No adverse effects of early weight bearing after uncemented total hip arthroplastyA randomized study of 20 patients

Experimental fibular defects in 16 rats were filled with an acid decalcified homogenous bone matrix (bone inductive material). Autogenous bone grafts in corresponding defects in the other legs of the same rats served as controls. After 3 months, 11 of the 16 defects filled with bone inductive material healed with bony union, but only 4 of the 16 defects treated with autogenous bone grafts had healed. The results suggest that bone inductive material can repair bone defects which are too large to be healed by autogenous bone grafts.     

Repair of bone defects by bone inductive material.

Experimental fibular defects in 16 rats were filled with an acid decalcified homogenous bone matrix (bone inductive material). Autogenous bone grafts in corresponding defects in the other legs of the same rats served as controls. After 3 months, 11 of the 16 defects filled with bone inductive material healed with bony union, but only 4 of the 16 defects treated with autogenous bone grafts had healed. The results suggest that bone inductive material can repair bone defects are too large to be healed by autogenous bone grafts.     

吻合血管节段性腓骨移植修复邻近关节巨大腔性骨缺损

目的：邻近关节骨肿瘤或肿瘤样病变切除后的修复。方法：仿据排骨血供的特性,设计吻合血管腓骨多节段移植,修复胫骨上端、股骨下端及股骨近端骨缺损。结果：临床应用10例,经术后3个月随访,移植骨愈合良好,关节功能恢复令人满意。结论：采用该方法,修复邻近关节骨肿瘤切除后巨大腔性骨缺损,远优于吻合血管或单纯松质骨植入,从根本上避免或替代了异体半关节移植。     

自体颅骨移植在眶底重建中的应用

目的 评价自体颅骨移植在治疗面部外伤致眶底缺损中的作用。方法 对34例面部创伤眶底爆裂骨折（以下简称眶底骨折）有骨质缺损者,采用冠状切口取自休遭受,结膜切口加外眦切开入路进行骨移植修复缺损。结果 所有病例术后创口愈合良好,无感染。供骨区无并发症发生。1例术后3个月内有轻微下睑外翻,通过自行按摩半年后已不明显,8例术前有眶下区麻木者,术后1-6个月全部恢复,4例有复视者术后消失,通过半年至5年（平衡11个月）的随诊,移植骨成活良好,供受骨区切口瘢痕不明显,均取得了满意的临床疗效。结论 自体颅骨移植并发症少,对眶底的重建有许多优点。是眶底重建的理想移植材料。     

Bone formation in rabbit cancellous bone defects filled with bioactive glass granules

We examined new bone formation after filling cancellous bone defects with bioactive glass (BG) in granular form. Cylindrical defects in the trochanter area of 18 rabbit femora were filled with BG granules (diameter 600-830 μm) and compared with similar defects filled with morcellized autogenous bone. New bone formation and surface reaction of BG particles were evaluated by light microscopy, histomorphometry, and scanning electron microscopy. The chemical profile at the bone- material interface was studied by energy dispersive x-ray analysis (EDXA). In the BG group, 41, 32, and 38 percent of the defects were filled with new bone after 3, 6, and 12 weeks, respectively. The corresponding figures for the autogenous bone group were 36, 29, and 34 percent. The thickness of the reaction layer on the glass surface increased from 82 to 163 μm during the observation periods. An intimate contact without intervening soft tissue between new bone lamellae and BG granules was a constant finding. EDXA showed a chemical continuum between the granules and the new bone. No adverse reactions related to BG were observed. BG is a promising material for filling cancellous bone defects.     

Bone matrix and marrow versus cancellous bone in rabbit radial defects

Implants of demineralized bone matrix induce new bone formation. In order to estimate the possible clinical usefulness of this phenomenon, autologous cancellous bone grafts were compared with composite grafts of bone matrix and marrow. Cancellous bone from the tuber ischii of the rabbit was transplanted to a preformed radial defect in the same animal. On the opposite side, a similar defect was filled with a mixture of either allogenous or autogenous bone-matrix particles and autogenous bone marrow. After 25 days, calcium 45 was injected intravenously. Three days later the animals were killed. Standardized segments of the rabbit's forearms, containing the middle of the defect, were cut out, ashed, and analyzed for 45Ca activity. No side difference in 45Ca deposition was found. The callus ash weight of the allogenous matrix-transplanted side was approximately 60% of that of the cancellous bone side. This side difference of ash weights corresponds to the estimated initial mineral content of the cancellous graft. Nontransplanted defects had very low ash weight and 45Ca activity. Thus, in the rabbit, composite grafts of bone matrix and marrow produce a bone yield comparable to that of cancellous bone.     

EH型复合材料在胫骨平台骨折中的初步应用

手术治疗12例有移位的胫骨平台骨折,复位后用EH型复合材料人工骨填塞干骺端缺损,术后平均随访12个月,经X线片和临床评价表明,EH型复合材料人工骨对自体松质骨移植治疗胫骨平台骨折而言是一种安全的和有效的替代物。     

牛脱蛋白松质骨、胶原、BMP、RBM复合物修复骨缺损的实验研究

目的探讨牛脱蛋白松质骨、胶原、骨形态发生蛋白(BMP)、自体红骨髓(RBM)复合物修复骨缺损的能力及其作为自体骨移植替代材料的合理性、可行性.方法在42只家兔双侧桡骨中段制备骨缺损模型,分为4组牛脱蛋白松质骨、胶原、BMP、RBM复合物植入组(A1组20侧)、单纯牛脱蛋白松质骨植入组(A2组20侧)、自体骨植入组(B1组20侧)、空白对照(B2组20侧).在2、4、8、12周分别进行大体标本观察、X线检查、病理组织学检查及生物力学测试.结果 12周时,A1组、B1组骨缺损均已完全修复,而A2组、B2组骨缺损未修复;生物力学测试术后4周A1组的最大扭矩和抗扭刚度均高于B1组,而术后8周后则无显著性差异.结论牛脱蛋白松质骨、胶原、BMP、RBM复合物具有较强的成骨能力,可修复骨缺损,并能作为自体骨移植的一种替代材料.     

Bone grafts prepared with selective cell retention technology heal canine segmental defects as effectively as autograft.

Using a canine critical-size segmental defect model, a two-phased study was undertaken to evaluate the healing efficacy of demineralized bone and cancellous chips (DBM-CC) enriched with osteoprogenitor cells using a Selective Cell Retention (SCR) technology. The goals of this study were: 1) to determine the bone-healing efficacy of SCR-enriched grafts versus autograft, and 2) to assess the value of clotting SCR-enriched grafts with platelet-rich plasma (PRP). Thirty dogs were included in Phase I: 18 dogs were treated with an SCR-enriched DBM-CC graft clotted with autologous bone marrow, and were compared to 12 autograft controls. In Phase II, 24 animals were divided into 4 groups of 6 animals, each treated with a different bone graft material: 1) iliac crest autograft, 2) DBM-CC alone, 3) DBM-CC saturated with marrow, and 4) SCR-enriched DBM-CC clotted with PRP. All grafts were placed unilaterally in a 21-mm long osteoperiosteal femoral, instrumented, critical-size defect. Radiographs were obtained for all animals postoperatively and every 4-16 weeks; animals were then sacrificed. All femurs were prepared for histology. Femurs in the Phase II study were also analyzed by micro-CT. At 16 weeks, healing--defined by bridging bone across the defects--was observed in 50% of the DBM-CC alone group and 67% of the DBM-CC saturated with marrow group; 100% of the autograft and SCR-enriched DBM-CC groups were healed. Histologically, grafts clotted with PRP showed more mature bone than those implanted with autologous bone, which in turn were similar to those implanted with bone marrow clotted SCR-enriched grafts. These results demonstrated that: 1) SCR-enriched DBM-CC was equivalent to autograft to repair critical-size defects, and 2) while not statistically significant, PRP may have accelerated bone maturation when used to clot osteoprogenitor-enriched DBM-CC grafts--as compared to cell-enriched, DBM-CC grafts without PRP--in large animal models.     

自体骨髓促进引导性骨再生

目的　研究自体骨髓增强引导性骨再生 (GBR)修复骨缺损的能力。方法　 18只兔分为 5组 ,每组 3只 (第 5组 6只 ) ,造成双桡骨干 10 mm骨缺损 ,以硅胶管桥接骨断端 ,实验组于 0、2和 4周分别在硅胶管内注射自体骨髓 0 .3ml;对照组于相同时间点注射等量外周静脉血。在不同时间内作 X线片、大体、组织学观察及生化检测。结果　实验组成骨活跃 ,10周骨缺损完全修复 ,对照组各时间点均较实验组差 ,10周时仍无 1只兔骨性愈合。术后 2、4周实验组钙及碱性磷酸酶含量明显高于对照组。结论　自体骨髓可明显增强 GBR修复骨缺损的能力     

Bone matrix and marrow versus cancellous bone in rabbit radial defects

Summary Implants of demineralized bone matrix induce new bone formation. In order to estimate the possible clinical usefulness of this phenomenon, autologous cancellous bone grafts were compared with composite grafts of bone matrix and marrow. Cancellous bone from the tuber ischii of the rabbit was transplanted to a preformed radial defect in the same animal. On the opposite side, a similar defect was filled with a mixture of either allogenous or autogenous bone-matrix particles and autogenous bone marrow. After 25 days, calcium 45 was injected intravenously. Three days later the animals were killed. Standardized segments of the rabbit's forearms, containing the middle of the defect, were cut out, ashed, and analyzed for ⁴⁵Ca activity. No side difference in ⁴⁵Ca deposition was found. The callus ash weight of the allogenous matrix-transplanted side was approximately 60% of that of the cancellous bone side. This side difference of ash weights corresponds to the estimated initial mineral content of the cancellous graft. Nontransplanted defects had very low ash weight and ⁴⁵Ca activity. Thus, in the rabbit, composite grafts of bone matrix and marrow produce a bone yield comparable to that of cancellous bone.     

Tricortical Calcaneal Bone Graft and Management of the Donor Site

The clinical outcomes of 19 patients requiring autogenous grafts for foot surgery were followed up until healing at the donor site occurred. In all cases, tricortical bone was extracted from the calcaneus for use at another pedal site. The first cohort of 9 patients had the calcaneal deficit replaced with allogenic cubes. The second cohort received no tissue replacement. Patients were reviewed postoperatively with a questionnaire and clinical examination to evaluate the outcome of the operations. Radiographic outcomes were observed at the donor and recipient sites in both groups until healing was confirmed as bridging trabeculation. Incorporation of the graft at the donor site was also reviewed. Clinical outcomes, namely pain, local sensory function, and return to footwear, were satisfactory in all patients and were not significantly different between groups. One patient from each group sustained a heel fracture. The donated autogenous grafts at the recipient sites were all incorporated uneventfully at 6 months. In the first cohort, allogenic graft incorporation in the calcaneus was complete in only 2 patients at the 12-month stage. The remaining 7 cases showed reduction of the deficit by new bone formation arising from the calcaneus. Donor sites with allogenic bone replacement healed at a median of 18 months (interquartile range, 18-18 months). In the group without replacement, healing occurred at a median of 6 months (interquartile range, 6-12 months), a highly statistically significant difference (P < .001). In the second cohort without allogenic graft replacement, radiographic filling at the donor site was complete within a 12-month period. Tricortical bone can be successfully harvested from the calcaneus, but there may an associated risk of heel fracture. The role of replacement allogenic bone in assisting healing at the donor site is unclear.     

Viability and Osteogenicity of Bone Graft Coated with Methylmethacrylate Cement

The idea of utilizing bone grafts during hip arthroplasty has been discussed in the literature and clinical successes have been indicated. These communications, however, did not relate to long-term results. Thus, to date, we still lack sufficient understanding as to the fate of bone grafts when they are coated with methyl-methacrylate. In order to elucidate the above issue further an experimental study has recently been initiated in an attempt to provide answers to the following questions: a) do bone grafts remain viable when they are held in place with methyl-methacrylate bone cement? and b) do such grafts retain their osteogenic potential? In the present study osteotomies were made in the femora of dogs and cortico-cancellous strips of autogenous bone were placed around the osteotomy site. The grafts were then surrounded by polymethylmethacrylate bone cement. Mechanical examinations and morphological studies, performed 3, 6 and 10 months following surgery, revealed the elaboration of fibro-osseous union. Our present findings tend to indicate that bone grafts, even if they are covered with methylmethacrylate bone cement, still retain their viability as well as their osteogenic potential.     

胶原膜与复合自体骨髓的自体骨引导骨再生的实验研究

目的　观察胶原膜引导骨再生的效果 ,探讨胶原膜的理化特性、自体骨髓、膜下空间的维持在引导性骨再生中的作用。方法　建立兔双侧桡骨缺损模型 ,实验组移植胶原膜与复合自体骨髓的自体骨 ,对照组仅移植复合自体骨髓的自体骨 ,并行大体标本、组织学、生物力学检查。结果　实验组新骨生长及成熟骨替代过程较对照组快 ,且有增生的小血管及神经纤维。结论胶原膜是一种理想的骨移植材料 ,它能有效地发挥阻隔及引导的作用     

Alternatives to Autogenous Bone Graft: Efficacy and Indications

Bone grafting is frequently used to augment bone healing with the numerous approaches to reconstructing or replacing skeletal defects. Autologous cancellous bone graft remains the most effective grafting material because it provides the three elements required for bone regeneration: osteoconduction, osteoinduction, and osteogenic cells. Autologous cortical bone graft provides these three components to a limited extent as well and also provides the structural integrity important in reconstruction of larger defects. However, because autogenous grafting is associated with several shortcomings and complications, including limited quantities of bone for harvest and donor-site morbidity, alternatives have been used in a wide range of orthopaedic pathologic conditions. Grafting substitutes currently available include cancellous and cortical allograft bone, ceramics, demineralized bone matrix, bone marrow, and composite grafts. No single alternative graft material provides all three components for bone regeneration. The clinical applications for each type of material are dictated by its particular structural and biochemical properties. Composite grafts consisting of several materials are often used to maximize bone healing, especially where the grafting site is compromised.     

Critically Sized Osteo-Periosteal Femoral Defects: A Dog Model

A 21-mm defect was created in 1 femoral diaphysis each of 15 dogs. Periosteum as well as a cylinder of bone was removed, and the defect was stabilized with a bone plate. Twelve of the defects were filled with an equal volume of autogenous cancellous bone harvested from the ipsilateral ilium. Three defects were left untreated. Cranial to caudal radiographs were taken postoperatively and every 4 weeks for 16 weeks. The radiographs were evaluated for healing using two ordinal scales. At 16 weeks, the dogs were euthanized and the femurs harvested for biomechanical testing and histologic evaluation. Both operated and contralateral not operated femurs were mechanically tested to failure in torsion, and load at failure and stiffness were calculated. All dogs tolerated the procedure well, and were using the operated limb within 1 or 2 days postoperatively. There were no complications noted during the 16 weeks of the study. Unfilled defects did not heal and became atrophic nonunions. The defects filled with autogenous cancellous bone healed in a consistent pattern of consolidation, incorporation, and remodeling, with uniform increases of both ordinal scales used. The femoral cortex opposite the bone plate demonstrated most mature remodeling, evident both radiographically as well as histologically. Unoperated femurs failed at 13.61 3.88 N-m and grafted femurs failed at 2.96 1.3 N-m, which was 23% of the measurement of the unoperated femur. Relative stiffness of the unoperated femurs was 5974 4316 N-m2/radian, and grafted femurs had a relative stiffness of 642 561 N-m2/radian, which was 10.4% of the measurement of unoperated femur. This model proved to be a critically sized defect, which when left unfilled resulted in an atrophic nonunion, and when filled with cancellous bone resulted in a consistent healing pattern.     

Critically sized osteo-periosteal femoral defects: a dog model.

A 21-mm defect was created in 1 femoral diaphysis each of 15 dogs. Periosteum as well as a cylinder of bone was removed, and the defect was stabilized with a bone plate. Twelve of the defects were filled with an equal volume of autogenous cancellous bone harvested from the ipsilateral ilium. Three defects were left untreated. Cranial to caudal radiographs were taken postoperatively and every 4 weeks for 16 weeks. The radiographs were evaluated for healing using two ordinal scales. At 16 weeks, the dogs were euthanized and the femurs harvested for biomechanical testing and histologic evaluation. Both operated and contralateral not operated femurs were mechanically tested to failure in torsion, and load at failure and stiffness were calculated. All dogs tolerated the procedure well, and were using the operated limb within 1 or 2 days postoperatively. There were no complications noted during the 16 weeks of the study. Unfilled defects did not heal and became atrophic nonunions. The defects filled with autogenous cancellous bone healed in a consistent pattern of consolidation, incorporation, and remodeling, with uniform increases of both ordinal scales used. The femoral cortex opposite the bone plate demonstrated most mature remodeling, evident both radiographically as well as histologically. Unoperated femurs failed at 13.61 +/- 3.88 N-m and grafted femurs failed at 2.96 +/- 1.3 N-m, which was 23% of the measurement of the unoperated femur. Relative stiffness of the unoperated femurs was 5974 +/- 4316 N-m2/radian, and grafted femurs had a relative stiffness of 642 +/- 561 N-m2/radian, which was 10.4% of the measurement of unoperated femur. This model proved to be a critically sized defect, which when left unfilled resulted in an atrophic nonunion, and when filled with cancellous bone resulted in a consistent healing pattern.     

异种牙本质修复兔颅骨缺损的实验研究

目的:观察异种牙本质修复兔颅骨骨缺损的疗效,探索其作为骨移植替代材料的有效性。方法:将因正畸原因拔除的人健康前磨牙,制成直径2~3mm的牙本质块。在1%氯己定中浸泡5min。使用12只雄性健康新西兰大白兔,在颅骨各建立4个临界骨缺损,将自体骨、人牙本质随机填入骨缺损区,术后4、8、12周随机处死4只兔子,取出颅骨,通过大体观察、Micro-CT及组织学观察颅骨缺损修复情况,使用Micro-CT分析每个时间点新骨形成面积占骨缺损总面积百分比。结果:所有实验动物伤口愈合良好,未见明显炎症反应。经影像学评估,自体骨比异种牙本质成骨量相似,且差异无统计学意义(P>0.05)。组织学染色示:围绕在移植材料周围,可见新骨形成。结论:异种牙本质能促进和加速骨缺损的修复,有望为促进骨缺损的修复提供一种新思路。     

Treatment of multiple enchondromatosis (Ollier's disease) of the hand

The clinical treatment and results for three hands in two patients with multiple enchondromatosis (Ollier's disease) are presented. Diaphyseal resection (total or subtotal) in 27 phalanges and metacarpals preceded autogenous fibular bone grafting to the defects. All bone grafts subsequently healed and were well incorporated. Hand function and cosmesis were restored satisfactorily in each case. There were no infections or recurrences.     

Incorporation of Bone Graft Covered with Methylmethacrylate onto Acetabular Wall: An Experimental Study

The acetabular model, as described in the present study, appears to serve as a promising experimental model for grafting procedures since it promotes the acceptance of autogenous grafts and the induction of new bone formation. Further, the biologic and mechanical properties of the femoro-acetabular joint appear permissive to the development of an efficient reparative system even when a foreign material such as methylmethacrylate cement is incorporated into the overall reconstructive procedure. Hence, it is hereby recommended to utilize the biological approach in the frame of replacement arthroplasty of severely damaged acetabulum.