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Autologous bone graft has long been the gold standard for bone defect repair after spinal fusion, trauma, or tumor resection. But autologous bone graft has disadvantages such as limited access, blood loss, prolonged operative time, increased patient pain. And it can cause complications at the access site. To reduce autologous bone donor site complications and improve bone defect repair, various autologous bone replacement materials with osteoconductive/osteoinductive potential have emerged, mainly including osteogenic, osteoconductive, and osteoinductive products.
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Osteogenic bone graft substitution
Osteoconductive Graft Alternatives
Osseo inductive graft substitution
Homogeneous allogeneic bone and demineralized bone matrix (DBM) are the most commonly used osteogenic bone graft materials. Although allogeneic bone is abundant, it carries the risk of infectious disease; programmed DBM is still subject to rejection. Animal studies have shown that allogeneic bone spine fusion rates are low, graft resorption is rapid, and infection rates are high when compared to autologous bone grafts. DBM is a decalcified bone matrix derived from allogeneic bone, it is widely used for spinal instability in patients requiring bone graft fusion. Human DBM contains a variety of BMPs but has failed to achieve the same results as autologous bone grafts in prospective randomized clinical trials of trauma repair and bone reconstruction.
Currently, the U.S. Food and Drug Administration (FDA) has approved several bone graft substitutes with osteoconductive properties including coral hydroxyapatite, collagen-hydroxyapatite composites, calcium phosphate, calcium sulfate, and calcium triphosphate for clinical use. By growing new bone into or over bone graft replacement materials, these products are commonly used for the filling of bone defects with spinal fusion. The effectiveness of such products cannot be confirmed clinically with certainty due to the high variability in the chemical composition, structural strength, and resorption, and plasticity of the materials. They are not highly manipulable and tend to disperse from the filler site into the surrounding soft tissue, making it difficult to remove in the event of infection. In addition, the bone bed of some hosts may be less suitable for tissue growth, thus affecting the integration of the material into the host bone.
Despite encouraging experimental results with Osseo inductive growth factors, widespread clinical use has been difficult. This situation has not changed until the recent adoption of recombinant technology and the mass production of products represented by rhBMP-2. rhBMP-2 induces new bone formation in animal models, and the safety and efficacy of rhBMP-2 have been well established in animal experiments. These products have been approved by the FDA. Due to the completion of numerous preclinical and clinical studies and the FDA approval of these products, rhBMP-2 has become one of the most published orthopedic research hotspots with significant progress.
Finding an alternative to autologous bone grafting has been the most attractive and challenging challenge for orthopedic surgeons. And the alternatives currently used do not yet have good osteogenic, osteoconductive, and Osseo inductive properties at the same time. The use of scaffold materials, cytokines, and stem cells to construct individualized tissue-engineered bone through standardized tissue engineering techniques is currently a hot topic in the research of bone defect repair and spinal fusion. And is the direction of development to establish a safe and effective alternative method for autologous bone grafting.
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