Rhinelander F W, Nelson C L, Stewart R D, Stewart C L
Clin Orthop Relat Res. 1979 Jun(141):74-89.
The technique of microangiography and correlated histology was used, in experiments on the proximal femora of mature mongrel dogs, to study the effects of simple medullary reaming and of reaming followed by insertion of acrylic cement. The hip joints were not disturbed. A segment of Steinmann pin, representing the stem of a hip prosthesis, was inserted into the cement as it was polymerizing. The most significant results, after reaming alone, were devascularization and apparent necrosis of large areas of the cortex of the subtrochanteric femoral diaphysis. Full recovery was observed in 6 months. However, when acrylic cement was introduced following the reaming, extensive necrosis of the inner layers of the diaphyseal cortex was still present after a year, when the observations were terminated. The presence of necrosis of bone was judged by the lack of visible osteocytes in the lacunae. After the devascularization caused by filling the diaphyseal medulla with acrylic cement, the apparently necrotic cortex was revitalized without osteoclasia. That is in contrast to the results in another study in which osteoclasia and osteoneogenesis were required to restore cortex with empty cell lacunae. This raises the question of dormant osteonecrosis in contrast to total osteonecrosis. These studies show, in thin histologic preparations, acrylic bone cement in situ in the tissues. A fibrous membrane was found at the cement-bone interface in most areas. It was thicker in the diaphysis than in the metaphysis. The physiologic effects of acrylic cement implantation are considered to be likely factors in the loosening which is observed clinically when the femoral components of hip prostheses are under protracted stress.
采用微血管造影术及相关组织学技术，在成年杂种犬股骨近端进行实验，以研究单纯髓腔扩髓以及扩髓后植入丙烯酸骨水泥的效果。髋关节未受干扰。在骨水泥聚合时，将一段代表髋关节假体柄的斯氏针插入其中。单独扩髓后，最显著的结果是股骨转子下骨干皮质的大片区域出现血管减少和明显坏死。6个月后观察到完全恢复。然而，在扩髓后引入丙烯酸骨水泥时，观察终止时，即1年后，骨干皮质内层仍存在广泛坏死。骨坏死的存在通过陷窝中可见骨细胞的缺失来判断。在用丙烯酸骨水泥填充骨干髓腔导致血管减少后，明显坏死的皮质在没有破骨细胞作用的情况下恢复活力。这与另一项研究结果形成对比，在该研究中，需要破骨细胞作用和成骨作用来修复有空细胞陷窝的皮质。这就提出了与完全性骨坏死相对的潜伏性骨坏死的问题。这些研究在薄组织学切片中显示了组织中原位的丙烯酸骨水泥。在大多数区域，在骨水泥 - 骨界面发现了一层纤维膜。骨干处的纤维膜比干骺端处的更厚。丙烯酸骨水泥植入的生理效应被认为可能是临床上观察到髋关节假体股骨部件长期受力时出现松动的因素。
