Radiographic Comparison of the Osteogenic Effects of Bone Morphogenetic Protein-2, Platelet-rich Plasmaand Platelet-rich Fibrinin Canine Bone Defect Model

Abstract

Bone defect is an important clinical injury commonly happensinfracture, tumor, or infection. Recently, bone morphogenetic protein-2 (BMP-2), platelet-rich plasma (PRP)and platelet-rich fibrin (PRF)came into the spotlight for bone defect patients. The purpose of this study is to compare theosteogenic effects of BMP-2, PRP, and PRF more precisely by excluding all the other effect of growth factors from the bone marrow with radiographs and computed tomography (CT), and to evaluate their practicality in clinical practice. Two healthy mongrel dogs were used in this study. In the lateral diaphysis of humerus and femur of each dog, four bone defects(2.5 ㎜in diameter, 2 ㎜in depth)were made at intervals of 10 ㎜without invasion ofthe bone marrow cavity. BMP-2, PRP, PRF, and saline(control group)were applied randomly using absorbable collagen sponge as a scaffold(n=8 for each group). Osteogenic effects were evaluated with radiography and CTuntil the 8thweek after the surgery. BMP-2 showed significantly higher result than that of PRP and PRF in 4th to7thweekin radiographicscore while4thand6thweekin CT value.On 8thweek, CT valuesof the BMP-2were significantly higher than that of the control group, while not showing much difference compared to PRP and PRF. The results found out that BMP-2 showed strong osteogenic effect for a longer period of time, while PRP and PRF were only effective on early bone-healing stage.Inconclusion, BMP-2 is more effective than PRP or PRF in treating bone defect patients and it may possibly complement the limitations of the autograft.

골결손은골절, 종양, 감염등에의해흔히발생하는임상에서중요한손상이다.골형성단백질-2(BMP-2), 혈소판풍부혈장(PRP), 혈소판풍부섬유소(PRF)는골결손환자를위해사용되는방법으로최근연구들에서주목받고있다.본연구의목적은골수에들어있는성장인자의영향을배제하여더욱정확하게방사선촬영과, 컴퓨터단층촬영(CT)을통해BMP-2,PRP,PRF의골형성효과를비교하고, 이들의임상에서의실용성을평가하는것이다. 두마리의건강한잡종견을본연구에서사용하였다. 각실험견의상완과대퇴의외측골간피질에4개의결손을골수강을침범하지않게10 ㎜간격으로만들어주었다. 그후BMP-2, PRP, PRF, saline(대조군)을흡수성콜라겐스펀지를비계로사용하여무작위로결손부에적용하였다(n = 8).수술후8주까지방사선촬영과, CT를통해골형성효과를 평가하였다.4~7째주방사선촬영점수와, 4째주6째주CT값에서BMP-2가PRP, PRF보다유의적으로높은결과를보여주었다. 8째주에서는BMP-2의CT값이대조군과비교해유의적으로높은값을보여주었지만PRP,PRF는대조군과유의적인차이를보이지않았다. 본연구의결과BMP-2는PRP, PRF보다더긴기간높은골형성효과를보여주었다. 이러한결과를통해골결손환자를치료하기위한방법으로BMP-2가PRP,PRF보다더욱효과적이며, 자가골이식이가지고있는한계점들을보안해줄수있을것으로판단된다.