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翻修全髋关节置换术中髋臼重建的骨移植、骨移植增强剂、替代物及促进剂

Bone grafts, bone graft extenders, substitutes and enhancers for acetabular reconstruction in revision total hip arthroplasty.

作者信息

Pierannunzii Luca, Zagra Luigi

机构信息

Gaetano Pini Orthopedic Institute, Milan, Italy.

IRCCS Galeazzi Orthopedic Institute, Milan, Italy

出版信息

EFORT Open Rev. 2017 Mar 13;1(12):431-439. doi: 10.1302/2058-5241.160025. eCollection 2016 Dec.

Abstract

Acetabular bone loss is a relevant concern for surgeons dealing with a failed total hip arthroplasty.Since the femoral head is no longer available, allografts represent the first choice for most reconstructive solutions, either as a structural buttress or impacted bone chips.Even though fresh-frozen bone is firmly recommended for structural grafts, freeze-dried and/or irradiated bone may be used alternatively for impaction grafting. Indeed, there are some papers on freeze-dried or irradiated bone impaction grafting, but their number is limited, as is the number of cases.Xenografts do not represent a viable option based on the poor available evidence but bioactive bioceramics such as hydroxyapatite and biphasic calcium phosphates are suitable bone graft extenders or even substitutes for acetabular impaction grafting.Bone-marrow-derived mesenchymal stem cells and demineralised bone matrix seem to act as reliable bone graft enhancers, i.e. adjuvant therapies able to improve the biological performance of standard bone grafts or substitutes. Among these therapies, platelet-rich plasma and bone morphogenetic proteins need to be investigated further before any recommendations can be made. Cite this article: 2016;1:431-439. DOI:10.1302/2058-5241.160025.

摘要

髋臼骨缺损是髋关节置换失败的外科医生所面临的一个重要问题。由于股骨头已无法使用,同种异体骨移植成为大多数重建方案的首选,既可以作为结构性支撑物,也可以作为打压植骨的骨碎片。尽管强烈推荐使用新鲜冷冻骨进行结构性植骨,但冻干骨和/或辐照骨也可用于打压植骨。实际上,有一些关于冻干骨或辐照骨打压植骨的文献,但数量有限,病例数也不多。基于现有证据不足,异种骨移植不是一个可行的选择,但生物活性生物陶瓷,如羟基磷灰石和双相磷酸钙,是合适的骨移植增强剂,甚至可替代髋臼打压植骨。骨髓间充质干细胞和脱矿骨基质似乎是可靠的骨移植增强剂,即能够改善标准骨移植或替代物生物学性能的辅助治疗方法。在这些治疗方法中,富血小板血浆和骨形态发生蛋白在提出任何建议之前都需要进一步研究。引用本文:2016;1:431 - 439。DOI:10.1302/2058 - 5241.160025。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/fa65/5367522/c604d79f767f/eor-1-431-g001.jpg

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