骨形态发生蛋白2复合异种脱蛋白骨支架材料修复山羊大段骨缺损

背景：单纯骨形态发生蛋白2修复骨缺损只有骨诱导性，单纯异种脱蛋白骨只有骨传导性。 目的：评估异种脱蛋白骨复合骨形态发生蛋白2修复山羊大段长骨缺损的效果。 设计、时间及地点：随机分组设计、动物对照观察实验，于2005-03/2007-02在解放军第三军医大学创伤、烧伤与复合伤国家重点实验室完成。 材料：山羊24只用于制备大段长骨缺损模型。市售猪股骨用于制备脱蛋白骨。重组骨形态发生蛋白2为美国Biosource公司产品。 方法：山羊右侧胫骨中下段截除胫骨总长度20%制备节段性骨缺损模型。24只山羊按植入材料的不同分为3组，单纯异种脱蛋白骨组、自体骨组和异种脱蛋白骨+重组骨形态发生蛋白2组，每组8只。 主要观察指标：植入后4，8，12，16，20，24周X射线评估骨缺损情况。植入后24周取新生骨组织进行双能X射线、组织学、生物力学检测修复效果。 结果：植入后12，24周自体骨组和异种脱蛋白骨+重组骨形态发生蛋白2组X射线评分均高于单纯异种脱蛋白骨组，差异有显著性意义（P < 0.05）。植入后24周自体骨组和异种脱蛋白骨+重组骨形态发生蛋白2组骨密度和骨矿含量均高于单纯异种脱蛋白骨组，差异有显著性意义（P < 0.05）。自体骨组和异种脱蛋白骨+重组骨形态发生蛋白2组之间比较差异均无显著性意义（P > 0.05）。植入后24周生物力学测试表明，自体骨组>异种脱蛋白骨+重组骨形态发生蛋白2组>单纯异种脱蛋白骨组。植入后24周，自体骨组、异种脱蛋白骨+重组骨形态发生蛋白2组，新生骨与最初两断端连成一体，新生骨骨小梁排列整齐有序。单纯异种脱蛋白骨组，新生骨与最初两断端部分相连。 结论：重组骨形态发生蛋白2复合异种脱蛋白骨修复山羊胫骨大段缺损成骨能力与自体骨相当。

Heterogeneous deproteinized bone with bone morphogenetic protein 2 for repair of large segmental bone defect in goats

BACKGROUND: Pure bone morphogenetic protein-2 has a osteoinductive role in repair of bone defect while heterogeneous deproteinized bone only has conductivity. OBJECTIVE: To evaluate the effect of bone morphogenetic protein-2 plus heterogeneous deproteinized bone scaffold materials in the repairing of large segmental bone defect. DESIGN, TIME AND SETTING: A randomized controlled animal experiment was performed at the State Key Laboratory of Trauma, Burns and Combined Injury, Institute of Burns, the Third Military Medical University of Chinese PLA from March 2005 to February 2007. MATERIALS: Twenty-four goats were adopted to prepare segmental bone defect model. Deproteinized bone was harvested from bought pig bone. Bone morphogenetic protein-2 was the product of Biosource Company. METHODS: Twenty-four goats were divided into 3 groups by different implanted materials, deproteinized bone group, autogenous bone group and heterogeneous deproteinized bone materials + bone morphogenetic protein-2 group, with 8 goats in each group. Segmental bone defects of 20 percent right tibia middle and inferior diaphysis of the 24 goats were made. MAIN OUTCOME MEASURES: At 4, 8, 12, 16, 20, 24 weeks after operation, all specimens were examined by X-ray photographs to assess the ability of repairing bone defect. At 24 weeks postoperative, new bone were observed with X-ray photographs, histological and biomechanical methods. RESULTS: Four to twenty-four weeks postoperation, X-ray results showed that score of autogenous bone group and heterogeneous deproteinized bone materials + bone morphogenetic protein-2 group were higher than that of heterogeneous deproteinized bone group (P < 0.05); 24 weeks after surgery, bone density and bone mine content had significant difference among autogenous bone group, heterogeneous deproteinized bone materials + bone morphogenetic protein-2 group and heterogeneous deproteinized bone group (P < 0.05). Deproteinized bone group was the lowest one. There were no significant difference between autogenous bone group and heterogeneous deproteinized bone materials + bone morphogenetic protein-2 group (P > 0.05). Biomechanical analysis of 24 weeks postoperatively showed that heterogeneous deproteinized bone materials + bone morphogenetic protein-2 group was higher than deproteinized bone group but lower than autogenous bone group. Broken ends of fractured bone was connected with new bone, trabecular-like structure ranged in order. In autogenous bone group and heterogeneous deproteinized bone materials + bone morphogenetic protein-2 group, new bone was partly connected with two ends of bone defect. CONCLUSION: Heterogeneous deproteinized bone materials combined with bone morphogenetic protein-2 have equivalent osteogenesis ability to autogenous bone in reparing goat large segmental bone defect.