Biologic model of bone transport distraction osteogenesis and vascular response

Abstract

We developed an experimental model in the rabbit of distraction osteogenesis through bone transport that closely corresponds to the clinical use of bone transport in humans. We also applied injection angiography to study the arterial response of a limb undergoing bone transport. This model includes a proximal osteotomy and bone transport to fill in a segmental tibial diaphyseal defect. Regenerate bone formed well in the gap that was created that trailed the transport segment, and slow healing at the docking site was observed, as seen in humans. The angiographic techniques clearly revealed, by radiography and anatomic dissection, the arterial response to bone transport. The results showed that the transport segment had an arterial supply after osteotomy and after transport. They also demonstrated an extensive increase in vessels in limbs that had undergone distraction osteogenesis, an observation made clinically in humans but not well demonstrated experimentally. Furthermore, angiography showed proximal stretching and distal kinking of the major artery of the leg. This model closely resembles distraction osteogenesis through bone transport in humans and definitively demonstrates that the transport segment can maintain blood supply and remain viable during the transport process. The results of this study provide a basis for further work on factors that enhance and interfere with successful bone transport in humans.

Long bone reconstruction using multilevel lengthening of bone defect fragments

“…Bone regeneration took a longer time but the process was adaptive. A number of previous experiments had also shown the importance of blood supply for bone regeneration and osteogenic potential of bone plasty but the conditions of experiments were different [16,17]. As for clinical situations, some surgeons use bone transport over intramedullary nail to avoid wearing an external fixator for a long time during defect repair but the combination cannot accelerate distraction osteogenesis [8,9,15].…”

Bone consolidation is enhanced by rhBMP‐2 in a rabbit model of distraction osteogenesis

“…The rabbit model of leg lengthening is a well-established model of distraction osteogenesis and has been used extensively to study various aspects of bone regeneration during distraction osteogenesis [6,7,11,[13][14][15][16]23,30]. Previous reports using this model have shown that the optimal rate of lengthening is between 0.7 and 1.3 mm, twice daily lengthening [14,16].…”

Mid-tibial distraction osteogenesis redistributes bone blood flow

“…This result is surprising and conflicts with previous research in this field. In previous studies, the angiogenic effects of distraction have been assessed by capillary density in the surrounding soft tissues (Shevtsov et al 1995, Rowe et al 1999, vascular casting of the regenerate (Choi et al 2000), histological changes in bone and soft tissues (Ilizarov 1989), arteriography (Mosheiff et al 1996, DeCoster et al 1999, and Doppler analysis of tibial and femoral arterial flows (Gil-Albarova et al 1997). These studies give evidence of increased blood flow in the soft tissues of the distracted extremity, but no evidence of increased bone blood flow.…”

“…Evidence of such an increase, however, remains weak. Proxy-parameters for blood flow such as Tc-scintigraphy, angiograms, morphological changes in blood vessels, capillary counting, and vascular casting have indicated increases in bone blood flow (Ilizarov 1989, Aronson 1994, Shevtsov et al 1995, Gil-Albarova et al 1997, DeCoster et al 1999, Rowe et al 1999, Choi et al 2000. These parameters may correlate well with the actual bone blood flow under ideal conditions, but not necessarily under conditions of inflammation and new bone formation.…”