CAJ | 학술논문

目的观察多孔中空人工股骨柄假体周围骨床骨质经界面长入金属空腔及其在腔室内成骨的特征,比较腔内复合骨诱导因子(rhBMP-2)与自身骨长入的成骨差异.方法健康成年杂交犬18条,随机分3组,行单侧人工全髋关节置换术,术后摄X线片.所有股骨柄假体(CoCrMo合金)近1/2表面均为羟基磷灰石涂层.A组股骨侧植入实心假体,为对照组;B组在中空假体腔室内填塞股骨头颈及处理股骨近端髓腔时获得的松质骨;C组于腔室内填入复合5 mg rhBMP-2的胶原蛋白海绵.各组分别随机抽取2犬,于术后2、4、8个月处死取材,复查股骨近段X线片,不脱钙骨切片行界面和腔窒带假体组织学观察及骨形态计量学分析.结果 X线显示术后4个月C组假体中空部分周围骨床骨质密度明显较高.组织学观察C组近端假体一骨界面及腔窜内早期成骨速度明显快于A组和B组.假体植入后2、4个月时,C组的界面骨结合率明显高于另外两组(P<0.05),腔室内骨长入率也明显高于B组(P<0.05),但植入8个月后差异无统计学意义(P0.05).A、B两组之间的骨结合率差异无统计学意义(P0.05).结论界面骨质町经孔洞长人中空金属假体腔室内,使假体与其周围骨床达成相对"一体化"结合.腔内复合rhBMP-2可有效促进早期假体一骨界面的骨结合及向假体腔室内的骨长入,为人类多孔中空股骨柄假体的研制和临床应用提供了可靠的实验依据.
목적 관찰다공중공인공고골병가체주위골상골질경계면장입금속공강급기재강실내성골적특정,비교강내복합골유도인자(rhBMP-2)여자신골장입적성골차이.방법 건강성년잡교견18조,수궤분3조,행단측인공전관관절치환술,술후섭X선편.소유고골병가체(CoCrMo합금)근1/2표면균위간기린회석도층.A조고골측식입실심가체,위대조조;B조재중공가체강실내전새고골두경급처리고골근단수강시획득적송질골;C조우강실내전입복합5 mg rhBMP-2적효원단백해면.각조분별수궤추취2견,우술후2、4、8개월처사취재,복사고골근단X선편,불탈개골절편행계면화강질대가체조직학관찰급골형태계량학분석.결과 X선현시술후4개월C조가체중공부분주위골상골질밀도명현교고.조직학관찰C조근단가체일골계면급강찬내조기성골속도명현쾌우A조화B조.가체식입후2、4개월시,C조적계면골결합솔명현고우령외량조(P<0.05),강실내골장입솔야명현고우B조(P<0.05),단식입8개월후차이무통계학의의(P0.05).A、B량조지간적골결합솔차이무통계학의의(P0.05).결론 계면골질정경공동장인중공금속가체강실내,사가체여기주위골상체성상대"일체화"결합.강내복합rhBMP-2가유효촉진조기가체일골계면적골결합급향가체강실내적골장입,위인류다공중공고골병가체적연제화림상응용제공료가고적실험의거.
Objective To study hone formation and osteointegration at the interface and inside the hollow porous femoral porsthesis filled with recombinant human bone morphogentic protein-2 (rhBMP-2). Methods 18 health adult hybrid dogs were divided into 3 groups randomly. Each animal received total hip arthroplasty at right hip joint. The femoral stems implanted were solid center prosthesis (group A), hollow porous prosthesis filled with cancellous bone taken from the femur head and neck (group B), and hollow porous prosthesis filled with gelfoam and 5 mg rhBMP-2(group C), respectively. All prosthesis were made of CoCrMo alloy with hydroxyapatite coating at the proximal half. The animals were sacrificed at 2,4,8 months post operation and X-ray of the femur samples were taken. The histological changes, interface osseointega- tion rate and bone ingrowth rate round and inside prosthesis were evaluated. Results The bone formation of group C was faster than group A and B histologically. The interface osteointegration rate of group C was sig- nificantly higher than that of group A and B (P< 0.05) at 2, 4 months, but there was no significantly differ- ence between them at 8 months (P 0.05). Also the bone ingrowth rate of group C was higher than that of group B(P<0.05), but no significant difference at 8 months(P 0.05). There was nosignificant difference be- tween goup A and B at interface osteointegration rate. Conclusion The hollow porous femoral prosthesis filled with rhBMP-2 can enhance interface osteointegration and bone ingrowth effectively, which can make the prosthesis fast fixed in the bone bed right at the early stage. And this may provide reliable experimental evidence for developing a kind of hollow porous femoral prosthesis for human.