Mayer M, Hollinger J, Ron E, Wozney J
Department of Plastic and Reconstructive Surgery, Walter Reed Army Medical Center, Washington, D.C., USA.
Plast Reconstr Surg. 1996 Aug;98(2):247-59. doi: 10.1097/00006534-199608000-00006.
Recombinant human bone morphogenetic protein-2 was evaluated in maxillary alveolar clefts in 24 adult, skeletally mature Foxhound dogs. Bilateral clefts were prepared, 1 cm in bony width, lined with healthy epithelium with functional teeth on each side, and were expected not to heal spontaneously with new bone. Preparation of bilateral clefts in 24 dogs permitted 48 recipient sites divided evenly among four treatment and two time periods (2 and 4 months), yielding six replicates per treatment per time. The overall goal for the study was to regenerate bone in the cleft using one of three treatments: (2) 200 microgram recombinant human bone morphogenetic protein-2 combined with the copolymer poly(lactide-co-glycolide) and autogenous blood, (2) poly(lactide-co-glycolide) and autogenous blood, or (3) an autograft from the posterior iliac crest. A fourth group consisted of untreated alveolar cleft defects. At designated times, dogs were euthanized, and the recipient beds with contiguous bone were recovered, processed, and assessed radiographically and histologically. Autograft-treated defects had more bone than other treatments at 2 months; however, by 4 months, there were no differences among treatments, except for the poly(lactide-co-glycolide) group, which had the least amount of bone. Response to the recombinant human bone morphogenetic protein-2 may have been suboptimal either because the dose was too low or because the poly(lactide-co-glycolide)-autogenous blood delivery system did not temporally maintain and spatially position recombinant human bone morphogenetic protein-2 at the recipient bed. In addition, the development of a nonhealing, critical-sized defect in the maxilla of the dog appears to require a more aggressive resection of bone to preclude spontaneous osseous regeneration.
在24只成年骨骼发育成熟的猎狐犬的上颌牙槽嵴裂中评估了重组人骨形态发生蛋白-2。制备双侧裂隙，骨宽度为1厘米，两侧衬有健康上皮且有功能牙，预期不会自发愈合形成新骨。对24只犬制备双侧裂隙可得到48个受体部位，在四种治疗方法和两个时间段（2个月和4个月）之间平均分配，每种治疗方法每个时间段有六个重复。该研究的总体目标是使用以下三种治疗方法之一在裂隙中再生骨：（1）200微克重组人骨形态发生蛋白-2与共聚物聚（丙交酯-共-乙交酯）和自体血联合使用；（2）聚（丙交酯-共-乙交酯）和自体血；或（3）取自后髂嵴的自体骨移植。第四组由未经治疗的牙槽嵴裂缺损组成。在指定时间，对犬实施安乐死，回收带有相邻骨的受体床，进行处理，并进行影像学和组织学评估。自体骨移植治疗的缺损在2个月时比其他治疗方法有更多的骨；然而，到4个月时，除了聚（丙交酯-共-乙交酯）组骨量最少外，各治疗方法之间没有差异。对重组人骨形态发生蛋白-2的反应可能未达最佳，原因可能是剂量过低，或者聚（丙交酯-共-乙交酯）-自体血递送系统未能在时间上维持并在空间上定位重组人骨形态发生蛋白-2于受体床。此外，犬上颌骨中不愈合的临界大小缺损的形成似乎需要更积极地切除骨以防止自发骨再生。
