异种脱蛋白松质骨支架在脊柱横突间融合中应用的可行性

Application feasibility of xenogeneic deproteinized cancellous bone scaffold in the treatment of spinal intertransverse fusion

背景:现如今关于组织工程骨的相关研究大多集中在骨干临界性骨缺损方面,关于其在脊柱融合中的相关研究和报道相对较少。目的:探讨在脊柱横突间融合治疗中异种脱蛋白松质骨作为骨组织工程支架的应用可行性。方法:取成年猪股骨远端松质部分,制备异种脱蛋白松质骨材料,与重组人骨形态发生蛋白复合后,再复合骨髓间充质干细胞制备组织工程骨。取24只山羊,制备横突间植骨床,随机均分为2组,观察组左侧植入组织工程骨,右侧植入载重组人骨形态发生蛋白的异种脱蛋白松质骨;对照组左侧植入自体髂骨,右侧植入异种脱蛋白松质骨。植入后4,8,12周获取融合节段,进行大体观察、X射线观察、组织学观察及生物力学检测。结果与结论:X射线显示,两组植入材料均固定良好,固定效果可靠。植入后不同时间点,各组植入材料均处于良好位置,材料周围组织未出现化脓或者坏死等,且均出现软组织长入、包裹,植入材料周围均未出现积液和坏死等,其中组织工程骨组影像学表现与组织学表现优于载重组人骨形态发生蛋白异种脱蛋白松质骨组、异种脱蛋白松质骨组,与自体骨最接近。植入后12周,组织工程骨组最大弯曲载荷最接近自体髂骨组,两组间比较差异无显著性意义。表明在脊柱横突间融合治疗中,异种脱蛋白松质骨作为骨组织工程支架具有一定的应用可行性。

BACKGROUND： Nowadays,most of the studies regarding tissue engineering bone have mostly focused on critical-size bone defects of the backbone; however,there are less studies and reports on its spinal fusion. OBJECTIVE： To explore the feasibility of xenogeneic deproteinized cancellous bone as bone tissue engineering scaffold in the treatment of spinal intertransverse fusion. METHODS： The cancellous part in the distal femur of adult pigs was obtained to prepare xenogeneic deproteinized cancellous bone. After combined with the recombinant human bone morphogenetic protein,the xenogeneic deproteinized cancellous bone was combined with bone marrow mesenchymal stem cells to prepare tissue engineering bone. Twenty-four goats were obtained to prepare intertransverse bone bed,and randomly divided into two groups： observation and control groups. In the observation group,the tissue engineered bone was implanted into the left side,and the xenogeneic deproteinized cancellous bone of recombinant human bone morphogenetic protein was implanted into the right side. In the control group,the autologous iliac bone was implanted into the left side,and xenogenic deproteinization cancellous bone was implanted into the right side. At the 4^th,8^th and 12^ th weeks after implantation,the fusion segment was obtained for gross observation,X-ray observation,histological observation and biomechanical testing. RESULTS AND CONCLUSION： X-ray films showed that the implant materials from these two groups werefixed well and reliably. At different time points after implantation,the implant materials from each group were all in good position. There were no purulent and necrotic tissues around the material. Soft tissue ingrow and wraping were present. There were no effusions and necrosis surrounding the implant materials. The imaging and histological performance in the tissue engineering bone group outperformed that in the recombinant human bone morphogenetic protein xenogenic deproteinized cancellous bone group and xenogenic deproteinized cancellous bone group,which was the most close to the autogenous bone. At the 12 ^th week after implantation,the maximum bending load in the tissue engineering bone group was the most close to the autogenous iliac bone group. There was no significant difference between these two groups. These results demonstrate that as bone tissue engineering scaffold,xenogenic deproteinized cancellous bone has a certain application feasibility in the treatment of spinal intertransverse fusion.