【作者】 牟明威；

【导师】 张新； 卢世璧；

【作者基本信息】 吉林大学 ， 骨科， 2004， 博士

【摘要】 机械性松动一直是人工关节置换手术最为突出和最受关注的远期并发症，自从提出骨长入生物固定的概念后，非骨水泥固定方法在近年来的发展迅速，但还需要增强骨-假体界面的骨长入能力。BMP由于具有诱导成骨活性，吸引了很多研究的关注，但用于人工关节界面的研究很少，是否能够促进界面的骨长入和结合强度尚无定论。本实验进行了BMP与多孔金属表面植入体的复合，并用植入犬股骨的方法与其它非骨水泥固定方法制备的植入体进行比较分析研究。 <WP=6>目 的通过对骨-植入体界面进行组织学和组织形态学的比较分析和生物力学测试（推出实验），分析BMP及各种非骨水泥固定方法在促进骨长入骨-和植入体界面、增强固定强度方面的作用。希望实验结果能够为人工关节生物固定方法的改进提供一些理论及实验依据。材料与方法我们采用多孔金属表面植入体（PCA）、复合BMP的PCA植入体PCA植入体表面喷涂HA植入体及HA涂层植入体植入犬皮质骨后在4周、8周及12周取出，通过X线摄片、不脱钙骨组织磨片、软X线照相、荧光显微镜检查、扫描电镜、骨组织计量学分析及生物力学测定等方法对骨-植入体界面的骨长入及界面的结合强度进行了比较分析。 <WP=7>结 果我们发现复合BMP的多孔金属表面植入体在实体显微镜下观察可见蜘蛛网状结构的物质沉积在植入体表面的孔隙，与未复合BMP的植入体比较有明显差别。X线摄片、不脱钙骨磨片观察、荧光显微镜检查、软X线照相及扫描电镜等方法显示骨-植入体界面加入BMP后，骨长入植入体界面的时间早于其它方法，新生骨组织成熟也较早。四种植入体在植入体内后4周至12周，不脱钙骨组织磨片观察显示骨组织长入界面及孔隙中，图像分析表明4周时BMP组新生骨形成率为26.58±4.56%，明显高于复合组17.23±2.11%、HA组16.89±3.13%、PCA组18.28±2.46，方差分析及相邻组间两两比较显示BMP组与其它各组间均有非常显著差异。四种植入体在植入体内后4周至12周，进行推出实验显示各种植入体界面剪切强度均随时间呈上升趋势，BMP在四周即达到较高水平18.94±5.11Mpa，接近其它各组4周时<WP=8>的剪切强度的2倍，复合组为10.28±1.05 Mpa、HA组9.76±3.28 Mpa、PCA组11.31±2.93 Mpa，方差分析及相邻组间两两比较显示BMP组与其它各组间均有显著差异，统计学分析有显著差异。结 论BMP与多孔金属植入体的复合方法是确实、可行的。复合BMP的多孔金属表面植入体能够促进骨-植入体界面的骨长入。加入BMP后可以提前促进成骨，促进骨长入假体界面中，从而可以提早达到生物固定。因此BMP用于人工关节假体的界面是一个值得探索的方向，对临床应用也有指导作用。HA涂层方法能够促进骨组织长入及增强骨-植入体界面结合强度，并在中晚期有一定的优势，因此表面喷涂HA是一种促进骨与假体界面结合的好方法。<WP=9>但是其喷涂工艺对固定效果有较大的影响，假体制造过程中一定要重视。更多还原

【Abstract】 Experimental Study of Bone Morphogenetic protein-2 in Noncemented Fixation of ProsthesisMechanical loosening has been the most critical and mostly concerned long-term complication. Non-cemented fixation has developed quickly in recent years since widely accepted of the concept of biological fixation. But the capacity of bone growing into bone-prosthesis interface still need to be improved. Because of its osteoinductivity, BMP has attracted many concerns of study. The study on the using of BMP in the interface of artificial joints is rare, and it is also not sure if BMP can improve bone-ingrowth and shear strength at the interface. we studied the method of combining BMP with porous-coated implants, and compared the histological and biomechanical results of 4 types of surface treatment methods by inserting the implants into femur of canine.PurposeHistological,histomorphologicalanalysisand <WP=11>biomechanical test methods were used to analyze the bony ingrowth and shear strength conditions in the interface of bone and implants of 4 groups. And also tried to find if BMP can enhance the fixation of the implants. We hope that the results of our research can provide the clinical using BMP to improve biological fixation of artificial joint with some theoretical and experimental data.Materials and MethodsWe have inserted 4 types of implants include porous-coated implants(PCA)、PCA implants combined with BMP、PCA implants coated with hydroxyapatite and HA coated implants into the femur of 12 canines. After 4, 8 and 12 weeks the femur of the canines with the implants were retrieved . Bone ingrowth and shear strength of the interface was studied and analysed by the means of X-ray, soft X-ray, fluorescence tag, non- decalcification ground section, computer-aided image analysis procedure and biomechanical test.ResultsImplants combined with BMP was observed under stereomicroscope and cobweb-like materials deposited in the pores can be observed. There was obvious differences compared with implants which was not compounded with BMP. <WP=12>X-ray, soft X-ray, fluorescence tag, non- decalcification ground section and computer-aided image analysis procedure was used in histological study, it shows that the bony ingrowth into interface appeared earlier than the other groups, so did the maturation of newly formed bone.Non- decalcification ground section observation and computer aided image analysis shows the results: the new bone formation ratio of BMP group is 26.58±4.56%, which is much higher than the other groups, and there is significant difference between BMP group and each of the other group statistically.Result of biomechanical study using push-out test shows that shear strength of each group appeare to rise with time. Shear strength of BMP group reached a high level at 4 weeks which is 18.94±5.11Mpa and almost twice of the other group. There is also statistical difference between BMP group and each of the other group.Conclusion 1. The method we used in the experiment to combine BMP with porous-coated implants is effective and feasible. 2. Porous-coated implants combined with BMP can enhance bony ingrowth at bone-implant interface. 3. Porous-coated implants combined with BMP can <WP=13>not only shorten the time of new bone formation and bony ingrowth but also enhance shear strength of bone-implant interface. 4. HA coating is also an effective method of prosthesis surface treatment to improve bone ingrowth and enhance the interface shear strength. But the technique of HA coating is essential factor in processing the prosthesis.更多还原