GeneralG12BoneGraftsSubsJTGrev101710章节幻灯片.pptVIP

* * Medical grade calcium sulfate is an osteoconductive void filler. It has low compressive strength so doesn’t offer structural support. Another disadvantage of the product is that it resorbs rather rapidly, perhaps more rapidly then it can be replaced by new bone. One way it which it may be used is an extender for autogenous bone graft. * Calcium sulfate products are available both as pellets, bead kits, and injectable preparations. The pellets can be poured into position, but some companies also provide an injector apparatus. The bead kits allow the addition of antibiotics if desired. * * * * * 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 sig