异体松质骨植骨打压质量对植骨转归的影响的实验研究
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摘要
目的：打压植骨在临床上用于填充骨缺损，但是填充的骨量目前国内外都是定性的判断，没有一个量化指标。本实验通过三组不同紧密程度的打压植骨，并将植入骨打压后密度和皮质骨密度及松质骨密度进行比较，观察其影像学和组织学变化，旨在得到一个量化指标，为临床打压植骨量化标准的制定提供实验依据。方法：一：取健康新西兰白兔3只，体重2.5~3kg：1、测量骨皮质密度均数D1和新鲜松质骨密度均数D2。2、取同种异体松质骨(取自髂骨，股骨髁部，肱骨头)，去细胞、脱脂处理，碘伏浸泡消毒后深低温保存2周，无菌保存，留作植骨用。二：取新西兰大白兔27只，完全随机法分成A,B,C三组，每组9只。所有兔子在其左侧后腿股骨远端利用环钻制造骨缺损体积V。[V=πr~2*h，r是环钻的半径，r=2.5mm；h是深度，h=9mm。计算得V=3.14*（0.25）^2~*0.9=0.1766(ml)]实验分组，A组：植骨的紧密程度相当于松质骨密度，即ρ1=1.0ρ松质骨=0.63ρ皮质骨，植骨的量m1=0.2225g；B组：尽可能多植骨但不至于骨折，ρ2=1.34ρ松质骨=0.85ρ皮质骨，植骨的量m2=0.3000g；C组：植骨紧密程度介于A组和B之间，即ρ3=0.75ρ皮质骨，植骨的量m3=0.2649g。三：分别于第4、8、12周每组处死三只试验兔进行X线、骨密度仪检测、大体观察和组织病理切片观察。X线观察骨吸收情况、有骨小梁形成、骨-植骨界面是否清晰连续。大体解剖观察植骨区有无死骨，植骨界面连续情况，植骨区域质地情况。组织病理学观察：植骨界面是否连续，纤维形成情况，新生骨小梁多少，炎性细胞浸润情况，骨细胞、骨母细胞数量多少。比较三组植骨愈合是否有差别。骨密度仪比较三组之间骨密度是否有差异，并用统计学检验。
结果：1、大体解剖观察显示术后12周A组：植骨区域和周围正常骨区无明显移行带，植骨区切面呈黄色，呈脂肪组织颜色，夹杂少许灰白纹理。 B组：植骨区域切面呈灰黄色，灰白纹理和黄色区域相互交错。C组：植骨区域切面灰黄，灰白纹理和黄色纹理交织。
2、组织病理切片观察显示术后4周A组：植骨中央区域可见大量萎缩坏死骨小梁，有脂肪坏死，见大量空泡，死骨周围可见纤维组织增生。周围区域可见少量新生骨小梁，内有骨小凹，骨小梁周边有少量骨母细胞反应。B组：植骨中央区域骨小梁萎缩，可见破骨细胞反应，部分区域可见死骨和脂肪坏死，可见纤维增生反应，周围大量新生骨小梁伴纤维增生，内有骨小凹，新生骨小梁周边见大量骨母细胞。C组与B组相似。术后8周A组：植骨区域中央可见多灶性脂肪坏死，可见部分填充骨小梁萎缩破碎，边缘有纤维组织增生，周围区域有新生骨小梁，其间有骨小凹，少量可见骨母细胞。B组：植骨中央区域见少量残存骨小梁，被增生纤维组织包绕，增生的骨小梁和纤维组织交叉，周围可见大量增生骨小梁内见骨小凹，周围部分增生骨小梁周围有骨母细胞。C组：植骨中央区域见部分残存萎缩骨小梁和脂肪局限性坏死，纤维组织显著增生，伴少量炎性反应，周围区域有较多反应性新生骨小梁伴纤维组织增生，并伴骨母细胞增生直接化生过渡生成骨小梁。术后12周A组:中央区域部分纤维组织增生，可见多灶性坏死脂肪轮廓和部分残存萎缩骨小梁，外周可见新生骨小梁和纤维组织移行区，部分边缘区域可见少量骨母细胞。B组，C组：中央区域可见少量萎缩骨小梁残存，其周围纤维组织显著增生，纤维组织间骨小梁部分增生，周边区域骨小梁显著增生，周围有反应性新生骨小梁，可见大量骨小凹细胞，未见骨母细胞。
3、X线观察显示术后4周A组：植骨区域和周围松质骨界线清晰可见，密度稍低于周围正常松质骨，开始出现植骨的吸收，其间散在小片状高密度影。B组：植骨区域和周围正常松质骨间界线不明显，其间有小片状高密度影，可见部分区域片状骨吸收。C组：植骨区域和周围松质骨间可见一较明显的界线。术后8周A组：植骨区域和周围组织有较明显的界线，植骨区域密度稍低于周围正常松质骨，其中散在数处线状较高密度影。B组，C组：植骨区域密度和周围松质骨相近，未见明显界线，其间可见线状高密度影，部分骨小梁和周围正常松质骨小梁连续。术后12周A组：植骨区域密度低于周围正常松质骨组织，和周围松质骨界线较明显，可见部分骨小梁线状影。B组，C组：植骨区域和周围正常松质骨组织间密度相似，无明显界线，几乎完全被新生骨小梁取代，和周围正常骨小梁呈连续的线状影。
4、骨密度仪检测结果显示，4w时，A、B、C三组间两两比较，P值均<0.05，表示有显著性差异。8w、12w时，A组与B、C组间比较，P值<0.05，表示有显著性差异；B、C组比较，P值>0.05，表明B、C组无显著性差异。结论：1、紧密打压植骨组和较紧密打压植骨组的组织学和影像学表现优于非紧密打压植骨组。
2、当植骨区紧密程度ρ=1.34ρ松质骨=0.85ρ皮质骨时，可以实现紧密打压植骨。
3、据文献报道，结合本实验观察，紧密打压植骨组能够提供更好的初始力学稳定性。
Object: Impaction bone grafting is used to fill bone defects in the clinical, but theamount of filled bone is decided by qualitative judgment, not having a quantitativeindicator. In this study, three different tightness graftings, compared with the densityof cortical bone and cancellous bone, have been done and we expect to get aquantitative indicator of impaction bone grafting, which can provide experimentalbasis for quantitative criteria of bone graft in clinical application.
Materials and Method: the first step: three healthy New Zealand white rabbits,weighting2.5~3kg. The average cortical bone density and cancellous bone densitywas measured. Allogeneic cancellous bone, taken from the iliac, femoral condyle andhumeral head, been decellularized and degreased, disinfected by iodophor, wascryopreserved for two weeks. The second step:27New Zealand white rabbits werecompletely randomly divided into A, B, C three groups (n=9). Ringlike bone defect Vwas constructed by trephine at the distal femoral condyle for each rabbit left hind leg.Group A: the degree of grafting tightness is equivalent to the cancellous bone density,that is, of ρ1=1.0ρcancellous bone=0.63ρcortical bone，of bone graft amountm1=0.2225g. Group B: as much as possible bone grafting but for fractures, that is, ofρ2=1.34ρ cancellous bone=0.85ρ cortical bone， of bone graft amountm2=0.3000g. Group C: the tightness between A and B, that is, of ρ3=0.75ρcortical bone，of bone graft amount m3=0.2649g. The third step: Three rabbits ineach group were sacrificed for X-ray photography, Dual-energy x-ray absorptiometrytesting, general observation and histopathology observation at the4th,8th,12th week.The state of bone absorption, new bone trabecula formation and bone-bone graftinginterface was observed by X-ray photography. The gross anatomy observationincludes the amount of sequestrums, the continuity situation of bone graft interface and the texture of the bone graft region. Histopathology observed: the continuity ofbone grafting; the situation of fiber formation, new bone trabecula, inflammatory cellinfiltration; the amount of osteocyte and osteoblast.
Rusults: General observation:12weeks after operation. In group A: There isn’tapparent transitional zone between bone grafting area and the surrounding normalbone area. The cut surface of bone grafting area, presents yellow color like the fattissue, mixed with a little grey texture. In group B: The section surface of thegrafting region, with gray texture and yellow texture interlaced, presents grayishyellow. In group C: What present is like group B.
Histopathological observation:4weeks after operation.In group A: in the centralbone graft area we observed a large number of atrophic necrotic trabecular boneenclosed with proliferous fibrous tissue and fat necrosis with numerous vacuolus. Ingroup B and C: in the central bone graft region, atrophy trabecular bone, osteoclastreaction, and partial bone and fat necrosis were observed. In peripheral region, there isa large number of newly formed bone trabecula with proliferous fiber tissue,surrounded by numerous osteoblast.8weeks after operation. In group A: in the centralbone graft region, multifocal fat necrosis can be seen; partial filled trabecula atrophyand be broken, at the edge of which fibrous tissue proliferate. In the peripheral area,new bone trabecula accompanying with a few osteoblast was seen. In group B: in thecentral bone graft area, we can see a small amount of atrophy bone trabeculasurrounding by proliferating fiber tissue and new bone trabecula crossing fiber tissue.New bone trabeculas were partial surrounded by osteoblast. In group C: in the centralbone graft area, some remnants of the atrophy trabecular bone, fat limitation necrosisand fibrous tissue hyperplasia were seen, with a few inflammatory reaction.12weeksafter operation. In group A: in the central bone graft region, partial fibrous tissueproliferation, the outline of multifocal fat necrosis and the remnants of atrophy filledtrabecula can be seen, at the edge of which new bone trabecula be transitional tofibrous tissue. In the peripheral area, new bone trabecula accompanying with a fewosteoblast was seen. In group B and C: in the central region of bone graft, a smallamount of atrophy trabecular bone surrounding by hyperplasia fibrous tissue was seen. In the peripheral region, new trabecular bone was significant proliferationsurrounding by reactive new bone trabecula with numerous osteocyte.
X ray photography:4weeks after operation. A distinct boundary line was seenbetween peripheral normal bone and the bone graft region of which density was lessthan normal bone. In group B, there isn’t a apparent boundary line between peripheralnormal bone and the bone graft region of which partial high density area can be seen.In group C, a boundary can be seen.8weeks after operation. In group A: An apparentboundary line was seen between peripheral normal bone and the bone graft region ofwhich density was slight less than normal bone. In group B and C: the density of bonegraft region is similar with the normal bone and there isn’t an apparent boundary linebetween them.12weeks after operation. In group A: An apparent boundary line can beseen between peripheral normal bone and the bone graft region of which density wasslight less than normal. In group B and C: the density of bone graft region is similar tothe normal bone and the trabecular line is continuous to the normal.
Dural energy X-ray absorptiometry observation: At the4thweek: A, B, Cpairwise comparisons, P value<0.05, indicating that there are significant differences.At the8th,12th, week: Between group A and group B, C, P value<0.05, difference issignificant; between B and C, P value>0.05, showing that B, C group have nosignificant differences.Conclusions:1) close impaction bone grafting and closer impaction bone grafting arebetter than no-close impaction bone grafting in histological and photography findings.
2) when the tightness degree ρ=1.34ρcancellous bone=0.85ρcortical bone, we can achieve close impaction bone grafting.
3) According to the report of literature combined the experimentalobservations, closely impaction bone grafting can provide better inntial mechanicalstability.
结果：1、大体解剖观察显示术后12周A组：植骨区域和周围正常骨区无明显移行带，植骨区切面呈黄色，呈脂肪组织颜色，夹杂少许灰白纹理。 B组：植骨区域切面呈灰黄色，灰白纹理和黄色区域相互交错。C组：植骨区域切面灰黄，灰白纹理和黄色纹理交织。
2、组织病理切片观察显示术后4周A组：植骨中央区域可见大量萎缩坏死骨小梁，有脂肪坏死，见大量空泡，死骨周围可见纤维组织增生。周围区域可见少量新生骨小梁，内有骨小凹，骨小梁周边有少量骨母细胞反应。B组：植骨中央区域骨小梁萎缩，可见破骨细胞反应，部分区域可见死骨和脂肪坏死，可见纤维增生反应，周围大量新生骨小梁伴纤维增生，内有骨小凹，新生骨小梁周边见大量骨母细胞。C组与B组相似。术后8周A组：植骨区域中央可见多灶性脂肪坏死，可见部分填充骨小梁萎缩破碎，边缘有纤维组织增生，周围区域有新生骨小梁，其间有骨小凹，少量可见骨母细胞。B组：植骨中央区域见少量残存骨小梁，被增生纤维组织包绕，增生的骨小梁和纤维组织交叉，周围可见大量增生骨小梁内见骨小凹，周围部分增生骨小梁周围有骨母细胞。C组：植骨中央区域见部分残存萎缩骨小梁和脂肪局限性坏死，纤维组织显著增生，伴少量炎性反应，周围区域有较多反应性新生骨小梁伴纤维组织增生，并伴骨母细胞增生直接化生过渡生成骨小梁。术后12周A组:中央区域部分纤维组织增生，可见多灶性坏死脂肪轮廓和部分残存萎缩骨小梁，外周可见新生骨小梁和纤维组织移行区，部分边缘区域可见少量骨母细胞。B组，C组：中央区域可见少量萎缩骨小梁残存，其周围纤维组织显著增生，纤维组织间骨小梁部分增生，周边区域骨小梁显著增生，周围有反应性新生骨小梁，可见大量骨小凹细胞，未见骨母细胞。
3、X线观察显示术后4周A组：植骨区域和周围松质骨界线清晰可见，密度稍低于周围正常松质骨，开始出现植骨的吸收，其间散在小片状高密度影。B组：植骨区域和周围正常松质骨间界线不明显，其间有小片状高密度影，可见部分区域片状骨吸收。C组：植骨区域和周围松质骨间可见一较明显的界线。术后8周A组：植骨区域和周围组织有较明显的界线，植骨区域密度稍低于周围正常松质骨，其中散在数处线状较高密度影。B组，C组：植骨区域密度和周围松质骨相近，未见明显界线，其间可见线状高密度影，部分骨小梁和周围正常松质骨小梁连续。术后12周A组：植骨区域密度低于周围正常松质骨组织，和周围松质骨界线较明显，可见部分骨小梁线状影。B组，C组：植骨区域和周围正常松质骨组织间密度相似，无明显界线，几乎完全被新生骨小梁取代，和周围正常骨小梁呈连续的线状影。
4、骨密度仪检测结果显示，4w时，A、B、C三组间两两比较，P值均<0.05，表示有显著性差异。8w、12w时，A组与B、C组间比较，P值<0.05，表示有显著性差异；B、C组比较，P值>0.05，表明B、C组无显著性差异。结论：1、紧密打压植骨组和较紧密打压植骨组的组织学和影像学表现优于非紧密打压植骨组。
2、当植骨区紧密程度ρ=1.34ρ松质骨=0.85ρ皮质骨时，可以实现紧密打压植骨。
3、据文献报道，结合本实验观察，紧密打压植骨组能够提供更好的初始力学稳定性。
Object: Impaction bone grafting is used to fill bone defects in the clinical, but theamount of filled bone is decided by qualitative judgment, not having a quantitativeindicator. In this study, three different tightness graftings, compared with the densityof cortical bone and cancellous bone, have been done and we expect to get aquantitative indicator of impaction bone grafting, which can provide experimentalbasis for quantitative criteria of bone graft in clinical application.
Materials and Method: the first step: three healthy New Zealand white rabbits,weighting2.5~3kg. The average cortical bone density and cancellous bone densitywas measured. Allogeneic cancellous bone, taken from the iliac, femoral condyle andhumeral head, been decellularized and degreased, disinfected by iodophor, wascryopreserved for two weeks. The second step:27New Zealand white rabbits werecompletely randomly divided into A, B, C three groups (n=9). Ringlike bone defect Vwas constructed by trephine at the distal femoral condyle for each rabbit left hind leg.Group A: the degree of grafting tightness is equivalent to the cancellous bone density,that is, of ρ1=1.0ρcancellous bone=0.63ρcortical bone，of bone graft amountm1=0.2225g. Group B: as much as possible bone grafting but for fractures, that is, ofρ2=1.34ρ cancellous bone=0.85ρ cortical bone， of bone graft amountm2=0.3000g. Group C: the tightness between A and B, that is, of ρ3=0.75ρcortical bone，of bone graft amount m3=0.2649g. The third step: Three rabbits ineach group were sacrificed for X-ray photography, Dual-energy x-ray absorptiometrytesting, general observation and histopathology observation at the4th,8th,12th week.The state of bone absorption, new bone trabecula formation and bone-bone graftinginterface was observed by X-ray photography. The gross anatomy observationincludes the amount of sequestrums, the continuity situation of bone graft interface and the texture of the bone graft region. Histopathology observed: the continuity ofbone grafting; the situation of fiber formation, new bone trabecula, inflammatory cellinfiltration; the amount of osteocyte and osteoblast.
Rusults: General observation:12weeks after operation. In group A: There isn’tapparent transitional zone between bone grafting area and the surrounding normalbone area. The cut surface of bone grafting area, presents yellow color like the fattissue, mixed with a little grey texture. In group B: The section surface of thegrafting region, with gray texture and yellow texture interlaced, presents grayishyellow. In group C: What present is like group B.
Histopathological observation:4weeks after operation.In group A: in the centralbone graft area we observed a large number of atrophic necrotic trabecular boneenclosed with proliferous fibrous tissue and fat necrosis with numerous vacuolus. Ingroup B and C: in the central bone graft region, atrophy trabecular bone, osteoclastreaction, and partial bone and fat necrosis were observed. In peripheral region, there isa large number of newly formed bone trabecula with proliferous fiber tissue,surrounded by numerous osteoblast.8weeks after operation. In group A: in the centralbone graft region, multifocal fat necrosis can be seen; partial filled trabecula atrophyand be broken, at the edge of which fibrous tissue proliferate. In the peripheral area,new bone trabecula accompanying with a few osteoblast was seen. In group B: in thecentral bone graft area, we can see a small amount of atrophy bone trabeculasurrounding by proliferating fiber tissue and new bone trabecula crossing fiber tissue.New bone trabeculas were partial surrounded by osteoblast. In group C: in the centralbone graft area, some remnants of the atrophy trabecular bone, fat limitation necrosisand fibrous tissue hyperplasia were seen, with a few inflammatory reaction.12weeksafter operation. In group A: in the central bone graft region, partial fibrous tissueproliferation, the outline of multifocal fat necrosis and the remnants of atrophy filledtrabecula can be seen, at the edge of which new bone trabecula be transitional tofibrous tissue. In the peripheral area, new bone trabecula accompanying with a fewosteoblast was seen. In group B and C: in the central region of bone graft, a smallamount of atrophy trabecular bone surrounding by hyperplasia fibrous tissue was seen. In the peripheral region, new trabecular bone was significant proliferationsurrounding by reactive new bone trabecula with numerous osteocyte.
X ray photography:4weeks after operation. A distinct boundary line was seenbetween peripheral normal bone and the bone graft region of which density was lessthan normal bone. In group B, there isn’t a apparent boundary line between peripheralnormal bone and the bone graft region of which partial high density area can be seen.In group C, a boundary can be seen.8weeks after operation. In group A: An apparentboundary line was seen between peripheral normal bone and the bone graft region ofwhich density was slight less than normal bone. In group B and C: the density of bonegraft region is similar with the normal bone and there isn’t an apparent boundary linebetween them.12weeks after operation. In group A: An apparent boundary line can beseen between peripheral normal bone and the bone graft region of which density wasslight less than normal. In group B and C: the density of bone graft region is similar tothe normal bone and the trabecular line is continuous to the normal.
Dural energy X-ray absorptiometry observation: At the4thweek: A, B, Cpairwise comparisons, P value<0.05, indicating that there are significant differences.At the8th,12th, week: Between group A and group B, C, P value<0.05, difference issignificant; between B and C, P value>0.05, showing that B, C group have nosignificant differences.Conclusions:1) close impaction bone grafting and closer impaction bone grafting arebetter than no-close impaction bone grafting in histological and photography findings.
2) when the tightness degree ρ=1.34ρcancellous bone=0.85ρcortical bone, we can achieve close impaction bone grafting.
3) According to the report of literature combined the experimentalobservations, closely impaction bone grafting can provide better inntial mechanicalstability.
引文
[1]宋会平，王志强，骨移植的过去、现在和未来，中国修复重建外科杂志，2009年5月第23卷第5期
[2]李锋，娄思权等，膝关节翻修胫骨侧骨缺损打压植骨术后初始稳定性的研究，中国骨与关节损伤杂志，2006年8月第21卷第8期
[3]刘文军，廖进民，谭小云等，椎体骨密度、体积骨密度与生物力学强度的比较[J]；中国临床康复，2004，8（5）
[4]朱加亮，侯树勋，衷鸿宾，等；脱脂程序对异体松质骨免疫原性影响的实验研究[J]；中国矫形外科杂志；2010,18(9):762-767
[5]韦从云,周磊,赖春花,卢海宾,王忠磊,李少冰。骨代用品实验中兔股骨远端标准骨缺损模型的建立，东牙病防治2010年6月第18卷第6期。304—308
[6] Mi o Far iaN, Mu oz Guz nF, L pez Pe aM, eta.l Quantita tive analysis of theresorption and osteoconduction of amacroporous Calcium phosphate bone cementfor the repair of acritical size defect In the femoral condyle. VetJ,2009,179(2):264272.
[7] Tsai CH, Lin RM, Ju CP, eta.l Bioresorption behavior of tetracalcium phosphatederived calcium phosphate cement implanted in femur of rabbits. Biomaterials,2008,29(8):984993
[8]周剑,张建湘,汤健,李全利,周健,蔡华琼。琼脂—磷灰石仿生纳米复合材料修复兔胫骨缺损的实验研究，山东医药2010年第50卷第20期，43—46
[9]唐建军，杨松涛，菟丝子多糖—羟基磷灰石复合物治疗松质骨骨缺损的实验研究[D]，成都中医药大学，2009
[10]万海云，郭征，不同粒径β-TCP植骨材料对腔隙性骨缺损骨修复的影响，第四军医大学西京医院骨科，中国人民解放军第四军医大学学位论文，2010-05
[11]张永光，王志强，骨移植替代材料研究进展，中华修复与重建外科杂志[J]，2008，22（10）：1264—1267
[12] T gil M, Aspenberg P. Impaction of cancellous bone grafts impairsosteoconduction in titanium chambers[J].Clin Orthop Relat Res.1998Jul;352(1):231-238.
[13]周勇刚，王岩;应用解剖型骨水泥股骨假体结合冻干骨打压植骨进行髋关节翻修[J];中国矫形外科杂志，2007，,15（7）：507-509
[14]曹学军，朱振安；全髋关节翻修术中打压移植骨的生物学表现及临床应用[J];生物骨科材料与临床研究，2009,6(2):34-41
[15]徐麟皓，王丽娜，朱一苗等，同种异体骨制备保存研究进展[J]，国际骨科学杂志，2008，29（5）：320—321
[16]宋会平，王志强，骨移植的过去现在和未来[J]，中国修复重建外科杂志，2009,23（5）：513—515
[17] Wang Q, Zhang XL, Jiang Y, Chen YS, Shen H, Shao JJ. Acetabular revision withimpacted irradiated frozen allografts[J], Zhonghua Wai Ke Za Zhi.2010Jul15;48(14):1045-1049.
[18] Sxhwarz N,Schlag G,Thurnher M,et al.Fresh autogeneic,frozen allogeneic,anddecalcified allogeneic bone grafrs in dogs, J Bone Joint SurgBr,1991;73(5):787-790
[19] van Haaren EH, Heyligers IC, Alexander FG, et al. High rate of failure ofimpaction grafting in large acetabular defects[J]. Bone Joint Surg Br.2007Mar;89(3):296-300
[20] Comba F, Buttaro M, Pusso R,et al. Acetabular revision surgery with impactedbone allografts and cemented cups in patient younger than55years[J].IntOrthop,2009,June,33(3):611-616
1Gibson S, McLeod I, Wardlaw D, Urbaniak S.Allograft versus autograft in instrumentedposterolateral lumbar spinal fusion:a randomized control trial[J]. Spine (Phila Pa1976).2002Aug1;27(15):1599-1603
2Nguyen H, Morgan DA, Forwood MR.Sterilization of allograft bone:effects of gammairradiation on allograft biology and biomechanics[J]. Cell Tissue Bank.2007;8(2):93-105.
3Cornu O, Boquet J, Nonclercq O,et al.Synergetic effect of freeze-drying and gammairradiation on the mechanical properties of human cancellous bone. Cell Tissue Bank.2011Nov;12(4):281-288
4Wang Q, Zhang XL, Jiang Y, Chen YS, Shen H, Shao JJ. Acetabular revision with impactedirradiated frozen allografts[J], Zhonghua Wai Ke Za Zhi.2010Jul15;48(14):1045-1049.
5陆海波，裴国献；复合环孢素同种异体骨的免疫学与组织学评价[J]；中华创伤骨科杂志，2007，9(05):442-447
6Weber P, Diehl P, Hofmann GO, et al. Gollwitzer H.Extracorporeal high hydrostatic pressureas a new technology for the disinfection of infected bone specimens[J]. Biomed Tech (Berl).
2008Aug;53(4):190-198.
7Vastel L, Meunier A, Siney H, Sedel L, Courpied JP.Effect of different sterilization processingmethods on the mechanical properties of human cancellous bone allograft. Biomaterials.2004May;25(11):2105-2110.
8黄爱军，彭建强，张旗，等；脱脂对异体皮质骨生物力学的影响[J]；中国组织工程研究与临床康复，2009，13（47）：9273-9277
9朱加亮，侯树勋；脱脂对异体松质骨免疫原性和成骨能力的影响[D]；解放军总医院，博士学位，2008
10朱加亮，侯树勋，衷鸿宾，等；脱脂程序对异体松质骨免疫原性影响的实验研究[J]；中国矫形外科杂志；2010,18(9):762-767
11Kligman M, Con V, Roffman M. Cortical and cancellous morselized allograft in revisiontotal hip replacement[J], Clin Orthop Relat Res.2002Aug;(401):139-48.
12Kligman M, Rotem A, Roffman M. Cancellous and cortical morselized allograft in revisiontotal hip replacement: A biomechanical study of implant stability [J]. Biomech.2003Jun;36(6):797-802.
13Kligman M,Pafgett DE,Vered R,et al. Cortical and cancellous morselized allograft inacetabular revision total hip replacement:minimum5-year follow-up[J]. Arthroplasty.2003Oct;18(7):907-913.
14Subramanian S,Jain Kd,Sreekumar R,et al. Early results of whole femoral head allograftwith articular cartilage for acetabular impaction grafting in revision hip replacements[J]. AnnR Coll Surg Engl.2010Jan;92(1):27-30.
15Ochs BG， Sehmid U， Rieth J,et al. Acetacular bone reconstruction in revisionarthroplasty:a comparision of freeze-dried,irradiated and chemically-treated allograftvitalized with autologous marrow versus frozen non-irradiated allograft[J].Bone Joint SurgBr2008;90(9):114-119.
16Belfrage O,Flivik G,Sundberg M,et al. Local treatment of cancellous bone grafts withBMP-7and zoledronate increases both the bone formation rate and bone density:a bonechamber study in rats[J]. Acta Orthop.2011Apr;82(2):228-233.
17Bolder SB,Verdonschot N,Schreurs BW.Techincal factors affecting cup stability in boneimpaction grafting[J].Proc Inst Mech Eng H2007;222(1):81-86
18黄德勇，周乙雄，徐辉等；打压植骨结合金属网重建全髋关节翻修术中髋臼侧严重骨缺损[J]；中国矫形外科杂志，2007，15（23）：1781-1784
19王雨，王爱民，沈岳等；22例全髋关节翻修术中对髋臼骨缺损的处理[J]；重庆医学，2007，36（10）：947-948
20Comba F, Buttaro M, Pusso R,et al. Acetabular revision surgery with impacted boneallografts and cemented cups in patient younger than55years[J].IntOrthop,2009,June,33(3):611-616
21Rigby M, Kenny PJ, Sharp R, Whitehouse SL, Gie GA, Timperley JA. Acetabular impactiongrafting in total hip replacement[J]. Hip Int.2011Jul-Aug;21(4):399-408.
22T gil M, Aspenberg P. Impaction of cancellous bone grafts impairs osteoconduction intitanium chambers[J].Clin Orthop Relat Res.1998Jul;352(1):231-238.
23周勇刚，王岩;应用解剖型骨水泥股骨假体结合冻干骨打压植骨进行髋关节翻修[J];中国矫形外科杂志，2007，,15（7）：507-509
24曹学军，朱振安；全髋关节翻修术中打压移植骨的生物学表现及临床应用[J];生物骨科材料与临床研究，2009,6(2):34-41
25van Haaren EH, Heyligers IC, Alexander FG, et al. High rate of failure of impaction graftingin large acetabular defects[J]. Bone Joint Surg Br.2007Mar;89(3):296-300.
[2]李锋，娄思权等，膝关节翻修胫骨侧骨缺损打压植骨术后初始稳定性的研究，中国骨与关节损伤杂志，2006年8月第21卷第8期
[3]刘文军，廖进民，谭小云等，椎体骨密度、体积骨密度与生物力学强度的比较[J]；中国临床康复，2004，8（5）
[4]朱加亮，侯树勋，衷鸿宾，等；脱脂程序对异体松质骨免疫原性影响的实验研究[J]；中国矫形外科杂志；2010,18(9):762-767
[5]韦从云,周磊,赖春花,卢海宾,王忠磊,李少冰。骨代用品实验中兔股骨远端标准骨缺损模型的建立，东牙病防治2010年6月第18卷第6期。304—308
[6] Mi o Far iaN, Mu oz Guz nF, L pez Pe aM, eta.l Quantita tive analysis of theresorption and osteoconduction of amacroporous Calcium phosphate bone cementfor the repair of acritical size defect In the femoral condyle. VetJ,2009,179(2):264272.
[7] Tsai CH, Lin RM, Ju CP, eta.l Bioresorption behavior of tetracalcium phosphatederived calcium phosphate cement implanted in femur of rabbits. Biomaterials,2008,29(8):984993
[8]周剑,张建湘,汤健,李全利,周健,蔡华琼。琼脂—磷灰石仿生纳米复合材料修复兔胫骨缺损的实验研究，山东医药2010年第50卷第20期，43—46
[9]唐建军，杨松涛，菟丝子多糖—羟基磷灰石复合物治疗松质骨骨缺损的实验研究[D]，成都中医药大学，2009
[10]万海云，郭征，不同粒径β-TCP植骨材料对腔隙性骨缺损骨修复的影响，第四军医大学西京医院骨科，中国人民解放军第四军医大学学位论文，2010-05
[11]张永光，王志强，骨移植替代材料研究进展，中华修复与重建外科杂志[J]，2008，22（10）：1264—1267
[12] T gil M, Aspenberg P. Impaction of cancellous bone grafts impairsosteoconduction in titanium chambers[J].Clin Orthop Relat Res.1998Jul;352(1):231-238.
[13]周勇刚，王岩;应用解剖型骨水泥股骨假体结合冻干骨打压植骨进行髋关节翻修[J];中国矫形外科杂志，2007，,15（7）：507-509
[14]曹学军，朱振安；全髋关节翻修术中打压移植骨的生物学表现及临床应用[J];生物骨科材料与临床研究，2009,6(2):34-41
[15]徐麟皓，王丽娜，朱一苗等，同种异体骨制备保存研究进展[J]，国际骨科学杂志，2008，29（5）：320—321
[16]宋会平，王志强，骨移植的过去现在和未来[J]，中国修复重建外科杂志，2009,23（5）：513—515
[17] Wang Q, Zhang XL, Jiang Y, Chen YS, Shen H, Shao JJ. Acetabular revision withimpacted irradiated frozen allografts[J], Zhonghua Wai Ke Za Zhi.2010Jul15;48(14):1045-1049.
[18] Sxhwarz N,Schlag G,Thurnher M,et al.Fresh autogeneic,frozen allogeneic,anddecalcified allogeneic bone grafrs in dogs, J Bone Joint SurgBr,1991;73(5):787-790
[19] van Haaren EH, Heyligers IC, Alexander FG, et al. High rate of failure ofimpaction grafting in large acetabular defects[J]. Bone Joint Surg Br.2007Mar;89(3):296-300
[20] Comba F, Buttaro M, Pusso R,et al. Acetabular revision surgery with impactedbone allografts and cemented cups in patient younger than55years[J].IntOrthop,2009,June,33(3):611-616
1Gibson S, McLeod I, Wardlaw D, Urbaniak S.Allograft versus autograft in instrumentedposterolateral lumbar spinal fusion:a randomized control trial[J]. Spine (Phila Pa1976).2002Aug1;27(15):1599-1603
2Nguyen H, Morgan DA, Forwood MR.Sterilization of allograft bone:effects of gammairradiation on allograft biology and biomechanics[J]. Cell Tissue Bank.2007;8(2):93-105.
3Cornu O, Boquet J, Nonclercq O,et al.Synergetic effect of freeze-drying and gammairradiation on the mechanical properties of human cancellous bone. Cell Tissue Bank.2011Nov;12(4):281-288
4Wang Q, Zhang XL, Jiang Y, Chen YS, Shen H, Shao JJ. Acetabular revision with impactedirradiated frozen allografts[J], Zhonghua Wai Ke Za Zhi.2010Jul15;48(14):1045-1049.
5陆海波，裴国献；复合环孢素同种异体骨的免疫学与组织学评价[J]；中华创伤骨科杂志，2007，9(05):442-447
6Weber P, Diehl P, Hofmann GO, et al. Gollwitzer H.Extracorporeal high hydrostatic pressureas a new technology for the disinfection of infected bone specimens[J]. Biomed Tech (Berl).
2008Aug;53(4):190-198.
7Vastel L, Meunier A, Siney H, Sedel L, Courpied JP.Effect of different sterilization processingmethods on the mechanical properties of human cancellous bone allograft. Biomaterials.2004May;25(11):2105-2110.
8黄爱军，彭建强，张旗，等；脱脂对异体皮质骨生物力学的影响[J]；中国组织工程研究与临床康复，2009，13（47）：9273-9277
9朱加亮，侯树勋；脱脂对异体松质骨免疫原性和成骨能力的影响[D]；解放军总医院，博士学位，2008
10朱加亮，侯树勋，衷鸿宾，等；脱脂程序对异体松质骨免疫原性影响的实验研究[J]；中国矫形外科杂志；2010,18(9):762-767
11Kligman M, Con V, Roffman M. Cortical and cancellous morselized allograft in revisiontotal hip replacement[J], Clin Orthop Relat Res.2002Aug;(401):139-48.
12Kligman M, Rotem A, Roffman M. Cancellous and cortical morselized allograft in revisiontotal hip replacement: A biomechanical study of implant stability [J]. Biomech.2003Jun;36(6):797-802.
13Kligman M,Pafgett DE,Vered R,et al. Cortical and cancellous morselized allograft inacetabular revision total hip replacement:minimum5-year follow-up[J]. Arthroplasty.2003Oct;18(7):907-913.
14Subramanian S,Jain Kd,Sreekumar R,et al. Early results of whole femoral head allograftwith articular cartilage for acetabular impaction grafting in revision hip replacements[J]. AnnR Coll Surg Engl.2010Jan;92(1):27-30.
15Ochs BG， Sehmid U， Rieth J,et al. Acetacular bone reconstruction in revisionarthroplasty:a comparision of freeze-dried,irradiated and chemically-treated allograftvitalized with autologous marrow versus frozen non-irradiated allograft[J].Bone Joint SurgBr2008;90(9):114-119.
16Belfrage O,Flivik G,Sundberg M,et al. Local treatment of cancellous bone grafts withBMP-7and zoledronate increases both the bone formation rate and bone density:a bonechamber study in rats[J]. Acta Orthop.2011Apr;82(2):228-233.
17Bolder SB,Verdonschot N,Schreurs BW.Techincal factors affecting cup stability in boneimpaction grafting[J].Proc Inst Mech Eng H2007;222(1):81-86
18黄德勇，周乙雄，徐辉等；打压植骨结合金属网重建全髋关节翻修术中髋臼侧严重骨缺损[J]；中国矫形外科杂志，2007，15（23）：1781-1784
19王雨，王爱民，沈岳等；22例全髋关节翻修术中对髋臼骨缺损的处理[J]；重庆医学，2007，36（10）：947-948
20Comba F, Buttaro M, Pusso R,et al. Acetabular revision surgery with impacted boneallografts and cemented cups in patient younger than55years[J].IntOrthop,2009,June,33(3):611-616
21Rigby M, Kenny PJ, Sharp R, Whitehouse SL, Gie GA, Timperley JA. Acetabular impactiongrafting in total hip replacement[J]. Hip Int.2011Jul-Aug;21(4):399-408.
22T gil M, Aspenberg P. Impaction of cancellous bone grafts impairs osteoconduction intitanium chambers[J].Clin Orthop Relat Res.1998Jul;352(1):231-238.
23周勇刚，王岩;应用解剖型骨水泥股骨假体结合冻干骨打压植骨进行髋关节翻修[J];中国矫形外科杂志，2007，,15（7）：507-509
24曹学军，朱振安；全髋关节翻修术中打压移植骨的生物学表现及临床应用[J];生物骨科材料与临床研究，2009,6(2):34-41
25van Haaren EH, Heyligers IC, Alexander FG, et al. High rate of failure of impaction graftingin large acetabular defects[J]. Bone Joint Surg Br.2007Mar;89(3):296-300.
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