To date, the procedure has always used spacers made of bone cement, which is the polymer polymethyl methacrylate (PMMA), to induce the foreign-body membrane. This study sought to compare (i) morphology, factor expression, and cellularity in membranes formed by PMMA, titanium, and polyvinyl alcohol sponge (PVA) spacers in the Masquelet milieu and (ii) subsequent bone regeneration in the same groups. Ten-week-old, male Sprague-Dawley rats were given an externally stabilized, 6 mm femur defect, and a pre-made spacer of PMMA, titanium, or PVA was implanted. All animals were given 4 weeks to form a membrane, and those receiving an isograft were given 10 weeks post-implantation to union. All samples were scanned with microCT to measure phase 1 and phase 2 bone formation. Membrane samples were processed for histology to measure membrane morphology, cellularity, and expression of the factors BMP2, TGFβ, VEGF, and IL6. PMMA and titanium spacers created almost identical membranes and phase 1 bone. PVA spacers were uniformly infiltrated with tissue and cells and did not form a distinct membrane. There were no quantitative differences in phase 2 bone formation. However, PMMA induced membranes supported functional union in 6 of 7 samples while a majority of titanium and PVA groups failed to achieve the same. Spacer material can alter the membrane enough to disrupt phase 2 bone formation. The membrane's role in bone regeneration is likely more than just as a physical barrier. © 2018 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res.

摘要

Masquelet技术依赖于异物膜的预先形成,以支持比传统最大移植量大三倍以上的移植物进行骨再生。迄今为止,该手术一直使用由骨水泥(即聚合物聚甲基丙烯酸甲酯(PMMA))制成的间隔物来诱导异物膜形成。本研究旨在比较:(i)在Masquelet环境中,由PMMA、钛和聚乙烯醇海绵(PVA)间隔物形成的膜的形态、因子表达和细胞构成;以及(ii)同一组中随后的骨再生情况。给10周龄的雄性Sprague-Dawley大鼠制造一个外部稳定的6毫米股骨缺损,并植入预先制作的PMMA、钛或PVA间隔物。所有动物均给予4周时间形成膜,接受同种异体移植的动物在植入后给予10周时间实现愈合。所有样本均用微型计算机断层扫描(microCT)进行扫描,以测量第1阶段和第2阶段的骨形成情况。对膜样本进行组织学处理,以测量膜的形态、细胞构成以及骨形态发生蛋白2(BMP2)、转化生长因子β(TGFβ)、血管内皮生长因子(VEGF)和白细胞介素6(IL6)等因子的表达。PMMA和钛间隔物形成的膜和第1阶段的骨几乎相同。PVA间隔物被组织和细胞均匀浸润,未形成明显的膜。第2阶段的骨形成在数量上没有差异。然而,PMMA诱导形成的膜在7个样本中的6个中支持功能性愈合,而大多数钛和PVA组未能达到相同效果。间隔物材料可对膜产生足够的改变,从而破坏第2阶段的骨形成。膜在骨再生中的作用可能不仅仅是作为一个物理屏障。©2018骨科学研究协会。由威利期刊公司出版。《矫形外科学研究杂志》

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