中空多孔股骨柄假体骨长入方式的在体实验研究  

In vivo experimental study of hollow porous femoral prosthesis filled with rhBMP-2

作　　者：蔡谞[1] 王达文[1] 樊宇平[1] 赵斌[1] 王岩[1] 

机构地区：[1]北京市海淀区复兴路28号解放军总医院骨科,100853

出　　处：《中华骨科杂志》2008年第12期1040-1045,共6页Chinese Journal of Orthopaedics

基　　金：国家自然科学基金（30471755）,国家发明专利（ZL00107241.2）

摘　　要：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）与自身骨长人的成骨差异。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5mg 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室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室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），腔室内骨长人率也明显高于B组（ P〈0．05），但植入8个月后差异无统计学意义（P〉0．05）。A、B两组之间的骨结合率差异无统计学意义（P〉0．05）。结论界面骨质可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。Objective To study bone 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 ge]foam 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 osseointegation 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 significantly higher than that of group A and B （P〈 0.05） at 2, 4 months, but there was no significantly difference between them at g months （P 〉0.05）. Also the bone ingrowth rate of group C was higher than that of group B（P〈O.05）, but no significant difference at 8 months（P 〉0.05）. There was nosignificant difference between 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.

关 键 词：髋假体 骨形态发生蛋白质类 组织学 

分 类 号：R686[医药卫生—骨科学]