Department of General and Trauma Surgery, BG University Hospital Bergmannsheil, Ruhr-University Bochum, Bürkle-de-la-Camp-Platz 1, 44789, Bochum, Germany.
Department of Surgical Research, BG University Hospital Bergmannsheil, Bürkle-de-la-Camp-Platz 1, 44789, Bochum, Germany.
Eur J Trauma Emerg Surg. 2022 Aug;48(4):3051-3061. doi: 10.1007/s00068-021-01844-4. Epub 2021 Dec 6.
The induced membrane technique (IMT) is a two-stage surgical procedure for reconstruction of bone defects. Bone grafting (second stage of IMT) is recommend after 4-8 weeks assuming the highest bioactivity of IMs. However, larger studies concerning the biology and maturation of IMs and a potential time dependency of the bioactivity are missing. Therefore, aim of this study was the time-dependent structural and cellular characterization of cement spacer IMs concomitantly to an analysis of membrane bioactivity.
IMs from 60 patients (35-82 years) were obtained at different maturation stages (1-16 weeks). IMs were studied by histology and co-culture with mesenchymal stem cells (MSC). IM lysates were analyzed by ELISA and protein microarray.
Increasing vascularization and fibrosis were found in membranes older than 4 and 7 weeks, respectively. MSC grew out from all membranes and all membranes enhanced proliferation of cultured MSC. Osteocalcin and osteopontin (in membrane lysates or induced in MSC by membrane tissue) were found over all time points without significant differences. In contrast to alkaline phosphatase activity, increasing levels of osteoprotegerin were found in membranes.
The histological structure of IMs changes during growth and maturation, however, biologically active MSC and factors related to osteogenesis are found over all time points with minor changes. Thus, membranes older than 8 weeks exert regenerative capacities comparable to the younger ones. The postulated narrow time frame of 4-8 weeks until bone grafting can be questioned and surgeons may choose timing for the second operation more independently and based on other clinical factors.
诱导膜技术（IMT）是一种两阶段的手术方法，用于重建骨缺损。假设 IM 具有最高的生物活性，在 4-8 周后进行植骨（IMT 的第二阶段）。然而，关于 IM 的生物学和成熟以及生物活性的潜在时间依赖性的更大研究仍然缺乏。因此，本研究的目的是同时分析膜生物活性，对水泥间隔物诱导膜的时间依赖性结构和细胞特性进行研究。
从 60 名患者（35-82 岁）中获得不同成熟阶段（1-16 周）的 IM。通过组织学和与间充质干细胞（MSC）的共培养来研究 IM。通过 ELISA 和蛋白质微阵列分析 IM 裂解物。
在 4 周和 7 周以上的膜中发现了血管生成和纤维化的增加。MSC 从所有膜中生长出来，所有膜都增强了培养 MSC 的增殖。在所有时间点均发现骨钙素和骨桥蛋白（在膜裂解物或膜组织诱导的 MSC 中），但无显著差异。与碱性磷酸酶活性相反，在膜中发现了骨保护素水平的增加。
IM 的组织学结构在生长和成熟过程中发生变化，然而，在所有时间点都发现了具有生物活性的 MSC 和与成骨相关的因子，且变化很小。因此，8 周以上的膜具有与年轻膜相当的再生能力。假设的 4-8 周的狭窄时间框架直到植骨可以受到质疑，并且外科医生可以根据其他临床因素更独立地选择第二次手术的时间。
