Bauer T W, Muschler G F
Department of Pathology, Cleveland Clinic Foundation, OH 44195, USA.
Clin Orthop Relat Res. 2000 Feb(371):10-27.
Autograft, allograft, and synthetic bone graft substitute materials play an important role in reconstructive orthopaedic surgery, and understanding the biologic effects of these materials is necessary for optimum use. Although vascularized and cancellous autograft show optimum skeletal incorporation, host morbidity limits autograft availability. Experimental studies have confirmed an immune response to allograft bone, but the clinical significance of this response in humans still is unclear. Small amounts of cancellous allograft in humans usually are remodeled completely; large allografts become incorporated by limited, surface intramembranous bone formation suggesting that these graft are primarily osteoconductive. Several synthetic skeletal substitute materials also are osteoconductive, and may show remodeling characteristics similar to allograft. Demineralized bone matrix and some isolated or synthetic proteins can induce endochondral bone formation, and therefore are osteoinductive. The extent and distribution of remodeling of bone graft materials are influenced by many factors, including the quality of the host site and the local mechanical environment (strain). Graft materials are likely to become more specialized for use in specific clinical applications, and composite preparations may soon provide bone graft materials with efficacy that equals or exceeds that of autogenous grafts.
自体骨移植、异体骨移植和合成骨移植替代材料在骨科重建手术中发挥着重要作用，了解这些材料的生物学效应对于其最佳应用至关重要。尽管带血管蒂的松质骨自体移植显示出最佳的骨整合效果，但供区并发症限制了自体骨的可用性。实验研究已证实对异体骨存在免疫反应，但这种反应在人类中的临床意义仍不明确。人类少量的松质骨异体移植通常会完全重塑；大型异体骨通过有限的表面膜内骨形成而融合，这表明这些移植主要是骨传导性的。几种合成骨替代材料也具有骨传导性，并且可能表现出与异体骨相似的重塑特征。脱矿骨基质和一些分离的或合成的蛋白质可诱导软骨内骨形成，因此具有骨诱导性。骨移植材料重塑的程度和分布受许多因素影响，包括宿主部位的质量和局部力学环境（应变）。移植材料可能会在特定临床应用中变得更加专业化，复合制剂可能很快会为骨移植材料提供等同于或超过自体移植的疗效。
