Heekin R D, Engh C A, Vinh T
Anderson Orthopaedic Research Institute, Arlington, VA 22206, USA.
Clin Orthop Relat Res. 1995 Oct(319):184-90.
Contained acetabular defects often are repaired at revision surgery using morselized bone allograft. The extent to which this graft becomes incorporated is unknown, and the value of radiographs for predicting allograft incorporation is unclear. To better understand the effectiveness of morselized allograft in revision hip arthroplasty, the authors studied postmortem specimens from 3 patients treated with this type of graft. Histologic analysis of acetabular components in situ for 18 months showed allograft fragments invested with loose myxofibrous tissue. Vascularized tissue had penetrated the allograft fragments to a depth of 4 mm. In peripheral areas, the vascularized ingrowth was accompanied by partial osteoclastic resorption of graft trabeculae and application of living bone to allograft fragments. After 53 months in situ, graft fragments had remodeled and showed progressive vascular ingrowth. By 83 months, the graft almost completely had incorporated. Morselized allograft bone is useful for restoring bone deficiency within contained acetabular defects. The graft does incorporate, but the extent of graft incorporation cannot be predicted accurately by postoperative radiographs.
髋臼包容型骨缺损在翻修手术中常采用颗粒状同种异体骨移植修复。这种移植骨的融合程度尚不清楚，且X线片预测同种异体骨融合的价值也不明确。为了更好地了解颗粒状同种异体骨在髋关节翻修术中的有效性，作者研究了3例接受此类移植治疗患者的尸体标本。对髋臼假体原位进行18个月的组织学分析显示，移植骨碎片被疏松的黏液纤维组织包裹。血管化组织已穿透移植骨碎片达4毫米深度。在周边区域，血管长入伴随着移植骨小梁的部分破骨细胞吸收以及新生骨贴附于移植骨碎片。原位53个月后，移植骨碎片发生重塑，显示出渐进性的血管长入。到83个月时，移植骨几乎完全融合。颗粒状同种异体骨有助于修复髋臼包容型骨缺损中的骨量不足。移植骨确实会融合，但术后X线片无法准确预测移植骨的融合程度。
