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Journal of Zhejiang University SCIENCE B

ISSN 1673-1581(Print), 1862-1783(Online), Monthly

Treatment of large bone defects in load-bearing bone: traditional and novel bone grafts

Abstract: Large bone defects in load-bearing bone can result from tumor resection, osteomyelitis, trauma, and other factors. Although bone has the intrinsic potential to self-repair and regenerate, the repair of large bone defects which exceed a certain critical size remains a substantial clinical challenge. Traditionally, repair methods involve using autologous or allogeneic bone tissue to replace the lost bone tissue at defect sites, and autogenous bone grafting remains the “gold standard” treatment. However, the application of traditional bone grafts is limited by drawbacks such as the quantity of extractable bone, donor-site morbidities, and the risk of rejection. In recent years, the clinical demand for alternatives to traditional bone grafts has promoted the development of novel bone-grafting substitutes. In addition to osteoconductivity and osteoinductivity, optimal mechanical properties have recently been the focus of efforts to improve the treatment success of novel bone-grafting alternatives in load-bearing bone defects, but most biomaterial synthetic scaffolds cannot provide sufficient mechanical strength. A fundamental challenge is to find an appropriate balance between mechanical and tissue-regeneration requirements. In this review, the use of traditional bone grafts in load-bearing bone defects, as well as their advantages and disadvantages, is summarized and reviewed. Furthermore, we highlight recent development strategies for novel bone grafts appropriate for load-bearing bone defects based on substance, structural, and functional bionics to provide ideas and directions for future research.

Key words: Bone graft; Bone scaffold; Biomaterial; Load-bearing bone defect; Osseointegration; Osteoconductivity

Chinese Summary  <15> 承重骨大段骨缺损的治疗:传统与新型骨移植材料

余丹1,2, 沈文怡1,2, 戴家慧1,2, 朱慧勇1,2
1浙江大学医学院第一附属医院口腔颌面外科, 中国杭州市, 310003
2浙江大学医学院口腔医学系, 中国杭州市, 310058
摘要:因严重创伤、肿瘤、囊肿以及广泛感染等原因造成的承重骨缺损是临床上常见的疾病。尽管骨具有自我修复和再生的潜能,但超过临界尺寸的大段骨缺损的修复仍是极大的临床挑战。传统的修复方法是使用自体骨或同种异体骨移植替代缺损部位缺失的骨组织,其中自体骨移植至今仍然是临床治疗的"金标准"。然而,传统骨移植材料的应用受到可获取骨量、供区并发症和免疫排斥等缺点的限制。近年来,临床对骨移植替代物的需求推动了新型骨移植材料的发展。除关注骨传导性和骨诱导性外,力学性能的优化是近年来增强新型骨移植材料治疗承重骨缺损可行性的重点。但大多数生物材料支架尚不能提供足够的力学强度。目前研究面临的核心挑战在于如何在机械需求和组织再生需求间找到适当的平衡。本文就传统和新型骨移植材料在承重骨缺损中的应用及其优缺点进行综述,并重点介绍了基于材料、结构和功能仿生的新型骨移植物发展策略,以期为未来的研究提供新的思路和方向。

关键词组:骨移植;骨支架;生物材料;承重骨缺损;骨整合;骨传导性


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DOI:

10.1631/jzus.B2300669

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On-line Access:

2025-05-28

Received:

2023-09-19

Revision Accepted:

2024-01-10

Crosschecked:

2025-05-29

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