Division of Orthopaedic Surgery, Faculty of Medicine, McGill University, Montreal, QC, Canada.
Clin Orthop Relat Res. 2012 Feb;470(2):357-65. doi: 10.1007/s11999-011-2011-y.
Noncemented revision arthroplasty is often complicated by the presence of bone implant gaps that reduce initial stability and biologic fixation. Demineralized bone matrix has osteoinductive properties and therefore the potential to enhance gap healing and porous implant fixation.
QUESTIONS/PURPOSES: We determined at what times and to what extent demineralized bone matrix promotes gap healing and bone ingrowth around a porous implant.
We inserted porous titanium implants into the proximal metaphyses of canine femora and humeri, with an initial 3-mm gap between host cancellous bone and implants. We left the gaps empty (control; n = 12) or filled them with either demineralized bone matrix (n = 6) or devitalized demineralized bone matrix (negative control; n = 6) and left them in situ for 4 or 12 weeks. We quantified volume healing of the gap with new bone using three-dimensional micro-CT scanning and quantified apposition and ingrowth using backscattered scanning electron microscopy.
The density of bone inside gaps filled with demineralized bone matrix reached 64% and 93% of surrounding bone density by 4 and 12 weeks, respectively. Compared with empty controls and negative controls at 4 and 12 weeks, gap healing using demineralized bone matrix was two to three times greater and bone ingrowth and apposition were up to 15 times greater.
Demineralized bone matrix promotes rapid bone ingrowth and gap healing around porous implants.
Demineralized bone matrix has potential for enhancing implant fixation in revision arthroplasty.
非骨水泥翻修关节置换术常因存在骨-植入物间隙而变得复杂，这些间隙会降低初始稳定性和生物固定。脱矿骨基质具有成骨诱导特性，因此有可能增强间隙愈合和多孔植入物固定。
问题/目的：我们确定脱矿骨基质在何时以及在何种程度上促进多孔植入物周围的间隙愈合和骨内生长。
我们将多孔钛植入物插入犬股骨和肱骨的近干骺端，宿主松质骨和植入物之间最初有 3mm 的间隙。我们让间隙保持空（对照组，n=12）或用脱矿骨基质（n=6）或去细胞脱矿骨基质（阴性对照组，n=6）填充，并将其原位放置 4 或 12 周。我们使用三维微 CT 扫描定量测量新骨填充间隙的愈合体积，并使用背散射电子显微镜定量测量骨沉积和骨内生长。
用脱矿骨基质填充的间隙内的骨密度在 4 周和 12 周时分别达到周围骨密度的 64%和 93%。与 4 周和 12 周时的空对照组和阴性对照组相比，使用脱矿骨基质的间隙愈合程度增加了两到三倍，骨内生长和骨沉积增加了 15 倍。
脱矿骨基质可促进多孔植入物周围的快速骨内生长和间隙愈合。
脱矿骨基质具有增强翻修关节置换术中植入物固定的潜力。
