The use of bone-graft substitutes in large bone defects: Any specific needs?

被引:308
作者
Calori, G. M. [1 ]
Mazza, E. [1 ]
Colombo, M. [1 ]
Ripamonti, C. [1 ]
机构
[1] Univ Milan, Reparat Orthopaed Surg Dept, Inst Orthopaed, COR, I-20122 Milan, Italy
来源
INJURY-INTERNATIONAL JOURNAL OF THE CARE OF THE INJURED | 2011年 / 42卷
关键词
Bone substitutes; Large bone defect; Biomaterials; Scaffolds; BMPs; Long bone non-unions; CALCIUM-PHOSPHATE CERAMICS; NON-UNIONS; MORPHOGENETIC PROTEINS; PROGENITOR CELLS; DIAMOND CONCEPT; FUSION MODEL; CEMENTED CUP; HYDROXYAPATITE; ACETABULUM; REVISION;
D O I
10.1016/j.injury.2011.06.011
中图分类号
R4 [临床医学];
学科分类号
1002 ; 100602 ;
摘要
Introduction: The gold standard for restoring bone defects is still considered to be autologous bone grafting. However, clinical benefits are not guaranteed and donor-site complications and morbidity is not infrequent. Research is on-going for the development of alternative bone substitutes of both biological and synthetic origin. The purpose of this study was to evaluate the type of materials used and their efficacy for the treatment of large bone defects in traumatology and orthopaedic surgery. Materials and method: A literature review was carried out of Embase and PubMed databases. Inclusion criteria were articles in English language focusing on the use of bone substitutes in trauma and orthopaedic surgery for the treatment of bone defects and included details on the structural, biological or biomechanical properties of the pure product. Furthermore, based on two clinical challenges, fracture non-union and impaction grafting we elaborated on the use of polytherapy for large bone defects as guided by the diamond concept. Results: All the products indicated in this manuscript possess osteoconductive activities but have different resorption times and biomechanical properties. Bone graft substitute materials are used for a wide range of clinical applications even when the level of clinical evidence is low. The size and location of the defect and the local biological and mechanical environment as well as the biomechanical characteristics of the material determine the type of device that can be implanted in a bone defect. Conclusion: Proper assessment of the biological and mechanical environment and accurate patient selection are necessary to judge the extent of therapy the injury warrants. A sound understanding of various aspects of biomaterial properties and their relation and influence towards bone healing is of utmost importance. We suggest the application of polytherapy for the treatment of large bone defects and advocate the use of the diamond concept as a guideline. (C) 2011 Elsevier Ltd. All rights reserved.
引用
收藏
页码:S56 / S63
页数:8
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