目的制备一种黏性载体和成骨基质颗粒均来源于人骨的可塑形骨填充材料,通过动物实验评价其安全性和骨诱导能力。方法取自愿捐赠的人体长骨,采用粉碎、清洗、脱矿等方法制备脱钙骨基质(demineralized bone matrix,DBM)颗粒,再将DBM颗粒...目的制备一种黏性载体和成骨基质颗粒均来源于人骨的可塑形骨填充材料,通过动物实验评价其安全性和骨诱导能力。方法取自愿捐赠的人体长骨,采用粉碎、清洗、脱矿等方法制备脱钙骨基质(demineralized bone matrix,DBM)颗粒,再将DBM颗粒经温浴法制备骨基质明胶(bone matrix gelatin,BMG),将BMG及DBM颗粒混合制备成可塑形骨填充材料(实验组);以单纯DBM颗粒作为对照组。取15只6~9周龄健康雄性无胸腺裸小鼠,于两侧臀中肌与臀大肌间制备肌间空隙,均植入实验组材料,术后1、4、6周处死动物,行HE组织学染色评价异位成骨效果。取8只9月龄日本大耳兔,于两侧后肢髁骨处制备直径6 mm骨缺损,左、右侧分别填充实验组和对照组材料,术后12、26周处死动物,行Micro-CT及HE组织学染色评价骨缺损修复效果。结果异位成骨实验HE染色示,术后1周可观察到大量软骨细胞,术后4、6周可观察到明显新生软骨组织。兔髁骨缺损修复实验HE染色示,术后12周,部分材料被吸收,实验组及对照组均可观察到新生软骨;术后26周,大部分材料被吸收,对照组可观察到大量新生骨,实验组可观察到新生骨单元结构。Micro-CT观测示,实验组成骨速率及成骨面积均优于对照组。骨形态计量学参数检测示,两组术后26周各参数均较术后12周显著增加(P<0.05)。术后12周,实验组骨密度、骨体积分数均显著高于对照组(P<0.05),两组骨小梁厚度差异无统计学意义(P>0.05);术后26周,实验组骨密度显著高于对照组(P<0.05),两组骨体积分数、骨小梁厚度差异无统计学意义(P>0.05)。结论新型可塑形骨填充材料具有良好的生物安全性及骨诱导活性,是一种良好的骨填充材料。展开更多
背景:脊柱融合术中选择有效的植骨材料十分有必要,自体骨移植被视为脊柱融合术的“金标准”,但其存在取骨区疼痛等并发症。同种异体骨供骨量充足、可避免取骨区并发症,不同的同种异体骨材料在不同部位的脊柱融合中展现了良好的成骨能力...背景:脊柱融合术中选择有效的植骨材料十分有必要,自体骨移植被视为脊柱融合术的“金标准”,但其存在取骨区疼痛等并发症。同种异体骨供骨量充足、可避免取骨区并发症,不同的同种异体骨材料在不同部位的脊柱融合中展现了良好的成骨能力。目的:综述近年来同种异体骨移植材料在脊柱融合术中的应用现状。方法:检索1990-2022年间,在PubMed、Web of Science数据库和中国知网发表的相关中英文文献,英文检索词:“fresh frozen bone,autograft,allograft,freeze-dried bone,demineralized bone matrix,allograft spacer,spinal fusion”;中文检索词:“新鲜冰冻骨,自体骨,同种异体骨,冷冻干燥骨,脱矿骨基质,同种异体骨椎间融合器,脊柱融合”,经筛选后最终纳入95篇文献进行综述。结果与结论:新鲜冰冻骨由于其存在免疫排斥、传播疾病等风险临床运用较少;冷冻干燥骨移植虽然存在延迟愈合,但是其最终融合效果与自体骨相似;脱钙骨基质常作为自体骨填充剂或用于填充椎间融合器而最大发挥其融合能力,与硫酸钙或羟磷灰石等载体的联用使其可塑性和成骨活性提升明显;新型解剖型同种异体椎间融合器成骨活性好、临床融合率高、可有效维持椎间隙高度和椎间孔的正常形状。现有的大量临床研究结果表明同种异体骨材料在脊柱融合术中能达到与自体骨一样的融合效率,并且和自体骨一样安全,是外科医生良好的选择,在临床中得到了大量应用。展开更多
目的:制备犬脱钙骨基质(demineralized bone matrix,DBM),研究DBM作为骨组织工程支架材料的可行性。方法:杂种犬的股骨行脱脂、脱钙、脱非胶原蛋白、冷冻干燥、灭菌制成DBM,与骨髓间充质干细胞(mesenchymal stemcells,MSCs)复合,应用倒...目的:制备犬脱钙骨基质(demineralized bone matrix,DBM),研究DBM作为骨组织工程支架材料的可行性。方法:杂种犬的股骨行脱脂、脱钙、脱非胶原蛋白、冷冻干燥、灭菌制成DBM,与骨髓间充质干细胞(mesenchymal stemcells,MSCs)复合,应用倒置相差显微镜、扫描电镜观察脱钙骨基质的结构及细胞在材料表面的生长情况。结果:犬脱钙骨基质具有三维立体网孔结构,平均孔隙直径为(254.39±88.71)μm,孔隙率约为70%。与MSCs复合培养后,细胞黏附其上,上架率高,生长状态良好,增殖迅速,并分泌大量细胞外基质。结论:DBM具有良好的生物相容性。展开更多
目的:建立骨形态发生蛋白4(bone morphogenetic protein 4,BMP4)、脱钙骨基质和切断跟腱诱导的异位骨化动物模型,并初步探讨其形成机制,为异位骨化的研究奠定实验基础。方法:制备动物模型:(1)构建BMP4重组腺病毒,实验组裸鼠的一侧腓肠...目的:建立骨形态发生蛋白4(bone morphogenetic protein 4,BMP4)、脱钙骨基质和切断跟腱诱导的异位骨化动物模型,并初步探讨其形成机制,为异位骨化的研究奠定实验基础。方法:制备动物模型:(1)构建BMP4重组腺病毒,实验组裸鼠的一侧腓肠肌内注入50μl1×107pfu BMP4重组腺病毒液,对照组腓肠肌内注入50μl1×107pfu空病毒液。4周后行X线和组织学检查。(2)无菌条件下,股后外侧入路,将50mg脱钙骨基质植入裸鼠股后肌群内,4周后行X线和组织学检查。(3)20只小鼠于跟腱中点行跟腱切断术,10周后行X线和组织学检查。结果:X线和组织学检查显示4周后,注射BMP4重组腺病毒的动物均出现异位骨,注射空病毒组未见异位骨形成。4周后,植入脱钙骨基质的动物均出现异位骨。10周后,行跟腱切断术的动物均在跟腱部位出现异位骨。结论:BMP4、脱钙骨基质和切断跟腱可有效诱导异位骨化,结果稳定可靠。展开更多
Autologous bone graft is considered as the gold standard for all indications for bone grafting procedures but the limited availability and complications in donor site resulted in seeking other options like allografts ...Autologous bone graft is considered as the gold standard for all indications for bone grafting procedures but the limited availability and complications in donor site resulted in seeking other options like allografts andbone graft substitutes. Demineralized bone matrix(DBM) is an allograft product with no quantity limitation. It is an osteoconductive material with osteoinductive capabilities, which vary among different products, depending on donor characteristics and differences in processing of the bone. The purpose of the present review is to provide a critical review of the existing literature concerning the use of DBM products in various procedures in the extremities. Clinical studies describing the use of DBM alone or in combination with other grafting material are available for only a few commercial products. The Level of Evidence of these studies and the resulting Grades of Recommendation are very low. In conclusion, further clinical studies of higher quality are required in order to improve the Recommendation Grades for or against the use of DBM products in bone grafting procedures.展开更多
Spinal fusion remains the gold-standard treatment for several pathological spine conditions. Although, autologous Iliac Crest Bone Grafting is considered the goldstandard graft choice to promote spinal fusion; however...Spinal fusion remains the gold-standard treatment for several pathological spine conditions. Although, autologous Iliac Crest Bone Grafting is considered the goldstandard graft choice to promote spinal fusion; however, it is associated with significant donor site morbidity and a limited graft quantity. Therefore, several bone graft alternatives have been developed, to augment arthrodesis. The purpose of this review is to present the results of clinical studies concerning the use of demineralized bone matrix(DBM), alone or as a composite graft, in the spinal fusion. A critical review of the English-language literature was conducted on Pubmed, using key word "demineralized bone matrix", "DBM", "spinal fusion", and "scoliosis". Results had been restricted to clinical studies. The majority of clinical trials demonstrate satisfactory fusion rates when DBM is employed as a graft extender or a graft enhancer.Limited number of prospective randomized controlled trials(4 studies), have been performed comparing DBM to autologous iliac crest bone graft in spine fusion. The majority of the clinical trials demonstrate comparable efficacy of DBM when it used as a graft extender in combination with autograft, but there is no clinical evidence to support its use as a standalone graft material. Additionally, high level of evidence studies are required, in order to optimize and clarify the indications of its use and the appropriate patient population that will benefit from DBM in spine arthrodesis.展开更多
文摘背景:脊柱融合术中选择有效的植骨材料十分有必要,自体骨移植被视为脊柱融合术的“金标准”,但其存在取骨区疼痛等并发症。同种异体骨供骨量充足、可避免取骨区并发症,不同的同种异体骨材料在不同部位的脊柱融合中展现了良好的成骨能力。目的:综述近年来同种异体骨移植材料在脊柱融合术中的应用现状。方法:检索1990-2022年间,在PubMed、Web of Science数据库和中国知网发表的相关中英文文献,英文检索词:“fresh frozen bone,autograft,allograft,freeze-dried bone,demineralized bone matrix,allograft spacer,spinal fusion”;中文检索词:“新鲜冰冻骨,自体骨,同种异体骨,冷冻干燥骨,脱矿骨基质,同种异体骨椎间融合器,脊柱融合”,经筛选后最终纳入95篇文献进行综述。结果与结论:新鲜冰冻骨由于其存在免疫排斥、传播疾病等风险临床运用较少;冷冻干燥骨移植虽然存在延迟愈合,但是其最终融合效果与自体骨相似;脱钙骨基质常作为自体骨填充剂或用于填充椎间融合器而最大发挥其融合能力,与硫酸钙或羟磷灰石等载体的联用使其可塑性和成骨活性提升明显;新型解剖型同种异体椎间融合器成骨活性好、临床融合率高、可有效维持椎间隙高度和椎间孔的正常形状。现有的大量临床研究结果表明同种异体骨材料在脊柱融合术中能达到与自体骨一样的融合效率,并且和自体骨一样安全,是外科医生良好的选择,在临床中得到了大量应用。
文摘目的:制备犬脱钙骨基质(demineralized bone matrix,DBM),研究DBM作为骨组织工程支架材料的可行性。方法:杂种犬的股骨行脱脂、脱钙、脱非胶原蛋白、冷冻干燥、灭菌制成DBM,与骨髓间充质干细胞(mesenchymal stemcells,MSCs)复合,应用倒置相差显微镜、扫描电镜观察脱钙骨基质的结构及细胞在材料表面的生长情况。结果:犬脱钙骨基质具有三维立体网孔结构,平均孔隙直径为(254.39±88.71)μm,孔隙率约为70%。与MSCs复合培养后,细胞黏附其上,上架率高,生长状态良好,增殖迅速,并分泌大量细胞外基质。结论:DBM具有良好的生物相容性。
文摘目的:建立骨形态发生蛋白4(bone morphogenetic protein 4,BMP4)、脱钙骨基质和切断跟腱诱导的异位骨化动物模型,并初步探讨其形成机制,为异位骨化的研究奠定实验基础。方法:制备动物模型:(1)构建BMP4重组腺病毒,实验组裸鼠的一侧腓肠肌内注入50μl1×107pfu BMP4重组腺病毒液,对照组腓肠肌内注入50μl1×107pfu空病毒液。4周后行X线和组织学检查。(2)无菌条件下,股后外侧入路,将50mg脱钙骨基质植入裸鼠股后肌群内,4周后行X线和组织学检查。(3)20只小鼠于跟腱中点行跟腱切断术,10周后行X线和组织学检查。结果:X线和组织学检查显示4周后,注射BMP4重组腺病毒的动物均出现异位骨,注射空病毒组未见异位骨形成。4周后,植入脱钙骨基质的动物均出现异位骨。10周后,行跟腱切断术的动物均在跟腱部位出现异位骨。结论:BMP4、脱钙骨基质和切断跟腱可有效诱导异位骨化,结果稳定可靠。
文摘Autologous bone graft is considered as the gold standard for all indications for bone grafting procedures but the limited availability and complications in donor site resulted in seeking other options like allografts andbone graft substitutes. Demineralized bone matrix(DBM) is an allograft product with no quantity limitation. It is an osteoconductive material with osteoinductive capabilities, which vary among different products, depending on donor characteristics and differences in processing of the bone. The purpose of the present review is to provide a critical review of the existing literature concerning the use of DBM products in various procedures in the extremities. Clinical studies describing the use of DBM alone or in combination with other grafting material are available for only a few commercial products. The Level of Evidence of these studies and the resulting Grades of Recommendation are very low. In conclusion, further clinical studies of higher quality are required in order to improve the Recommendation Grades for or against the use of DBM products in bone grafting procedures.
文摘Spinal fusion remains the gold-standard treatment for several pathological spine conditions. Although, autologous Iliac Crest Bone Grafting is considered the goldstandard graft choice to promote spinal fusion; however, it is associated with significant donor site morbidity and a limited graft quantity. Therefore, several bone graft alternatives have been developed, to augment arthrodesis. The purpose of this review is to present the results of clinical studies concerning the use of demineralized bone matrix(DBM), alone or as a composite graft, in the spinal fusion. A critical review of the English-language literature was conducted on Pubmed, using key word "demineralized bone matrix", "DBM", "spinal fusion", and "scoliosis". Results had been restricted to clinical studies. The majority of clinical trials demonstrate satisfactory fusion rates when DBM is employed as a graft extender or a graft enhancer.Limited number of prospective randomized controlled trials(4 studies), have been performed comparing DBM to autologous iliac crest bone graft in spine fusion. The majority of the clinical trials demonstrate comparable efficacy of DBM when it used as a graft extender in combination with autograft, but there is no clinical evidence to support its use as a standalone graft material. Additionally, high level of evidence studies are required, in order to optimize and clarify the indications of its use and the appropriate patient population that will benefit from DBM in spine arthrodesis.
