Stevenson S, Emery S E, Goldberg V M
Department of Orthopaedics, Case Western Reserve University, Cleveland, OH, 44106-5043, USA.
Clin Orthop Relat Res. 1996 Mar(324):66-74. doi: 10.1097/00003086-199603000-00009.
Successful graft incorporation requires that an appropriate match be made among the biologic activity of a bone graft, the condition of the perigraft environment, and the mechanical environment. The authors have studied, in a wide variety of animal models, the factors that affect the main components of bone graft incorporation: revascularization, new bone formation, and host-graft union. The principal determinant of the rate, pattern, and amount of revascularization is the presence or absence of a vascular pedicle. The nonvascularized bone graft is entirely dependent on the surrounding tissue for its revascularization, which results in a noticeable delay in vessel ingrowth. The principal determinant of the rate and amount of new bone formation on, in, or about a bone graft is the presence or absence of living, histocompatible, committed bone-forming cells. When living cells are not part of the graft at the time of implantation, the cells that form new bone are derived from host tissues, and new bone formation is delayed. The principal determinants of host-graft union are stability of the construct and contact between host bone and the graft. Factors that slow or inhibit all of these processes are reduction of the biologic activity of the graft by freezing or some other treatment, histocompatibility antigen disparities between donor and recipient, mechanical instability between the graft and the perigraft environment, and local and systemic interference with the biologic activity of the graft and surrounding tissue, for example, by irradiation or the administration of cisplatin. The task of the clinician who does a bone grafting procedure is to choose the right graft or combination of grafts for the biologic and mechanical environment into which the graft will be placed.
成功的移植物融合要求在骨移植物的生物活性、移植物周围环境状况和力学环境之间进行适当匹配。作者在多种动物模型中研究了影响骨移植物融合主要成分的因素：血管再生、新骨形成和宿主与移植物的结合。血管再生的速度、模式和数量的主要决定因素是有无血管蒂。无血管蒂的骨移植物完全依赖周围组织进行血管再生，这导致血管长入明显延迟。骨移植物上、内部或周围新骨形成的速度和数量的主要决定因素是有无有活力的、组织相容性良好的、定向成骨细胞。当植入时活细胞不是移植物的一部分时，形成新骨的细胞来源于宿主组织，新骨形成会延迟。宿主与移植物结合的主要决定因素是结构的稳定性以及宿主骨与移植物之间的接触。减缓或抑制所有这些过程的因素包括通过冷冻或其他处理降低移植物的生物活性、供体和受体之间的组织相容性抗原差异、移植物与移植物周围环境之间的力学不稳定，以及例如通过辐射或给予顺铂对移植物和周围组织生物活性的局部和全身干扰。进行骨移植手术的临床医生的任务是为移植物将要植入的生物和力学环境选择合适的移植物或移植物组合。
