Cleemann Rasmus, Sorensen Mette, West Andreas, Soballe Kjeld, Bechtold Joan E, Baas Jorgen
Orthopedics, Zealand University Hospital Koge, Køge, Denmark.
Orthopedic Research Laboratory, Aarhus University Hospital, Aarhus, Denmark.
Bone Joint Res. 2021 Aug;10(8):488-497. doi: 10.1302/2046-3758.108.BJR-2020-0280.R1.
We wanted to evaluate the effects of a bone anabolic agent (bone morphogenetic protein 2 (BMP-2)) on an anti-catabolic background (systemic or local zoledronate) on fixation of allografted revision implants.
An established allografted revision protocol was implemented bilaterally into the stifle joints of 24 canines. At revision surgery, each animal received one BMP-2 (5 µg) functionalized implant, and one raw implant. One group (12 animals) received bone graft impregnated with zoledronate (0.005 mg/ml) before impaction. The other group (12 animals) received untreated bone graft and systemic zoledronate (0.1 mg/kg) ten and 20 days after revision surgery. Animals were observed for an additional four weeks before euthanasia.
No difference was detected on mechanical implant fixation (load to failure, stiffness, energy) between local or systemic zoledronate. Addition of BMP-2 had no effect on implant fixation. In the histomorphometric evaluation, implants with local zoledronate had more area of new bone on the implant surface (53%, p = 0.025) and higher volume of allograft (65%, p = 0.007), whereas implants in animals with systemic zoledronate had the highest volume of new bone (34%, p = 0.003). Systemic zoledronate with BMP-2 decreased volume of allograft by 47% (p = 0.017).
Local and systemic zoledronate treatment protects bone at different stages of maturity; local zoledronate protects the allograft from resorption and systemic zoledronate protects newly formed bone from resorption. BMP-2 in the dose evaluated with experimental revision implants was not beneficial, since it significantly increased allograft resorption without a significant compensating anabolic effect. Cite this article: 2021;10(8):488-497.
我们想要评估一种骨合成代谢剂（骨形态发生蛋白2，BMP-2）在抗分解代谢背景（全身或局部唑来膦酸盐）下对同种异体移植翻修植入物固定的影响。
在24只犬的双侧膝关节实施已确立的同种异体移植翻修方案。在翻修手术时，每只动物接受一枚用BMP-2（5微克）功能化的植入物和一枚未处理的植入物。一组（12只动物）在植入前接受含唑来膦酸盐（0.005毫克/毫升）的骨移植。另一组（12只动物）接受未处理的骨移植，并在翻修手术后第10天和第20天接受全身唑来膦酸盐（0.1毫克/千克）治疗。在安乐死之前，对动物再观察四周。
局部或全身使用唑来膦酸盐在机械性植入物固定（失效载荷、刚度、能量）方面未检测到差异。添加BMP-2对植入物固定没有影响。在组织形态计量学评估中，使用局部唑来膦酸盐的植入物在植入物表面有更多新骨面积（53%，p = 0.025）和更高的同种异体骨体积（65%，p = 0.007），而使用全身唑来膦酸盐的动物体内的植入物有最高的新骨体积（34%，p = 0.003）。全身使用唑来膦酸盐联合BMP-2使同种异体骨体积减少47%（p = 0.017）。
局部和全身唑来膦酸盐治疗在不同成熟阶段保护骨骼；局部唑来膦酸盐保护同种异体骨不被吸收，全身唑来膦酸盐保护新形成的骨不被吸收。在实验性翻修植入物评估剂量下的BMP-2并无益处，因为它显著增加了同种异体骨吸收，而没有显著的补偿性合成代谢作用。引用本文：2021;10(8):488-497。
