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目的观察假体周围骨缺损重建中,骨形态发生蛋白(BMP)2基因治疗对假体骨界面骨整合的影响。方法14条成年Beagle犬,于双侧股骨外髁造成横向骨缺损,植入光滑面钛合金假体后保持假体周围3mm骨缺损。共28侧分成4组:空白对照组(2侧),缺损区未行处理;其余分3组为无细胞组(8侧)、细胞组(8侧)和基因组(10侧),采用压缩植骨技术重建股骨髁假体周围骨缺损,分别植入犬异体冻干骨、复合自体骨髓基质干细胞的冻干骨以及复合转BMP2基因自体骨髓基质干细胞的冻干骨。通过组织学、组织形态计量学及生物力学评估假体骨界面的愈合和整合。结果术后6周,基因组假体表面明显较多的新骨沉积,可见散在的假体与新骨间点状接触,假体骨接触率(BIC)达10%左右,而空白对照组、无细胞组和细胞组界面为厚薄不一的软组织,BIC为0;12周时,空白对照组界面仍是较厚的软组织,无细胞组和细胞组的界面主要为结缔组织纤维膜,少量点状骨接触,BIC均未超过10%,基因组的假体骨界面主要为骨组织,假体骨界面可见连续性骨接触,部分BIC达50%,远高于前两组(39.2±7.5比8.4±1.3、7.2±1.5,均P<0.01)。各组的界面推出强度随时间增加,基因组的强度在各个时间段均远高于前两组(1.40±0.22比0.09±0.04、0.08±0.04,均P<0.01)。结论BMP2基因治疗可明显提高假体骨界面的骨整合。
Objective To observe the effect of bone morphogenetic protein (BMP) 2 gene therapy on the osseointegration of the prosthesis bone in the reconstruction of the defect around the prosthesis. Methods Fourteen adult Beagle dogs were caused by bilateral lateral femoral condyle defects, and 3 mm bone defects around the prosthesis were maintained after the smooth titanium alloy prosthesis was implanted. A total of 28 sides were divided into 4 groups: the blank control group (2 sides), the defect area was not treated; the other 3 groups were cell-free group (8 sides), cell group (8 sides) and genome (10 sides) Bone technique to reconstruct the bone defects around the femoral condylar prosthesis, and then freeze-dry allogeneic lyophilized bone, freeze-dried bone of autologous bone marrow stromal cells and freeze-dried bone of BMP2 gene autologous bone marrow stromal cells respectively. The healing and integration of the prosthetic bone interface was assessed by histology, histomorphometry and biomechanics. Results Six weeks postoperatively, there were significantly more new bone deposits on the surface of the prosthesis. The scattered prosthesis had punctate contact with the new bone and the prosthetic bone contact rate (BIC) was about 10%. However, in the blank control group, The interface of cell group and cell group was soft tissue with different thickness, the BIC was 0. At 12 weeks, the interface of blank control group was still thick soft tissue. The interface of cell-free group and cell group was mainly connective tissue fiber membrane, BIC and BIC were not more than 10%. The genome bone prosthesis bone interface was mainly bone. Prosthetic bone interface showed continuous bone contact with some BIC reaching 50%, much higher than the former two groups (39.2 ± 7.5 vs 8.4 ± 1.3, 7.2 ± 1.5, all P <0.01). The intensities of the interface launch in each group increased with time, and the intensity of the genome was much higher than that of the first two groups at each time point (1.40 ± 0.22 vs. 0.09 ± 0.04, 0.08 ± 0.04, all P <0.01). Conclusion BMP2 gene therapy can significantly improve the osseointegration of the prosthesis bone interface.