自体松质骨加骨玻璃植入治疗缺血性股骨头坏死——犬股骨头骨缺损模型初步实验研究  

Autogenous bone and synthetic bone-graft substitutes-bioglass(NovaboneTM)graft in the treatment of the osteonecrosis of the femoral head(A Preliminary study of canine femoral head bone defect model)

作　　者：张念非[1] 李子荣[1] 绳厚福[1] 赵凤朝[2] 王跃[3] 杨连兴[4] 

机构地区：[1]中日友好医院骨科骨坏死与关节保留重建中心,北京100029 [2]徐州市中心医院骨科 [3]中日友好医院病理科 [4]中日友好临床医学研究所实验动物手术室,北京100029

出　　处：《中日友好医院学报》2005年第3期153-157,F002,共6页Journal of China-Japan Friendship Hospital

基　　金：首都二四八工程重大创新工程(生物医药领域)资助

摘　　要：目的:探讨使用人工合成骨移植替代材料——骨玻璃部分或完全代替自体骨移植,用于保存自身股骨头手术中充填股骨头骨缺损灶。方法:实验犬12只随机分为3组,每组4只,单侧髋制作成股骨头骨缺损模型,对侧髋作为对照。Ⅰ组植入自体松质骨;Ⅱ组植入自体松质骨加骨玻璃;Ⅲ组植入骨玻璃。对实验侧和对照侧犬股骨头行大体观察、X线检查、力学性质测定和组织学观察。结果:共10只犬术后存活4个月。大体观察:只有Ⅰ组1髋未发生塌陷,三组间平均塌陷高度无显著差异。X线检查:Ⅲ组塌陷高度显著高于Ⅰ、Ⅱ组。组织学观察:回植愈合的软骨帽软骨均出现软骨增厚纤维化,Ⅰ组和Ⅱ组的植入物区均出现骨小梁粗大、骨细胞量增加新生骨形成、骨髓腔小;Ⅲ组的植入物区呈现类粗大骨小梁样改变但骨细胞样结构量少,无新生骨形成。股骨头压应力强度测定:Ⅰ组对照侧与实验侧间无显著差异;Ⅱ组和Ⅲ组对照侧与实验侧间差异显著。结论:对股骨头缺血坏死实验犬植入自体骨和植入自体骨加骨玻璃后,组织学和影像学均显示愈合良好。采用“活门板”式手术充填股骨头骨缺损灶时骨玻璃可部分替代自体骨。Objective:To study using synthetic bone(NovaboneTM,US Biomaterials Corp.) as substitute for autogenous bone,partially or completely in filling the bone defect,in the treatment of osteonecrosis of the femoral head.Methods:Twelve skeletal mature dogs were used in the experiment and four dogs in each group.A trapdoor and bone defect were created in one femoral head of each dog.The bone defect was filled with autogenous bone in group Ⅰ;autogenous bone and synthetic bone were filled in group Ⅱ.Synthetic bone was filled in group Ⅲ.Gross appearance,radiographic,biomechanical and histological test of the femoral head were carried out.Results:Ten dogs lived 4 months after operation.In gross appearance,only one femoral head of the three group no collapse occurred,the collapse heights among the three groups have no significance difference. In radiographic,the collapse height of group Ⅲ was higher than other two groups.Biomechanical:the stiffness of group Ⅰ have no difference with the control group,group Ⅱ and Ⅲ were lower than the control group. Histological:fibrillation of the cartilage in all of the femoral head.In group Ⅰ and Ⅱ,the grafted material demonstrated mesenchymal tissue and thickened trabecular bone with new bone formation.but group Ⅲ showed less mesenchymal tissue and the grafted material revealed trabecular bone like tissue with less bone cells and no new bone formation.Conclusion:Moderate to excellent healing was seen both radiographically and histologically in the groups grafted with autogenous bone and with autogenous bone and NovaboneTM.NovaboneTM could be used as a substitute of autogenous bone partially in the trapdoor procedure for avascular necrosis of the femoral head.

关 键 词：股骨头坏死 骨玻璃 骨移植 动物模型 

分 类 号：R687.3[医药卫生—骨科学]