Greis P E, Kang J D, Silvaggio V, Rubash H E
Ferguson Laboratory for Orthopaedic Research, University of Pittsburgh, Pennsylvania.
Clin Orthop Relat Res. 1992 Jan(274):47-59.
When performing primary and revision total hip arthroplasty (THA), bone defects are often encountered. At present, grafting osseous defects with autogeneic bone is a common means of treatment. In this study, defects in bone were created in the femora and acetabula of dogs being treated with cementless THA with a fiber metal implant (Group A) or a hydroxyapatite tricalcium phosphate (HA/TCP) sprayed implant (Group B). The following methods of defect filling were compared: (1) leaving defects unfilled, (2) filling with autogeneic bone graft, (3) filling with a 50:50 mixture of autograft and a biphasic ceramic composed of HA/TCP, and (4) filling with a collagen-HA/TCP-bone marrow mixture. Analysis of defect healing and the extent of ingrowth into the overlying fiber metal, at defect sites and sites distant from defects, was made at six, 12, and 24 weeks postimplantation. Defect healing was enhanced at six and 12 weeks in all grafted groups when compared with ungrafted controls. Bone ingrowth into the porous fiber metal overlying the defects was not significantly affected by grafting the defects, compared with the ungrafted defects. The extent of bone ingrowth into the fiber metal acetabular implant at sites away from the defects increased during the entire study. In contrast, the extent of bone ingrowth on the femoral side was maximal at 12 weeks. The HA/TCP coating enhanced ingrowth into the acetabular component at 12 weeks, compared with the uncoated prosthesis, but did not enhance ingrowth on the femoral side. The data from this study demonstrate that defect healing is enhanced with graft materials. However, this does not necessarily result in increased ingrowth into porous surfaces overlying osseous defects. General bone ingrowth and ingrowth at defect sites at 12 weeks postimplantation can be enhanced on the acetabular side with the use of HA/TCP-sprayed implants. However, no positive effect is seen with the use of an HA/TCP-sprayed femoral implant.
在进行初次和翻修全髋关节置换术（THA）时，经常会遇到骨缺损。目前，用自体骨移植骨缺损是一种常见的治疗方法。在本研究中，对接受非骨水泥THA治疗的犬只，在其股骨和髋臼中制造骨缺损，植入纤维金属植入物（A组）或喷涂羟基磷灰石磷酸三钙（HA/TCP）的植入物（B组）。比较了以下骨缺损填充方法：（1）不填充缺损；（2）用自体骨移植填充；（3）用自体移植骨与由HA/TCP组成的双相陶瓷按50:50的混合物填充；（4）用胶原蛋白-HA/TCP-骨髓混合物填充。在植入后6周、12周和24周，对缺损愈合情况以及在缺损部位和远离缺损部位向覆盖的纤维金属内生长的程度进行分析。与未移植对照组相比，所有移植组在6周和12周时缺损愈合得到增强。与未移植的缺损相比，移植缺损对覆盖缺损的多孔纤维金属内的骨生长没有显著影响。在整个研究过程中，远离缺损部位的纤维金属髋臼植入物内的骨生长程度增加。相比之下，股骨侧的骨生长程度在12周时最大。与未涂层假体相比，HA/TCP涂层在12周时增强了髋臼部件内的骨生长，但在股骨侧没有增强骨生长。本研究的数据表明，移植材料可增强缺损愈合。然而，这不一定会导致向骨缺损上方多孔表面的内生长增加。使用喷涂HA/TCP的植入物，在植入后12周时，髋臼侧的一般骨生长和缺损部位的骨生长可得到增强。然而，使用喷涂HA/TCP的股骨植入物未见积极效果。
