Grundel R E, Chapman M W, Yee T, Moore D C
Department of Orthopedic Surgery, University of California, Davis, Sacramento 95817.
Clin Orthop Relat Res. 1991 May(266):244-58.
The purpose of this study was to evaluate a porous biphasic hydroxyapatite-calcium phosphate ceramic as a modifier and extender of an autogeneic marrow graft for filling a 2.5-cm segmental bony defect. Twenty adult mongrel dogs were surgically treated to create diaphyseal defects in the left ulnae. The defects were (1) filled with autogeneic bone marrow mixed with granular hydroxyapatite-tricalcium phosphate ceramic (granular ceramic); (2) grafted with a solid block of ceramic soaked in autogeneic bone marrow (block ceramic); (3) received no graft (no implant); or (4) were grafted with autogeneic bone marrow alone (bone marrow). All animals were followed clinically and roentgenographically for 24 weeks and then killed. Repair of diaphyseal defects with the block ceramic led to three solid unions and three fibrous unions; with the granular ceramic implants and marrow, the defects of five dogs formed solid unions, and one progressed to a fibrous union. Defects in all five dogs grafted with autogeneic bone marrow united. The three dogs with no implant formed nonunions. Histology showed normal marrow and only a light immune reaction. Complete bridging of the defect in the dogs treated with the granular ceramic occurred significantly earlier than bridging in the dogs grafted with bone marrow alone. Histomorphometry, performed on the block ceramic implants indicated active resorption of ceramic. Clinically, addition of ceramic to a marrow graft improved the handling characteristics of the graft material and accelerated healing according to roentgenographic evaluation.
本研究的目的是评估一种多孔双相羟基磷灰石 - 磷酸钙陶瓷作为自体骨髓移植物的改性剂和增量剂，用于填充2.5厘米的节段性骨缺损。对20只成年杂种犬进行手术，在其左尺骨制造骨干缺损。缺损处分别：（1）填充自体骨髓与颗粒状羟基磷灰石 - 磷酸三钙陶瓷（颗粒状陶瓷）的混合物；（2）植入浸泡在自体骨髓中的固体陶瓷块（块状陶瓷）；（3）不进行移植（无植入物）；或（4）仅移植自体骨髓（骨髓）。所有动物均接受临床和X线检查随访24周，然后处死。使用块状陶瓷修复骨干缺损导致3处牢固愈合和3处纤维性愈合；使用颗粒状陶瓷植入物和骨髓时，5只犬的缺损形成牢固愈合，1只进展为纤维性愈合。所有5只移植自体骨髓的犬的缺损均愈合。3只无植入物的犬形成骨不连。组织学显示骨髓正常，仅有轻度免疫反应。使用颗粒状陶瓷治疗的犬缺损完全桥接明显早于仅移植骨髓的犬。对块状陶瓷植入物进行的组织形态计量学表明陶瓷有活跃吸收。临床上，根据X线评估，在骨髓移植物中添加陶瓷可改善移植物材料的操作特性并加速愈合。
