Efficacy of Combined Therapy of Periosteum and Bone Allograft in a Critical-Sized Defect Model in New Zealand White Rabbits

Abstract

BackgroundLarge segmental bone defects caused by trauma, infection, or bone tumor resection are difficult to cure and have been a problem in the field of bone repair for decades. The objective of this study was to discuss the efficacy of combined therapy of free periosteum and bone allograft in treating bone defects and to provide a theoretical basis for clinical application of this therapy.Material/MethodsA unilateral tibia cortical defect model in New Zealand white rabbits was established according to Girolamo method. Total 48 rabbits were randomized into 3 groups: a simple bone defect group (n=16), an autogenous bone graft group (n=16), and a periosteum and bone allograft combined therapy group (n=16). The efficacy was evaluated by imaging inspections and scoring, HE staining, and RT-PCR in postoperative weeks 2, 4, 8, and 12.ResultsThe results of imaging and histopathological inspections in the study indicated that in postoperative weeks 4, 8, and 12 the experimental and control groups had statistically significant differences in Lane-Sandhu radiographic scoring and relative bone density when compared with the simple bone defect group (P<0.05). The RT-PCR results suggested that the expression of SPP-1, BMP-2, and VEGF in the experimental group was higher than in the control group (P<0.05) and the expression of Col Iα1 in the control group was higher than in the experimental group (P<0.05).ConclusionsEfficacies of the combined therapy (periosteum combined with bone allografting) and the criterion standard therapy (autogenous bone grafting) are equivalent in treating bone defects in New Zealand white rabbits.

Autogenous bone particles combined with platelet‑rich plasma can stimulate bone regeneration in rabbits

“…ii) Reparative phase (callus formation), in areas closer to the well-vascularized healthy bone tissue, osteogenic cells differentiate into osteoblasts, which produce spongy bone trabeculae, this stage lasts ~4-8 weeks. iii) Remodeling phase, this is the final phase of healing, where compact bone replaces spongy bone around the periphery of the fracture site, this stage lasts ~8-12 weeks ( 23 ). Therefore, 4, 8 and 12 weeks were chosen as the time points assessed in the present study; this is consistent with other studies ( 23 , 24 ).…”

“…An X-ray device (45 kV, 100 mA, 0.12 sec; Siemens 1350; Siemens AG) was used to investigate the bone-healing process. X-ray scoring was performed according to the Lane-Sandhu standards ( Table I ) ( 23 ), including bone connection, recanalization of the medullary cavity and bone formation in the bone defect area, which were scored by three independent examiners. The images were captured three per group at three time points.…”

“…The Lane-Sandhu score of each image was the sum of sub-parts of the scoring standard. The mean of the scores given by the three observers were accepted to be the final score ( 23 ).…”

Periosteum: Functional Anatomy and Clinical Application

“…Bone allograft is usually used to replace bone defects due to its size and shape, but it usually resulted in junctional nonunion and bone fracture (88). The utilisation of periosteal transplantation on allograft surgery have been reported in several experimental and clinical studies (53,(89)(90)(91). Karaoglu et al (89) demonstrated that demineralized deep-frozen allograft covered with non-vascularised periosteum resulted in rapid and high quality ossification it was reported that bone allograft wrapped with non-vascularised periosteal graft have similar efficacy with standard treatment using autogenous bone graft transfer for the repair of bone defects in rabbits (90).…”

“…The utilisation of periosteal transplantation on allograft surgery have been reported in several experimental and clinical studies (53,(89)(90)(91). Karaoglu et al (89) demonstrated that demineralized deep-frozen allograft covered with non-vascularised periosteum resulted in rapid and high quality ossification it was reported that bone allograft wrapped with non-vascularised periosteal graft have similar efficacy with standard treatment using autogenous bone graft transfer for the repair of bone defects in rabbits (90). Likewise, a study by Santić et al (57) revealed better bone healing in tibial defect of rabbits that were treated with allogenous bone graft covered with vascularised periosteal graft, compared to their counterparts that received allogenous bone graft with non-vascularised periosteal graft (85).…”