Limits...
Demineralized Bone Matrix Injection in Consolidation Phase Enhances Bone Regeneration in Distraction Osteogenesis via Endochondral Bone Formation.

Kim JB, Lee DY, Seo SG, Kim EJ, Kim JH, Yoo WJ, Cho TJ, Choi IH - Clin Orthop Surg (2015)

Bottom Line: We examined the effect of percutaneous injection of demineralized bone matrix (DBM) during the consolidation phase on bone regeneration after distraction.DBM administration into the distraction gap at the end of the distraction period resulted in a significantly greater regenerate bone area, trabecular number, and cortical thickness in the rabbit tibial DO model.These data suggest that percutaneous DBM administration at the end of the distraction period or in the early consolidation period may stimulate regenerate bone formation and consolidation in a clinical situation with delayed bone healing during DO.

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopedic Surgery, Seoul National University Hospital, Seoul, Korea.

ABSTRACT

Background: Distraction osteogenesis (DO) is a promising tool for bone and tissue regeneration. However, prolonged healing time remains a major problem. Various materials including cells, cytokines, and growth factors have been used in an attempt to enhance bone formation. We examined the effect of percutaneous injection of demineralized bone matrix (DBM) during the consolidation phase on bone regeneration after distraction.

Methods: The immature rabbit tibial DO model (20 mm length-gain) was used. Twenty-eight animals received DBM 100 mg percutaneously at the end of distraction. Another 22 animals were left without further procedure (control). Plain radiographs were taken every week. Postmortem bone dual-energy X-ray absorptiometry and micro-computed tomography (micro-CT) studies were performed at the third and sixth weeks of the consolidation period and histological analysis was performed.

Results: The regenerate bone mineral density was higher in the DBM group when compared with that in the saline injection control group at the third week postdistraction. Quantitative analysis using micro-CT revealed larger trabecular bone volume, higher trabecular number, and less trabecular separation in the DBM group than in the saline injection control group. Cross-sectional area and cortical thickness at the sixth week postdistraction, assessed using micro-CT, were greater in the regenerates of the DBM group compared with the control group. Histological evaluation revealed higher trabecular bone volume and trabecular number in the regenerate of the DBM group. New bone formation was apparently enhanced, via endochondral ossification, at the site and in the vicinity of the injected DBM. DBM was absorbed slowly, but it remained until the sixth postoperative week after injection.

Conclusions: DBM administration into the distraction gap at the end of the distraction period resulted in a significantly greater regenerate bone area, trabecular number, and cortical thickness in the rabbit tibial DO model. These data suggest that percutaneous DBM administration at the end of the distraction period or in the early consolidation period may stimulate regenerate bone formation and consolidation in a clinical situation with delayed bone healing during DO.

No MeSH data available.


Related in: MedlinePlus

(A, B) Fig. 5B is a 4 times magnified picture of the black square in Fig. 5A. On the second day of consolidation period, injected demineralized bone matrix (DBM) distorted bone regenerate in distraction gap and inflammatory cells accumulated around the injected DBM (H&E). (C, D) At the second week of consolidation period, endochondral ossification around injected DBM (safranin O and fast green staining) and resorption of DBM by multi-nucleated giant cell (arrows, H&E) were observed. (E, F) At the third week of consolidation period, DBM group (E) had denser bone trabeculae than control group (F) (H&E). (G, H) At the sixth week of consolidation period, DBM group (G) showed thicker cortical bone and wider total bone diameter than control group (H) (H&E). The remnants of injected DBM were still observed at the sixth week of consolidation period (G).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
getmorefigures.php?uid=PMC4553289&req=5

Figure 5: (A, B) Fig. 5B is a 4 times magnified picture of the black square in Fig. 5A. On the second day of consolidation period, injected demineralized bone matrix (DBM) distorted bone regenerate in distraction gap and inflammatory cells accumulated around the injected DBM (H&E). (C, D) At the second week of consolidation period, endochondral ossification around injected DBM (safranin O and fast green staining) and resorption of DBM by multi-nucleated giant cell (arrows, H&E) were observed. (E, F) At the third week of consolidation period, DBM group (E) had denser bone trabeculae than control group (F) (H&E). (G, H) At the sixth week of consolidation period, DBM group (G) showed thicker cortical bone and wider total bone diameter than control group (H) (H&E). The remnants of injected DBM were still observed at the sixth week of consolidation period (G).

Mentions: We performed histologic examination to investigate the difference in bone regeneration process between the DBM group and the control group. At the beginning of the consolidation period, we injected DBM into the distraction gap percutaneously. On the second day of the consolidation period, we observed that the woven bone architecture was distorted and inflammatory cells had infiltrated around the injected DBM. At the third week of the consolidation period, the DBM group showed more apparent remodeling and bone regeneration than the control group. We performed safranin O and fast green staining for visualizing the cartilaginous component. We observed the cartilaginous component in the DBM group, and this component was not observed in the control group. The presence of the cartilaginous component indicated that endochondral bone formation had occurred around the DBM. At the sixth week of the consolidation period, the DBM group showed a larger diameter of regenerated bone and thicker cortical bone than the control group. The injected DBM was absorbed slowly; hence, it could be observed at the sixth week of the consolidation period (Fig. 5).


Demineralized Bone Matrix Injection in Consolidation Phase Enhances Bone Regeneration in Distraction Osteogenesis via Endochondral Bone Formation.

Kim JB, Lee DY, Seo SG, Kim EJ, Kim JH, Yoo WJ, Cho TJ, Choi IH - Clin Orthop Surg (2015)

(A, B) Fig. 5B is a 4 times magnified picture of the black square in Fig. 5A. On the second day of consolidation period, injected demineralized bone matrix (DBM) distorted bone regenerate in distraction gap and inflammatory cells accumulated around the injected DBM (H&E). (C, D) At the second week of consolidation period, endochondral ossification around injected DBM (safranin O and fast green staining) and resorption of DBM by multi-nucleated giant cell (arrows, H&E) were observed. (E, F) At the third week of consolidation period, DBM group (E) had denser bone trabeculae than control group (F) (H&E). (G, H) At the sixth week of consolidation period, DBM group (G) showed thicker cortical bone and wider total bone diameter than control group (H) (H&E). The remnants of injected DBM were still observed at the sixth week of consolidation period (G).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4553289&req=5

Figure 5: (A, B) Fig. 5B is a 4 times magnified picture of the black square in Fig. 5A. On the second day of consolidation period, injected demineralized bone matrix (DBM) distorted bone regenerate in distraction gap and inflammatory cells accumulated around the injected DBM (H&E). (C, D) At the second week of consolidation period, endochondral ossification around injected DBM (safranin O and fast green staining) and resorption of DBM by multi-nucleated giant cell (arrows, H&E) were observed. (E, F) At the third week of consolidation period, DBM group (E) had denser bone trabeculae than control group (F) (H&E). (G, H) At the sixth week of consolidation period, DBM group (G) showed thicker cortical bone and wider total bone diameter than control group (H) (H&E). The remnants of injected DBM were still observed at the sixth week of consolidation period (G).
Mentions: We performed histologic examination to investigate the difference in bone regeneration process between the DBM group and the control group. At the beginning of the consolidation period, we injected DBM into the distraction gap percutaneously. On the second day of the consolidation period, we observed that the woven bone architecture was distorted and inflammatory cells had infiltrated around the injected DBM. At the third week of the consolidation period, the DBM group showed more apparent remodeling and bone regeneration than the control group. We performed safranin O and fast green staining for visualizing the cartilaginous component. We observed the cartilaginous component in the DBM group, and this component was not observed in the control group. The presence of the cartilaginous component indicated that endochondral bone formation had occurred around the DBM. At the sixth week of the consolidation period, the DBM group showed a larger diameter of regenerated bone and thicker cortical bone than the control group. The injected DBM was absorbed slowly; hence, it could be observed at the sixth week of the consolidation period (Fig. 5).

Bottom Line: We examined the effect of percutaneous injection of demineralized bone matrix (DBM) during the consolidation phase on bone regeneration after distraction.DBM administration into the distraction gap at the end of the distraction period resulted in a significantly greater regenerate bone area, trabecular number, and cortical thickness in the rabbit tibial DO model.These data suggest that percutaneous DBM administration at the end of the distraction period or in the early consolidation period may stimulate regenerate bone formation and consolidation in a clinical situation with delayed bone healing during DO.

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopedic Surgery, Seoul National University Hospital, Seoul, Korea.

ABSTRACT

Background: Distraction osteogenesis (DO) is a promising tool for bone and tissue regeneration. However, prolonged healing time remains a major problem. Various materials including cells, cytokines, and growth factors have been used in an attempt to enhance bone formation. We examined the effect of percutaneous injection of demineralized bone matrix (DBM) during the consolidation phase on bone regeneration after distraction.

Methods: The immature rabbit tibial DO model (20 mm length-gain) was used. Twenty-eight animals received DBM 100 mg percutaneously at the end of distraction. Another 22 animals were left without further procedure (control). Plain radiographs were taken every week. Postmortem bone dual-energy X-ray absorptiometry and micro-computed tomography (micro-CT) studies were performed at the third and sixth weeks of the consolidation period and histological analysis was performed.

Results: The regenerate bone mineral density was higher in the DBM group when compared with that in the saline injection control group at the third week postdistraction. Quantitative analysis using micro-CT revealed larger trabecular bone volume, higher trabecular number, and less trabecular separation in the DBM group than in the saline injection control group. Cross-sectional area and cortical thickness at the sixth week postdistraction, assessed using micro-CT, were greater in the regenerates of the DBM group compared with the control group. Histological evaluation revealed higher trabecular bone volume and trabecular number in the regenerate of the DBM group. New bone formation was apparently enhanced, via endochondral ossification, at the site and in the vicinity of the injected DBM. DBM was absorbed slowly, but it remained until the sixth postoperative week after injection.

Conclusions: DBM administration into the distraction gap at the end of the distraction period resulted in a significantly greater regenerate bone area, trabecular number, and cortical thickness in the rabbit tibial DO model. These data suggest that percutaneous DBM administration at the end of the distraction period or in the early consolidation period may stimulate regenerate bone formation and consolidation in a clinical situation with delayed bone healing during DO.

No MeSH data available.


Related in: MedlinePlus