多层粗大孔隙表层股骨柄假体联合自体植骨的生物学固定研究

STUDY ON BIOLOGICAL FIXATION OF FEMORAL STEM PROSTHESIS WITH MULTILAYER MACROPORES COATING BY COMBINED USE OF AUTOGENOUS BONE GRAFTING

目的观察股骨柄假体表层改为多层粗大孔隙结构联合自体植骨的生物学固定效果。方法自行设计完成犬骨重建型股骨柄假体,将股骨柄假体近2/3段表层改成粗大、多层立体孔隙结构。对24只成年杂种犬随机分成两组,行右侧人工股骨头置换术。实验组将假体表面孔隙内充填自体股骨头颈骨质制成的骨泥后,再行人工股骨头置换术;对照组不填充碎骨泥。术后1、3和6个月行大体观察、X线片、组织学检查及生物力学测试,以了解假体内外成骨和固定情况。结果与对照组相比,实验组3、6个月标本大体观察可见大量骨质重建现象;X线检测亦明显优于对照组;组织学观察显示多孔层孔隙内最大骨长入深度(μm)与新生骨平均充盈率(%)均明显高于对照组;生物力学测试假体-骨界面最大剪切强度明显高于对照组(P<0.01)。结论将股骨柄假体表层制成多层粗大孔隙结构联合自体植骨能显著加强生物学固定强度。

Objective To observe the effect of biological fixation of femoral stem prosthesis with multilayer macropores coating by combined use ofautologous bone grafting. Methods The reconstructing femoral stem prostheses were designed personally, proximal 2/3 surfaces of which were reformed by thick multilayer stereo pore structure. Twenty-four adult mongrel canines underwent right femoral head replacement and were divided randomly into two groups. The autogenous bone mud of femoral head and neck were not used in the control group. The histologic examination, roentgenograms and biomechanical test were carried out in the 1st, 3rd and 6th month after operation to observe the bone formation and fixation in the exterior and interior sides of the prostheses. Results On the whole view, bone reconstruction occurred in experimental group in the 3rd and 6th month. Roentgenograms also proved to be superior to the control group. Histological examination showed that both the maximum bone inserting depth（μm） and average engorging ratio （%） of newly formed bone in experimental group surpassed those in the control group. The maximum shear strength of prosthesis bone interface in experimental group was significantly higher than that in the control group（P〈0.01）. Conclusion Intensity of biological fixation can be strengthened remarkably by using femoral stem prothesis with multilayer macropores coating by combined use of autologous bone grafting.