细胞和组织对含同种异体骨的聚对苯二甲酸乙二酯网片的体内外反应
Cell and Tissue Response to Polyethylene Terephthalate Mesh Containing Bone Allograft in Vitro and in Vivo.
作者信息
Cohen D Joshua, Ferrara Lisa, Stone Marcus B, Schwartz Zvi, Boyan Barbara D
机构信息
Department of Biomedical Engineering, Virginia Commonwealth University, Richmond, Virginia.
OrthoKinetic Technologies, Southport, North Carolina.
出版信息
Int J Spine Surg. 2020 Dec;14(s3):S121-S132. doi: 10.14444/7135. Epub 2020 Oct 29.
BACKGROUND
Extended polyethylene terephthalate mesh (PET, Dacron) can provide containment of compressed particulate allograft and autograft. This study assessed if PET mesh would interfere with osteoprogenitor cell migration from vertebral plates through particulate graft, and its effect on osteoblast differentiation or the quality of bone forming within fusing vertebra during vertebral interbody fusion.
METHODS
The impact of PET mesh on the biological response of normal human osteoblasts (NHOst cells) and bone marrow stromal cells (MSCs) to particulate bone graft was examined in vitro. Cells were cultured on rat bone particles +/- mesh; proliferation and osteoblast differentiation were assessed. The interface between the vertebral endplate, PET mesh, and newly formed bone within consolidated allograft contained by mesh was examined in a sheep model via microradiographs, histology, and mechanical testing.
RESULTS
Growth on bone particles stimulated proliferation and early differentiation of NHOst cells and MSCs, but delayed terminal differentiation. This was not negatively impacted by mesh. New bone formation in vivo was not prevented by use of a PET mesh graft containment device. Fusion was improved in sites containing allograft/demineralized bone matrix (DBM) versus autograft and was further enhanced when stabilized using pedicle screws. Only sites treated with allograft/DBM+screws exhibited greater percent bone ingrowth versus discectomy or autograft. These results were mirrored biomechanically.
CONCLUSIONS
PET mesh does not negatively impact cell attachment to particulate bone graft, proliferation, or initial osteoblast differentiation. The results demonstrated that bone growth occurs from vertebral endplates into graft material within the PET mesh. This was enhanced by stabilization with pedicle screws leading to greater bone ingrowth and biomechanical stability across the fusion site.
CLINICAL RELEVANCE
The use of extended PET mesh allows containment of bone graft material during vertebral interbody fusion without inhibiting migration of osteoprogenitor cells from vertebral end plates in order to achieve fusion.
LEVEL OF EVIDENCE
背景
延长聚对苯二甲酸乙二酯网片（PET，涤纶）可对压缩颗粒状同种异体移植物和自体移植物起到容纳作用。本研究评估PET网片是否会干扰骨祖细胞从椎板通过颗粒状移植物的迁移，及其对椎体间融合过程中融合椎体中成骨细胞分化或骨形成质量的影响。
方法
在体外研究PET网片对正常人成骨细胞（NHOst细胞）和骨髓基质细胞（MSCs）对颗粒状骨移植物生物学反应的影响。将细胞接种于大鼠骨颗粒上，有无网片；评估细胞增殖和成骨细胞分化情况。通过微放射照相、组织学和力学测试，在绵羊模型中检查椎骨终板、PET网片以及网片容纳的巩固同种异体移植物内新形成骨之间的界面。
结果
在骨颗粒上生长刺激了NHOst细胞和MSCs的增殖及早期分化，但延迟了终末分化。这并未受到网片的负面影响。使用PET网片移植物容纳装置并未阻止体内新骨形成。与自体移植物相比，含同种异体移植物/脱矿骨基质（DBM）的部位融合情况有所改善，使用椎弓根螺钉固定时进一步增强。只有接受同种异体移植物/DBM+螺钉治疗的部位与椎间盘切除术或自体移植物相比，骨长入百分比更高。这些结果在生物力学上得到了印证。
结论
PET网片不会对细胞附着于颗粒状骨移植物、增殖或初始成骨细胞分化产生负面影响。结果表明，骨生长从椎骨终板向PET网片内的移植物材料发生。通过椎弓根螺钉固定可增强这种生长，导致融合部位骨长入增加和生物力学稳定性提高。
临床意义
使用延长PET网片可在椎体间融合过程中容纳骨移植材料，同时不抑制骨祖细胞从椎骨终板的迁移以实现融合。
证据水平
5级。
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