Srnec R, Divín R, Škorič M, Snášil R, Krbec M, Nečas A
Oddělení chirurgie a ortopedie, Klinika chorob psů a koček, Fakulta veterinárního lékařství, Veterinární a farmaceutická univerzita Brno 2.
Acta Chir Orthop Traumatol Cech. 2018;85(5):359-365.
INTRODUCTION Traumatic bone injuries or pathological processes may sometimes result in very extensive bone defects. Currently, the standard procedure applied in clinical humane as well as veterinary medicine to fill a bone defect is the autogenous bone graft which, however, necessitates a more invasive procedure for the patient and in the cases of extensive defects it fails to provide adequate amount of graft. Synthetic bone replacements can be used with no further burden for the patient and can simultaneously be used as the carriers for bioactive molecules or therapeutic drugs. For clinical use, an easy and simple application is one of the requirements that have to be taken into consideration. These requirements are best satisfied by preparations in the form of gel, which may be injected into the defects of various shapes even through minimal surgical approach. MATERIAL AND METHODS Synthetic transparent PGD-AlphaProA hydro-peptide-gel was used as a basis to develop a composite hydrogel scaffold. This gel was enriched by cryogenically ground poly- -caprolactone nanofibers (PCL) in a ratio of 1 ml of gel to 16 μg of nanofibres. In experimental animals (laboratory rat Wistar, n=20), a single regular circular defect of 1.5 mm in diameter was drilled by a low speed drill machine across the whole width of distal femur diaphysis, identically in both the hind legs. In the right hindleg, this defect was filled by injection of 0.05 ml of the composite peptide gel with nanofibers (experimental defect). In the contralateral limb a similar defect was left untreated, without filling (control defect), for spontaneous healing. The group of experimental animals was subsequently divided into four sub-groups (A, B, C, D) for the purpose of further follow-up. One week after the surgical implantation, in the first group of experimental animals (Group A; n = 5) lege artis euthanasia was performed, a radiological examination of both the hind legs was carried out and a sample of the bone from both the control and experimental defect was collected for histologic examination. The other groups of experimental animals were evaluated similarly at 2, 4 and 6 weeks after the surgical procedure (Group B, C, D; n = 5). These groups of experimental animals were assessed using various histological techniques by two independent pathologists. RESULTS A difference between the control and the experimental bone defect was observed only at the healing stage at two weeks after the implantation, when a tendency for greater formation of new bone trabeculas was seen in the defect treated with the composite hydro-peptide-gel with PCL nanofibers. The results show a slightly higher angiogenesis and cellularity at the bone defect site with an increase of newly formed bone tissue and faster colonisation of lamellar bone structures by bone marrow cells at early stages of the healing process (1-2 weeks old defect). In the experimental and control groups, at the later stage of healing (4-6 weeks old defect), the process of healing and bone modelling at the defect site shows no detectable morphological differences. CONCLUSIONS The experimental use of hydro-peptide-gel with PCL nanofibers in vivo in laboratory rats shows very good applicability into the defect site and, compared to the untreated defect within two weeks after the implantation, accelerates the bone healing. This fact could be an advantage especially at the early stage of healing, and thus accelerate the healing of more extensive defects. Key words: peptide gel, polycaprolactone, PCL, replacement, bone, healing, scaffold, nanofibers, biomaterial.
引言
创伤性骨损伤或病理过程有时可能导致非常广泛的骨缺损。目前,临床兽医学和人类医学中用于填充骨缺损的标准方法是自体骨移植,然而,这对患者来说需要更具侵入性的手术,并且在广泛缺损的情况下,它无法提供足够量的移植骨。合成骨替代物可以使用,不会给患者带来进一步负担,并且可以同时用作生物活性分子或治疗药物的载体。对于临床应用,简单易用是必须考虑的要求之一。凝胶形式的制剂最能满足这些要求,即使通过最小的手术切口,也可以将其注入各种形状的缺损中。
材料与方法
以合成透明的PGD - AlphaProA水肽凝胶为基础,开发一种复合水凝胶支架。这种凝胶以每1毫升凝胶加入16微克纳米纤维的比例,用低温研磨的聚己内酯纳米纤维(PCL)进行富集。在实验动物(Wistar实验室大鼠,n = 20)中,用低速钻孔机在双侧后腿股骨远端骨干的整个宽度上钻出直径为1.5毫米的单个规则圆形缺损。在右后腿,通过注射0.05毫升含纳米纤维的复合肽凝胶来填充该缺损(实验性缺损)。在对侧肢体留下类似的缺损不进行填充(对照缺损),使其自然愈合。随后将实验动物组分为四个亚组(A、B、C、D)以进行进一步随访。手术植入一周后,对第一组实验动物(A组;n = 5)实施安乐死,对双侧后腿进行放射学检查,并从对照和实验性缺损处采集骨样本进行组织学检查。在手术后2、4和6周对其他组实验动物进行类似评估(B组、C组、D组;n = 5)。由两名独立的病理学家使用各种组织学技术对这些组的实验动物进行评估。
结果
仅在植入后两周的愈合阶段观察到对照骨缺损和实验骨缺损之间存在差异,此时在用含PCL纳米纤维的复合水肽凝胶处理的缺损处,可见新骨小梁形成增多的趋势。结果表明,在愈合过程的早期阶段(1 - 2周龄缺损),骨缺损部位的血管生成和细胞密度略高,新形成的骨组织增加,骨髓细胞对板层骨结构的定植更快。在实验和对照组中,在愈合后期(4 - 6周龄缺损),缺损部位的愈合和骨塑形过程未显示出可检测到的形态学差异。
结论
在实验室大鼠体内对含PCL纳米纤维的水肽凝胶进行的实验表明,其在缺损部位具有很好的适用性,并且与植入后两周内未处理的缺损相比,能加速骨愈合。这一事实在愈合早期可能具有优势,从而加速更广泛缺损的愈合。
肽凝胶;聚己内酯;PCL;替代物;骨;愈合;支架;纳米纤维;生物材料