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【medical-news】骨移植替代物：让事实远离想象
Roy Sanders, MD
Past President, Orthopaedic Trauma Association
Tampa, Florida
http://www.ncbi.nlm.nih.gov/sites/entrez
Although great advances have been made in fracture care, treatment failures are not uncommon. Highenergy injuries that result in bone devitalization, or open fractures that are associated with bone loss, can be followed by postoperative infection or, if treated with inadequate methods, may result in the development of a pseudarthrosis.These complex problems require much care before healing can occur. Since the development and use of stainless steel in orthopaedics in the 1920s, surgeons have tried to use advances in metallurgy and implant design to assist fracture-healing. Nails were improved with locking technology, while simple plates were transformed into blade plates, compression plates, and now locking plates. External fixation was revolutionized by G. Ilizarov with the development of distraction osteogenesis. Stainless steel itself was altered to create vanadium, Vitallium, and now titanium alloys. While all of these techniques have decreased the rate of nonunion, they have not completely solved the problem because there are limits to what metal can do to affect the biology of fracture-healing.
Although the biologic approach to fracture-healing seems intuitive, surgeons have had limited options for decades. An ideal bone-graft substitute must provide scaffolding for osteoconduction, growth factors for osteoinduction, and progenitor cells for osteogenesis. Autologous bone-grafting was described by Fred Albee in 19151. Bone-grafting requires additional surgery, can be painful, and is not without complications. Although Albee also described the use of calcium phosphates as an alternative to bone in the 1920s, it was not until 1965, when Marshall Urist identified “bone formation by autoinduction”2, that new options unfolded. Twenty-three years later, Wozney et al.3 and Luyten et al.4 discovered the proteins responsible for this phenomenon, BMPs-2, 3, and 4. Today these proteins can be harvested from a variety of bone sources or synthesized through recombinant gene therapy, and they are available to the practicing orthopaedist.
There has been an explosion of commercial products for the orthopaedic surgeon to choose from. Calcium phosphate ceramics, calcium sulfate, bioactive glass, biodegradable polymers, and recombinant human BMPs (OP-1 and BMP-2) are all offered as solutions to the problem of bone-healing. While the actions of each product can be confusing, suggested combination therapy can be simply baffling, especially when there are few objective scientific data. Hospital administrators are equally perplexed, particularly by the costs of these products, and in many cases they refuse to allow the surgeon to use them even though they are thought to be useful.
This issue is of critical importance to the orthopaedic surgeon involved in fracture care and treatment of nonunions. As the leaders in fracture care in North America, the Orthopaedic Trauma Association has responded by charging a committee under the leadership of Dr. William De Long to generate a white paper to more clearly identify the issues surrounding these products and their use. This initial report was expanded into the Current Concepts Review5 in this issue of The Journal to offer the information to the general orthopaedic community. It is hoped that, after reading this review, surgeons will be better able to make decisions based on sound scientific principles and to understand the limitations as well as the benefits of these commercially available bone-graft substitutes. In the end, it is the responsibility of the physician to prescribe the correct treatment for the patient, and that decision must be made on the basis of fact, not fiction.
本人已认领该文编译，48小时后若未提交译文，请其他战友自由认领。 Bone Graft Substitutes: Separating Fact from Fiction
骨移植替代物：让事实远离想象
Although great advances have been made in fracture care, treatment failures are not uncommon. Highenergy injuries that result in bone devitalization, or open fractures that are associated with bone loss, can be followed by postoperative infection or, if treated with inadequate methods, may result in the development of a pseudarthrosis.These complex problems require much care before healing can occur. Since the development and use of stainless steel in orthopaedics in the 1920s, surgeons have tried to use advances in metallurgy and implant design to assist fracture-healing. Nails were improved with locking technology, while simple plates were transformed into blade plates, compression plates, and now locking plates. External fixation was revolutionized by G. Ilizarov with the development of distraction osteogenesis. Stainless steel itself was altered to create vanadium, Vitallium, and now titanium alloys. While all of these techniques have decreased the rate of nonunion, they have not completely solved the problem because there are limits to what metal can do to affect the biology of fracture-healing.
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作者:admin@医学,生命科学 2011-05-27 05:11
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