骨形态发生蛋白复合物结合CAD/CAM技术原位修复喉甲状软骨缺损

背景：临床修复喉甲状软骨缺损时使用一定的支架材料。骨形态发生蛋白具有成骨诱导活性，与其他形式的载体联合起来进行复合应用可以更好的发挥出其诱导成骨作用。联合使用计算机辅助设计/计算机辅助制造技术能提高修复效果。 目的：进一步验证骨形态发生蛋白复合物结合计算机辅助设计/计算机辅助制造技术在原位修复喉甲状软骨缺损中的应用效果。 方法：纳入18只新西兰大白兔，对动物喉部进行三维扫描，建立兔甲状软骨三维数字模型。利用泡沫凝胶注模法制备羟基磷灰石支架，再制备骨形态发生蛋白复合物。18只动物随机分为观察组和对照组。两组兔行一侧甲状软骨切除后，观察组植入珊瑚羟基磷灰石支架；对照组填充明胶海绵。处理后 4，8，12周，进行大体观察和评分；处理后12周，对动物行喉镜检查，喉组织常规切片后进行苏木精-伊红染色，进行组织学观察。 结果与结论：处理后12周，对照组兔的喉腔出现明显的变窄现象，且存在轻微充血；观察组喉腔黏膜光滑，且通畅、宽敞，未出现肉芽生长情况。处理后4，8，12周，两组喉甲状软骨评分均呈现出不断下降的情况，且不同时间点，观察组评分均显著低于对照组(均P < 0.05)。处理后12周，对照组未出现成熟骨细胞和软骨细胞的生成；观察组则可见植入材料完全降解，存在大量多核样组织细胞增生和吞噬，手术区域软骨母细胞出现增生现象，并伴有成软骨区域形成情况，另外还以观察到软骨骨质形成以及软骨细胞增生现象。结果表明，利用骨形态发生蛋白复合物结合计算机辅助设计/计算机辅助制造技术进行原位喉甲状软骨缺损修复可以获得良好的效果，实验过程中所使用的复合物具有良好的骨诱导作用以及组织相容性。 中国组织工程研究杂志出版内容重点：组织构建；骨细胞；软骨细胞；细胞培养；成纤维细胞；血管内皮细胞；骨质疏松；组织工程 

Bone morphogenetic protein complex combined with CAD/CAM technique in the in situ repair of laryngeal cartilage defects

BACKGROUND: In the process of repairing laryngeal cartilage defects, a certain scaffold material can be used. Bone morphogenetic proteins have the activity of osteogenic induction, which can be used in combination with other materials. In order to improve the repairing effect, the combination of bone morphogenetic protein complex and computer aided design/computer aided manufacturing (CAD/CAM) technology is preferred. OBJECTIVE: To investigate the effect of bone morphogenetic protein complex combined with CAD/CAM technology for in situ repair of laryngeal cartilage defects. METHODS: Eighteen New Zealand white rabbits were enrolled and randomly divided into observation and control  groups followed by three-dimensional scanning of the throat. Then, three-dimensional rabbit models of the thyroid cartilage were made. Porous hydroxyapatite scaffold was prepared using gelcasting-foam method and combined with bone morphogenetic proteins. After unilateral removal of the thyroid cartilage, the composite scaffold and gelatin sponge were implanted into the rabbits in the observation and control groups, respectively. At 4, 8, 12 weeks after implantation, the rabbits in the two groups were observed grossly. At 12 weeks, the animals were sacrificed following laryngoscopy to observe the histological and pathological changes. RESULTS AND CONCLUSION: At 12 weeks after implantation, the laryngeal cavity was narrowed and appeared to have a slight congestion in the control group; while in the observation group, the laryngeal cavity was smooth, unobstructed and spacious, with no granulation growth. At 4, 8, 12 weeks after implantation, the scores on the thyroid cartilage were decreased dramatically in the two groups, especially in the observation group (P < 0.05). At 12 weeks after implantation, there were no mature osteocytes and chondrocytes in the control group; in the observation group, the scaffold degraded completely, there was a large amount of cell proliferation and phagocytosis, and chondroblastic proliferation and cartilage formation were found in the surgical region. These results indicate that the use of bone morphogenetic protein complex combined with CAD/CAM technique can have good achievements in the treatment of in situ laryngeal cartilage defects. Additionally, the composite material used in the experimental procedure has good osteoinductive effect and histocompatibility.