recuperarea defectului de dimensiune critică al osului parietal la

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  • Nr.6 (306), 2008

    66

    cilor de familie n depistarea persoanelor cu factori de risc (cardiovascular i diabet zaharat de tipul 2 componente ale SM), ntru luarea msurilor preventive precoce, din motivul c acetia sunt factori de risc modificabili.

    Bibliografie1. ACE. American College of Endocrinology Task Force on the Insulin Resistance

    syndrome: American College of Endocrinology Position Statement on the Insulin Resistance Syndrome, in Endocr. Pract., 2003:236-252.

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    Ghenadie Curocichin, dr., confereniarCatedra Medicina de FamilieUSMF Nicolae TestemianuClinica Universitar de Asisten Medical PrimarMD-2004 ChiinuStr. 31 august 1989, 137A, of. 302Tel/fax: 205226E-mail: [email protected] ; [email protected]

    Recepionat 03.09.2008

    Recuperarea defectului de dimensiune critic al osului parietal la iepure prin grefe compozite

    V. Nacu

    Laboratorul Inginerie Tisular i Culturi Celulare, Catedra Chirurgie Operatorie i Anatomie Topografic Catedra Ortopedie, Traumatologie i Chirurgie n Campanie, USMF Nicolae Testemianu

    Critical Rabbit Parietal Bone Defect Reconstruction by Composite GraftsThe aim of the study was to evaluate grafts containing autogenous bone marrow cells or allogenous cord blood cells with allogenic demineralized

    bone or collagen sponge to stimulate bone formation in critical rabbit parietal bone defects. The experimental research was carried out on 40 adult male rabbits 12-13 months old. The animals were divided into four experimental groups: the first as control injected with a nutritional medium; the second collagen sponge with autologus bone marrow cells; the third decalcified bone matrix and allogenous umbilical cord blood cells; the fourth morselized autogenous cortico-cancelous bone from the iliac crest. The ability of morphoinductive grafts to stimulate bone formation in the parietal bone defect was evaluated histologically, radiologically and by the use of Computed Tomography at 15, 30, 60, 120 and 180 days after surgery. The treatments given to Group 2 combination grafts of collagen sponge with autologus bone marrow cells and to Group 3 decalcified bone matrix with allogenous umbilical cord blood cells were both shown to promote the healing process in critical parietal bone defects. Pending future research these materials may be found to be alternatives for use in the reconstruction of bone defects in the cranial vault. Compared to autogenous cancelous bone these materials are more compatible with the recipients and provide active and uniform osteogenesis in the bone defect.

    ey words: bone marrow cells, cord blood cells, bone regeneration.

  • 67

    STUDII CLINICO-TIINIFICE

    IntroducereEste cunoscut faptul c oasele bolii craniene dispun de

    capaciti minore de regenerare la diferite animale, inclusiv la om, la care se consider c procesul reparator osos e totalmente stagnat n caz de defecte ale oaselor bolii craniului [1, 10].

    Regiunea craniofacial este specific din punct de vedere anatomic i estetic, ceea ce face ca ingineria tisular, grefarea n aceat regiune s reprezinte unele probleme specifice ei [2]. Se tie c defectele oaselor bolii craniene nu regenereaz spontan i necesit plastie cu auto-, alo-, xenogrefe sau cu implanturi din diferite materiale (titan, aur, platin, materiale din plastic etc.). De asemenea, sunt anumite cerine vizavi de materialele utilizate pentru substituirea acestor defecte: a) materialele utilizate, cu sau fr componente biologice, trebuie sa fie apte de a-i ndeplini funcia de protecie acolo unde sunt plasate; b) grefele utilizate necesit s fie compatibile cu esuturile recipientului, capabile s se adapteze n regiunea plasat i chiar s creasc sau s fie nlocuite cu un esut propriu de calitate corespunztoare [6].

    Obiectivele studiului vizat sunt de a stabili capacitatea de osteoformare a grefelor compozite: spongie de colagen cu autocelule osteomedulare; aloos demineralizat cu celule om-bilicale i autoosul morcelizat spongios din aripa osului iliac, n procesul de regenerare, n defect critic al osului parietal (os plat) la iepure i analiza comparativ a eficacitii utilizrii acestor materiale.

    Material i metodeStudiul experimental a fost efectuat pe 40 de animale

    experimentale mature, iepuri Shinshila, masculi, la care, sub anestezie general (intramuscular a fost administrat Calipsol + Seduxen (cte 50 mg/kg)) ulterior s-a produs, cu o frez, un defect circular cu diametrul de 10 mm care include grosimea integral (ambele lamele corticale) a osului parietal, fr a fi lezat pahimeningele cerebral. Ulterior, animalele au fost repartizate n 4 loturi experimentale: lotul I lotul-martor, n care, dup suturarea etan a esuturilor moi, defectul a fost su-plinit cu un mediu nutritiv DMEM (Dulbecco Modified Eagle Medium); lotul al II-lea a fost utilizat spongie de colagen i celule din mduv osoas (CMO); lotul al III-lea matrice osoas demineralizat (MOD) cu celule ombilicoplacentare (COP) i n lotul al IV-lea s-a folosit autoos morcelizat spon-gios din aripa osului iliac.

    Animalele au fost ntreinute n condiii similare, n conformitate cu cerinele Comisiei Naionale de Etic pentru studiul clinic al medicamentelor.

    Celulele osteomedulare i autoosul au fost obinute prin rezecia aripilor oaselor iliace, dup care, prin frmiare, s-a cptat osul corticospongios mrunit. A fost prelucrat corespunztor protocolului: tripsinizare cu sol. 0,25% de tripsin (Sigma), la 100C, i centrifugare la 800 de turaii. A fost obinut suspensia celular osteomedular care, ulterior, dup numrarea celulelor a fost plasat n cutii de cultur Petri (NUNC) cu diametrul de 60 mm, cantitatea de celule a constituit 0,25 x 106/ml i au fost cultivate pe mediu nutritiv DMEM cu 10% ser bovin fetal (SBF). Dup ce a fost obinut cantitatea necesar de celule i au fost create grefele compozite, animalelor li s-a realizat un defect n osul parietal, suplinit cu grefe, corespunztor loturilor experimentale. Dup intervenia chirurgical, animalele au fost excluse din experiment peste 15, 30, 60, 120, 180 de zile. Ele au fost eutanaziate prin ad-ministrarea intravenoas a 3 ml soluie de eter.

    Dup secionarea craniului, a fost colectat calota lui i pstrat n sol. Formol de 10%, pH 7,4. Pn la efectu-area seciunilor histologice, piesele anatomice au fost supuse investigaiilor radiologice i tomografiei computerizate. Ulterior, dup demineralizare au fost incluse n parafin i au fost efectuate seciuni cu grosimea de 5 mkm. Seciunile histologice au fost colorate cu hematoxilin-eozin, apoi supuse