Kammerer Andreas, Hartmann Frederik Alexander, Nau Christoph, Leiblein Maximilian, Schaible Alexander, Neijhoft Jonas, Henrich Dirk, Verboket René, Janko Maren
Department of Trauma, Hand and Reconstructive Surgery, Goethe University Frankfurt, University Hospital, Theodor-Stern-Kai 7, 60596 Frankfurt, Germany.
Bioengineering (Basel). 2024 Mar 19;11(3):287. doi: 10.3390/bioengineering11030287.
Critical-size bone defects up to 25 cm can be treated successfully using the induced membrane technique established by Masquelet. To shorten this procedure, human acellular dermis (HAD) has had success in replacing this membrane in rat models. The aim of this study was to compare bone healing for smaller and larger defects using an induced membrane and HAD in a rat model. Using our established femoral defect model in rats, the animals were placed into four groups and defects of 5 mm or 10 mm size were set, either filling them with autologous spongiosa and surrounding the defect with HAD or waiting for the induced membrane to form around a cement spacer and filling this cavity in a second operation with a cancellous bone graft. Healing was assessed eight weeks after the operation using µ-CT, histological staining, and an assessment of the progress of bone formation using an established bone healing score. The α-smooth muscle actin used as a signal of blood vessel formation was stained and counted. The 5 mm defects showed significantly better bone union and a higher bone healing score than the 10 mm defects. HAD being used for the smaller defects resulted in a significantly higher bone healing score even than for the induced membrane and significantly higher blood vessel formation, corroborating the good results achieved by using HAD in previous studies. In comparison, same-sized groups showed significant differences in bone healing as well as blood vessel formation, suggesting that 5 mm defects are large enough to show different results in healing depending on treatment; therefore, 5 mm is a viable size for further studies on bone healing.
高达25厘米的临界尺寸骨缺损可通过Masquelet建立的诱导膜技术成功治疗。为缩短该过程,人脱细胞真皮(HAD)在大鼠模型中成功替代了该膜。本研究的目的是在大鼠模型中比较使用诱导膜和HAD治疗大小不同的骨缺损时的骨愈合情况。利用我们建立的大鼠股骨缺损模型,将动物分为四组,设置5毫米或10毫米大小的缺损,要么用自体松质骨填充并用HAD围绕缺损,要么等待诱导膜在骨水泥间隔物周围形成,并在第二次手术中用松质骨移植填充该腔隙。术后八周使用显微CT、组织学染色以及使用既定的骨愈合评分评估骨形成进展来评估愈合情况。对用作血管形成信号的α平滑肌肌动蛋白进行染色并计数。5毫米缺损的骨愈合和骨愈合评分明显优于10毫米缺损。用于较小缺损的HAD甚至比诱导膜产生了明显更高的骨愈合评分和明显更高的血管形成,证实了在先前研究中使用HAD所取得的良好结果。相比之下,相同尺寸的组在骨愈合以及血管形成方面存在显著差异,表明5毫米缺损大到足以根据治疗显示出不同的愈合结果;因此,5毫米是进一步研究骨愈合的可行尺寸。