Yamamoto Norio, Hayashi Katsuhiro, Tsuchiya Hiroyuki
Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, Japan.
Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, Japan.
J Orthop Sci. 2019 May;24(3):387-392. doi: 10.1016/j.jos.2019.01.015. Epub 2019 Feb 21.
Bone defect reconstruction with artificial materials may produce good functional recovery in the short term. Over time, the durability of artificial materials becomes an issue, and therefore, artificial materials cannot be considered a permanent solution to reconstruction. For long-term outcomes, the goal is to regain function, permanence, and form that are as close to normal as possible. Thus, physiological materials are desirable for use in reconstruction. Biological reconstruction involves the use of materials that are modified in vivo following reconstruction of bone defects. The goal is to achieve bone union, bone revival and remodeling, with biointegration of soft tissue and bone. Allograft use has been the mainstay of bone defect reconstruction in most parts of the world, although in some countries like Japan, allogeneic bone is difficult to obtain due to socio-religious concerns. Therefore, we developed new biological reconstruction techniques to overcome this problem. Bone derived from distraction osteogenesis is autologous bone, which must be an ideal reconstruction material for its biological affinity, strength, resilience, and immunity to infection. When applying this method to patients with malignant disease however, it is important to preserve as much of the local soft tissue as possible, and the clinician must be especially careful of infection and callus formation. Liquid nitrogen treatment of tumor-bearing bone produces equal, if not better, bone revitalization compared to other forms of treatment to date. Reconstruction with liquid nitrogen-treated bone involves resecting the diseased bone and returning it to the body following liquid nitrogen treatment (free-freezing method). Another method involves dislocating the joint proximal to the tumor, or cutting the bone while the distal side remains attached to the body and the limb inverted and treated with liquid nitrogen (pedicle freezing method). When both methods are possible, the pedicle freezing method is preferable since it is performed with minimal osteotomy. Our recent research has looked into the possible role of adipose-derived stem cells in promoting bone fusion and revitalization. This method has produced promising results for the future of biological reconstruction.
使用人工材料进行骨缺损重建在短期内可能会产生良好的功能恢复。随着时间的推移，人工材料的耐久性成为一个问题，因此，人工材料不能被视为重建的永久解决方案。对于长期效果而言，目标是恢复尽可能接近正常的功能、永久性和形态。因此，生理材料适合用于重建。生物重建涉及在骨缺损重建后使用在体内经过修饰的材料。目标是实现骨愈合、骨再生和重塑，以及软组织与骨的生物整合。在世界上大多数地区，同种异体骨移植一直是骨缺损重建的主要方法，尽管在一些国家，如日本，由于社会宗教方面的顾虑，同种异体骨难以获得。因此，我们开发了新的生物重建技术来克服这个问题。牵张成骨获得的骨是自体骨，因其生物亲和力、强度、弹性和抗感染能力，必定是理想的重建材料。然而，当将这种方法应用于患有恶性疾病的患者时，尽可能多地保留局部软组织很重要，临床医生必须特别小心感染和骨痂形成。与迄今为止的其他治疗形式相比，液氮处理含肿瘤骨产生的骨再生效果即使不更好，也至少相当。用液氮处理过的骨进行重建包括切除患病骨，在液氮处理后将其放回体内（游离冷冻法）。另一种方法是使肿瘤近端的关节脱位，或者在远端仍与身体相连且肢体倒置的情况下切断骨头并进行液氮处理（带蒂冷冻法）。当两种方法都可行时，带蒂冷冻法更可取，因为它进行的截骨术最少。我们最近的研究探讨了脂肪来源干细胞在促进骨融合和再生方面可能发挥的作用。这种方法为生物重建的未来带来了有希望的结果。
