Bone Grafting and Bone Graft Substitutes - Home ：骨移植和骨移植替代物-首页.ppt

* * * * * Two bone morphogenetic proteins are commercially available. These are BMP-2,marketed by Medtronics, and BMP-7, more commonly known of osteogenic protein 1, produced by Stryker Biotech. These products are produced by recombinant technology in which large quantities of the material are produced in cell culture. * BMPs have been studies in several human investigations including open fractures and nonunions. BMP-2 was studied in a prospective, randomized study of 450 patients with open tibial shaft fractures treated with fracture debridement and an IM nail. At the time of definitive wound closure patients were randomized to one of three treatments placebo 0.75 mg/ml BMP-2/ACS (lower BMP dose) 1.50 mg/ml BMP-2/ACS (higher BMP dose) * The primary outcome measure was the proportion of patients requiring secondary intervention because of delayed union or nonunion within twelve months postoperatively. In the group treated with the higher dose BMP-2 there was a 44% reduction in risk of nonunion/delayed union Significantly faster fracture healing Significantly fewer invasive interventions Significantly fewer hardware failures and fewer infections The graph from their publication shows the placebo control groups in black representing the standard of care. The Gustilo IIIBs are on the left and the Gustilo I, II and IIIAs on the right. There is a statistically significant reduction in the number of secondary interventions in those fractures treated with the higher dose of BMP-2. * Calcium Phosphate Injectable Very high compressive strength once hardens Some studies of its use have allowed earlier weightbearing and range of motion Osteoconductive void filler Low compressive strength – no structural support Rapidly resorbs May be used as a autogenous graft extender Available from numerous companies Osteoset, Calceon 6, Bone Blast, etc. Calcium Sulfate Pellets Pellet injectors Bead kits Allows addition of antibiotics Injectable May be used to augment s