Rabie A B, Deng Y M, Samman N, Hägg U
Department of Children's Dentistry and Orthodontics, Faculty of Dentistry, University of Hong Kong.
J Dent Res. 1996 Apr;75(4):1045-51. doi: 10.1177/00220345960750040701.
A clinical dilemma exists regarding the type of bone that should be used to replace diseased or traumatized osseous tissue. Oral, plastic, and orthopedic surgeons normally implant viable mineralized endochondral (EC) autografts or demineralized EC allografts. A few clinicians have recognized the disadvantages of using EC bone in craniofacial surgery and advocated the replacement of intramembranous (IM) bone with healthy IM bone. However, controversy and uncertainty surround our understanding of these matrices to induce bone formation. Recent studies have advocated the use of other materials with osteoinductive properties, such as demineralized bone matrix (DBM). The proposed delivery system used in this study included IM bone grafts, DBM, and fixation of the IM bone graft. The purpose of this work was to gain further insights into the mechanism of healing of IM bone, in both the presence and the absence of DBM, and to compare the healing of IM bone grafts with that of DBM alone. Critical-sized (10 x 5 mm), full-thickness bony defects in rabbit parietal bone, devoid of periosteum, were filled with IM bone graft (mandible) alone, demineralized cortical bone matrix (DBM) alone, or combined DBM-IM bone graft, or were left unfilled. Histologic changes were examined 14 days later. The IM bone graft healed through IM ossification with no intermediate cartilage stage. DBM and composite DBM-IM healed through an EC ossification with an intermediate cartilage stage. It is hypothesized that the role of the IM graft is to induce neovascularization into the defect site, and that the undifferentiated mesenchymal cells in the perivascular region of the new blood vessels are induced by the bone morphogenetic protein(s) in the DBM into bone-forming cells.
在应使用何种类型的骨来替代患病或受创伤的骨组织方面存在临床困境。口腔外科医生、整形外科医生和骨科医生通常植入有活力的矿化软骨内（EC）自体骨或脱矿EC异体骨。一些临床医生已经认识到在颅面外科手术中使用EC骨的缺点，并主张用健康的膜内（IM）骨替代IM骨。然而，围绕我们对这些基质诱导骨形成的理解存在争议和不确定性。最近的研究主张使用其他具有骨诱导特性的材料，如脱矿骨基质（DBM）。本研究中使用的提议的递送系统包括IM骨移植、DBM以及IM骨移植的固定。这项工作的目的是进一步深入了解在有和没有DBM的情况下IM骨的愈合机制，并比较IM骨移植与单独使用DBM的愈合情况。在兔顶骨上制造了临界尺寸（10×5毫米）、无骨膜的全层骨缺损，分别单独用IM骨移植（下颌骨）、单独用脱矿皮质骨基质（DBM）、联合使用DBM-IM骨移植填充，或者不进行填充。14天后检查组织学变化。IM骨移植通过膜内骨化愈合且无中间软骨阶段。DBM和复合DBM-IM通过有中间软骨阶段的软骨内骨化愈合。据推测，IM移植的作用是诱导新血管长入缺损部位，并且新生血管血管周围区域未分化的间充质细胞被DBM中的骨形态发生蛋白诱导成为成骨细胞。
