Establishment of a primate animal model of mandibular reconstruction with the prefabricated, customized bone flaps

doi:10.3969/j.issn.2095-4344.2014.18.005

Abstract

Abstract:

BACKGROUND: Prefabricated customized bone flaps have the advantages of few trauma, good vascularization, ossification with predetermined shape, and can be used to restore bone defects with compromised blood bed.
OBJECTIVE: To establish animal models of mandibular reconstruction with prefabricated, customized bone flaps.
METHODS: After computed tomography scanning of nine rhesus’ head, customized meshes were made. After loading with recombinant human bone morphogenetic protein-2-incorporated demineralized freeze-dried bone allograft (DFDBA) or coralline hydroxyapatite (CHA), the constructs were implanted in latissimus dorsi muscle. Meanwhile, segmental mandibular defects were created, and the customized meshes loaded with DFDBA, CHA, or recombinant human bone morphogenetic protein-2-incooperated DFDBA and CHA were implanted in situ. At 13 weeks, prefabricated bone flaps with recombinant human bone morphogenetic protein-2-incorporated DFDBA or CHA were transferred to repair segmental mandibular defects. Clinical and histological analyses were used to evaluate the ossification and vascularization of the prefabricated implants in ectopic and orthotopic sites.
RESULTS AND CONCLUSION: Segmental mandibular defects were successfully restored with prefabricated bone flaps and recombinant human bone morphogenetic protein-2-incorporated CHA in situ, but other segmental mandibular defects remained with recombinant human bone morphogenetic protein-2-incorporated DFDBA, DFDBA and CHA in situ. Moreover, mandibles reconstructed with prefabricated bone flaps revealed more regenerated and homogeneous bone formation than other reconstructions. These findings suggest that the animal model of mandibular reconstruction with prefabricated, customized bone in rhesus monkey is applicable.

中国组织工程研究杂志出版内容重点：肾移植；肝移植；移植；心脏移植；组织移植；皮肤移植；皮瓣移植；血管移植；器官移植；组织工程

全文链接：

Key words: models, animal, mandibular fractures, maxillofacial prosthesis, titanium, bone morphogenetic proteins

CLC Number:

R318

Zhou Miao, Peng Xin, Che Yue-juan, Mao Chi, Hu Min, Yu Guang-yan. Establishment of a primate animal model of mandibular reconstruction with the prefabricated, customized bone flaps[J]. Chinese Journal of Tissue Engineering Research, 2014, 18(18): 2812-2817.

Figures/Tables 2

2.1 动物大体观察结果所有动物都能耐受手术，修复后1-3 h苏醒，当天可进食流质，行动自如，健康生存至取材时。P-DFDBA-BMP组和P-CHA-BMP组背阔肌植入材料后，2到3周肿胀消失；P-DFDBA组和P-CHA组植入材料后，1周肿胀消失。P-DFDBA组在植入13周时发现，钛网从肌层部分暴露，内为软组织充满，未触及硬组织，手术刀易切割。材料植入13周，P-DFDBA-BMP组和P-CHA-BMP组行组织工程骨瓣转移修复下颌骨缺损，未出现骨瓣坏死，伤口正常愈合。在转移后5周时发现，口腔黏膜愈合良好，骨折两端固定良好，无松动；触诊发现缺损区的两端有硬组织再生，中间部分缺损犹存；转位后9周，触诊发现缺损处黏膜下有坚硬的再生骨，未及残端，颊侧可及部分缺损；转位后13周取材时见，缺损处黏膜角化完全，黏膜下再生骨表面光滑，再生骨和宿主骨连续性好，高度和邻近宿主骨一致，残端完全不可及；组织工程骨瓣的肌蒂未萎缩，附着于钛网的颊侧和下方。 S-DFDBA-BMP组和S-CHA-BMP组，修复后两三周肿胀消失。S-DFDBA-BMP组在修复后4周发现，缺损部位黏膜无红肿，能触诊到骨缺损长度轻微缩小；移植后13周时，缺损区有骨再生，颊侧骨缺损依然存在；移植后26周时，骨连续性未恢复，可触及骨缺损存在。S-CHA-BMP组移植后4周缺损部位黏膜无红肿，缺损面积明显缩小，两端有牙槽骨再生，残端仍可及；移植后13周再生骨基本充满缺损区，再生骨表面有缺损；移植后26周，缺损区连续性恢复，再生骨质地坚硬，牙槽嵴外形平滑，外形和高度与邻近下颌骨一致。 2.2 不脱钙组织学检查 P-DFDBA-BMP组在转位时活检显示，钛网内有成熟的再生骨、粗大的骨小梁和骨髓形成，新生骨包绕DFDBA；在骨小梁的周围有圆形的成骨细胞围绕。P-CHA-BMP组的组织学观察显示CHA表面有大量的骨、骨髓组织再生，可见破骨细胞形成的骨陷窝，成骨细胞呈线条状沿再生骨的边缘分布。P-DFDBA组可见DFDBA大部分被吸收，钛网内为纤维组织占据，有少量的DFDBA残余物。P-CHA组可见钛网内为纤维组织包裹CHA块。后两组无成骨，没有转位。 P-DFDBA-BMP组，预制骨瓣转移3个月后，可见下颌骨缺损完全被修复，再生骨高度略低于周围的宿主骨，可见残余的肌肉组织；钛网和网内的再生骨之间未见骨结合形成。P-CHA-BMP和S-CHA-BMP组，取材时可见下颌骨连续性恢复，下颌骨缺损处为粗大的骨小梁、骨髓和CHA占据，再生骨的高度略低于两侧下颌骨的高度。预制组成骨明显强于rhBMP-2原位植入组。P-CHA-BMP组修复下颌骨的效果强于P-DFDBA-BMP组。在S-DFDBA-BMP组，在材料植入后6个月，下颌骨只有中部连续性没有恢复，骨缺损处可见纤维结缔组织存在。S-DFDBA 和S-CHA组发现骨缺损大部分没有被修复(图2)。各组下颌骨缺损的修复率见图3。"

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