骨小梁金属AVN 重建棒在早期股骨头坏死中的应用 2 年45 髋临床观察☆.pdf -- 5 元

中国组织工程研究与临床康复第14卷第39期2010–09–24出版JournalofClinicalRehabilitativeTissueEngineeringResearchSeptember24,2010Vol.14No.39ISSN16738225CN211539/RCODENZLKHAH72951DepartmentofOrthopedics,FourthHospitalofChinaMedicalUniversity,Shenyang110034,LiaoningProvince,China2DepartmentofOrthopedics,ChanghaiHospitalofSecondMilitaryMedicalUniversity,Shanghai200433,China3DepartmentofOrthopedics,ChinaJapanFriendshipHospital,theMinistryofHealth,Beijing10001,China4OutpatientClinicofCadreResetInstitute,ShenyangMilitaryAreaCommandofChinesePLA,Shenyang100032,LiaoningProvince,ChinaZhangZhiyu,Doctor,Associateprofessor,DepartmentofOrthopedics,FourthHospitalofChinaMedicalUniversity,Shenyang110034,LiaoningProvince,Chinadavidzhang77sohu.comReceived20100429Accepted20100806骨小梁金属AVN重建棒在早期股骨头坏死中的应用2年45髋临床观察张治宇1，蔡郑东2，王立强3，吴军4，崔岩1ApplicationoftrabecularmetalAVNreconstructionrodforearlyosteonecrosisofthefemoralheadClinicalobservationof45hipsin2yearsZhangZhiyu1,CaiZhengdong2,WangLiqiang3,WuJun4,CuiYan1AbstractBACKGROUNDCoredecompressionandbonegraftinghavebeenusedtotreatosteonecrosisofthefemoralhead.However,coredecompressionalonehasnoadequatesupportstoboneplatebeneathcartilage,andbloodvesselpediclefibulargraftinginducesdamageindonorregion,prolongedoperationtime,bloodlossandcomplicationsduringrehabilitation.OBJECTIVETojudgethesurvivalrateofcoredecompressionandtantalumrodtotreattheosteonecrosisofthefemoralhead.METHODSAtotalof40patients45hipswithosteonecrosisofthefemoralheadatstageIandIIbeforecollapse,comprising32malesand8females,aged29.52040years,wereselected.ThecombinationofcoredecompressionandTantalumrodmethodwasusedtotreatthefemoralheadosteonecrosis.Harrisscoreswereusedtoevaluatehipfunctionandimagingwasperformedtoevaluatecomplications.RESULTSANDCONCLUSIONAll40patientscompletedtheoperationsuccessfully,withnoevents.Allpatientswerefollowedup,including12for24months,18for12months,and10for6months.Thejointfunctionofallpatientswassignificantlyimprovedfollowingtreatment.Imagingdatashowedthatthetantalumrodwaswellplacedincorrespondingregion,withnoabnormaldensity,collapse,prosthesislooseningandradioactivelucency.Resultsshowthatcoredecompressionandtantalumrodinthetreatmentofosteonecrosisoffemoralheadcandelayorpreventcontinuoussinkingofjointcartilage.ZhangZY,CaiZD,WangLQ,WuJ,CuiY.ApplicationoftrabecularmetalAVNreconstructionrodforearlyosteonecrosisofthefemoralheadClinicalobservationof45hipsin2years.ZhongguoZuzhiGongchengYanjiuyuLinchuangKangfu.2010143972957298.http//www.crter.cnhttp//en.zglckf.com摘要背景以往股骨头骨坏死的治疗方法多采用髓芯减压和某种植骨。但单纯髓芯减压缺少对软骨下骨板的结构支撑，血管蒂腓骨移植容易出现包括取骨区伴发的病损、延长的手术时间、失血以及在康复过程中的并发症。目的评定采用多孔钽置入联合髓芯减压治疗股骨头坏死髋关节的生存率。方法选择股骨头坏死Ⅰ期和Ⅱ期塌陷前的患者40例45髋，男32例，女8例，年龄29.52040岁。采用联合多孔钽置入联合髓芯减压治疗股骨头坏死，置入前后Harris评分评价髋关节功能，影像学评估并发症情况。结果与结论40例患者手术均顺利完成，无意外发生，均获得随访，12例随访24个g7388，18例随访12个g7388，10例随访6个g7388。40例患者术后关节功能均g17751术前g7138g7186g6925g2904，影像学g7186g12046g3386g7846均g8503g11842置入g11468g5224区g3507，g7422出现g5334g5132的骨g4506g5242、塌陷、g1563g1319g7506g2172及g6930g4568g5627g17891g1821g13459的g15932现。g16840g7138采用多孔钽置入g10301联合髓芯减压治疗股骨头坏死，g2499延g13543g6122g20056g19462关节软骨的g17892g9188塌陷。关键词多孔钽g727股骨头坏死g727置入g727手术g727髓芯减压g727g2319学植入g10301doi10.3969/j.issn.16738225.2010.39.018g5364治g4443，g15093g18085g1008，g10591g12447g5390，g2568g1903，g4840g4733.骨g4579g7765g18341g4658AVNg18337g5326g7846在g7101期股骨头坏死中的g5224用g7262年45髋g1032g5214g16278g4531J.中g3281g13464g13467g5049程g11752g12362g994g1032g5214康复，2010，143972957298.http//www.crter.orghttp//cn.zglckf.com0引言股骨头骨坏死是一种多病理机制，最终达到同一转归，导致骨髓细胞缺血和骨细胞坏死的多因素疾病，其主要在年轻人中发病12。病因包括酗酒、激素药物应用史、创伤、血液系统病、放射治疗以及气压，Mont等31996年统计在美国，估计每年有1000030000例发生。其中510须用人工关节置换治疗，年轻患者还将面临人工关节翻修的问题，因此如何延缓或阻止其病程发展是推迟关节置换的关键。此前常用的两种治疗方法是由Arlet和Ficat首先开展的髓芯减压和某种植骨。单纯髓芯减压的缺点是缺少对软骨下骨板的g13479g7512g6915g6757418。g13792血g12661g14934g14119骨g12239植的缺点包括g2474骨g2318g1288发的病g6451、延g19283的g6175g7427g7114g19400、g3845血以及在g5259g3809g17819程中的g5194发g11163。g4466g20576g18331用g13864g2524多g4392g19089置g1849和髓芯减压治疗股骨头坏死，g7094g2499g6564g1391软骨下骨g13479g7512g5627g6915g6757，g2460g2499g18003g1825g5114血g12661g14119骨g12239植和g7092血g12661植骨g6228g7427g6164g5114g7481的病g6451。g7100在g16792g4462g18331用髓芯减压和多g4392g19089置g1849治疗股骨头坏死g20639关节的生g4396g10587，g5194g16792估临g5214和g5445g1699g4410g6940g7536。1对象和方法设计g3250g20050g5627病例g2010g7524。张治宇，等.骨小梁金属AVN重建棒在早期股骨头坏死中的应用2年45髋临床观察P.O.Box1200,Shenyang110004cn.zglckf.com7296www.CRTER.org1中国医科大学附属第四医院骨科，辽宁省沈阳市1100342解放军第二军医大学长海医院骨科，上海市2004333卫生部北京中日友好医院骨科，北京市100014解放军沈阳军区空军崇山路干休所门诊，辽宁省沈阳市10032张治宇，男，1972年生，辽宁省沈阳市人，汉族，2009年解放军第二军医大学博士后出站，博士后，副教授，主要从事关节外科，骨肿瘤外科的基础与临床研究。davidzhang77sohu.com中图分类号R318文献标识码B文章编号167382252010390729504收稿日期20100429修回日期2010080620091229007/GWA时间及地点病例来自200708/200910中国医科大学附属四院及上海长海医院骨科。对象选择中国医科大学附属四院及上海长海医院骨科收治的股骨头坏死Ⅰ期和Ⅱ期塌陷前的患者40例45髋，男32例，女8例，年龄29.52040岁，体质量指数40kg/m2。40例患者中14例有类固醇类药物应用史，11例长期饮酒史，其余病因不详。Pennsylvania分型Ⅰ期患者11例，Ⅱ期患者29例，其中双侧Ⅰ期股骨头坏死2例，双侧Ⅱ期股骨头坏死4例。全部患者均采用髓芯减压和多孔钽置入治疗，所有患者均已签署知情同意书，并通过医院伦理委员会批准。材料临床应用多孔钽金属棒由Zimmer公司提供，外形设计为一10mm直径的圆柱体，长度以5mm递进，末端g15758g13453部分长25mm，g1290714mm，g8504设计g2499g994骨质g1147g10995g20652g6717g6842g2159，g1457g16789g1114g1563体置入的g2033期g12295g4462g5627，g13792g2334g10711形g4586端g2029用g1122g6281g6251压g2159及g6915g6757g17731骨g991骨g7507。g16277g32821。技术路线置入前准备置入前g5132g16280g6251g10995g13044，g6251g19693d。应用g5445g1699学g6228g7427g5326g16770MRIg6122CTg11842g16760股骨头g1863g14422g19766有g7092塌陷，g11842g16760分期。g7427前1dg5132g16280g6251g10995g13044g19757g9869g20056g19462g5875g7591。治疗方法患者g10995g2641体g5461g451g5527g11017g3282g451g1998g1969g15892g7114g19400g8503g5132。全部患者均采用g11840g14192外g19400g19565g19471g9394g13864g2524g15535g13605g14192g991g19565g19471g9394g21647g18269，置入前患者g1220g2363g1122g10313g5353g5214上，病髋准g3803和g19150g5074g2530，采用股骨g17829端外侧g2011g2487，外侧g13449g159042.5cmg2011g2487，g8851g19432g12575g14192g5364g13920g451股外侧g13920g13432g13512g7053g2533g2011g5332，g7304g19718股骨g17829端外侧部。g17891g16282g991以g4579g17728g4388g12257上g7053g8712g5191g13459g994股骨外侧g11394质的g1144g9869为进g19036g9869，g2375骨g11394质由g2414g2052g15192的g1144g11040g9869，以10°15°前g1554g16294g7409股骨头坏死g2318g3507的中央钻入导g19036，直至g1863g14422g19766g9915mm处，g11842g1457导g19036在g8503侧位上均处g1122股骨颈中央然g2530g8851导g19036在g17891g16282导g5353g991用3把空g5527钻8，9，10mm在套桶g1457护g991去除骨直g2052g17731骨g991g2318，去除钉道中骨屑g8504g7114g2499用活检器械取坏死组织活检。导g5353g19036长度测量g2530，髓芯减压孔进g15904攻丝。随g253010mm多孔钽置入物在g17891g16282导g5353g991g1457持g994钉道g7053g2533一致旋入g1563体进入g2052g17731骨g991g2318。g2011g2487逐层g1863闭，g7427g2530嘱患者扶拐免负重46周，然g2530g5332始康复训练，允许逐渐全部负重。置入后处理置入g25306周避免完全负重，然g2530g5332始康复训练，允许逐渐全部负重。功能评估采用Harris评分g7053法评价髋g1863g14422功能12。主要观察指标患者Harris评分及g5445g1699学表现是否有病例g1998现异g5132的骨密度g451股骨头塌陷g451g1563体松动及放射g5627g17891光g13459。设计、实施、评估者实验设计为第一g451二作者，干g20056实施为第一g451三作者，评估为第一g451三g451四g451五作者。均经g8503g16280培训，采用盲法评估。2结果2.1参与者数量分析40例患者均进入结果分析。2.2手术时间40例患者均顺利完成手g7427，g7092意外发g10995，手g7427g7114g19400373060min。2.3随访情况40例患者均获得随访，12例随访24个月，18例随访12个月，10例随访6个月。2.4治疗结果及功能评估40例患者置入g2530g1863g14422功能均较置入前明显改善，g5445g1699学显示坦棒均g8503g11842置入相应g2318g3507。置入前Harris评分g5191均61分，置入g25306个月76分，置入g25301年78分，置入g25302年78分。g5445g1699学显示没有病例g1998现异g5132的骨密度g451塌陷g451g1563体松动及放射g5627g17891光g13459的表现。2.5不良反应置入g25301个月内5例患者发g10995大腿疼痛，物理治疗g2530均好g17728，未发g10995其他不良反应。2.6典型病例病例1男g5627患者，28岁，右侧股骨头坏死，g15904右侧钽棒置入g2530g5445g1699学表现，g16277g32822。Figure1Clinicalapplicationofporoustantalumrod图1临床应用多孔钽金属棒张治宇，等.骨小梁金属AVN重建棒在早期股骨头坏死中的应用2年45髋临床观察ISSN16738225CN211539/RCODENZLKHAH7297www.CRTER.org病例2男g5627患者，32岁，双侧股骨头坏死，g15904双侧钽棒置入g2530g5445g1699学表现，g16277g32823。3讨论3.1相关知识点目前治疗股骨头坏死中如减轻症状g451延缓进展并g7092一致的最佳g7053案。许多g11752g12362显示有症状的g7101期患者采取g1457g4444治疗g6940果g5058，g17241过80患者会g1998现塌陷10。g2524g17878的治疗g7101期股骨头坏死SteinbergI和Ⅱ期的g7053法，有髓芯减压g13864g2524g6122不g13864g2524g7905骨g6122g5114g15892g12661g14119骨g12239g7905。髓芯减压g7427的g1032g5214结果不g11842g4462，随g11540g7044月g5461g6122股骨头最g13468塌陷的g1998现SteinbergⅢ期g6122g7368g20652，g2419有疗g6940g5332始g19489g13147。不g5114g15892g12661g7905骨并附g2164g9795g8885g6122活g7507g6228g7427g2499g13485g17731骨g991g2318g3507g5114来结g7512g5627g6915g67578，g1306是g17837g12193g7053法g19668g6205大手g7427过g12255及进g15904髋g1863g14422g14085位，因g8504会g5114来相应的病g6451。有g11752g12362g6265道g5114g15892g12661g14119骨g12239g7905治疗股骨头坏死g2499g1363疼痛减轻g451功能改善9，g4600其g4557g7427前没有g17731骨g991塌陷的患者g2499获得最好的疗g6940，g1306手g7427较大g1000g1288较g20652并发症发g10995g10587，g2265g6336g311取g14119骨g2530供g2318病g6451g17828动g7092g2159g451g5875g16285异g5132g451g17393g1863g14422疼痛。g312股骨g17829端骨g6252g2373g19517。g313g3698g2164未来全髋g1863g14422置g6454g6228g7427上的g19602度。g314g1315院和康复g7114g19400延长。多孔钽g18341属是g1867有g10432g10317的物理和g7438械g10317g9869的g10995物g7460g7021。g4439g1867有g20652体g12227孔g19565g1058780和完全相通的孔g19565，g5191均孔g19565大g4579为430µm，g5389g5627g8181量g994骨相g54153GPa，允许g2499g19764和g5567g17907的骨g10995长，g1000g994骨有g5468g20652的g11964g6842g12295g4462g5627。多孔钽g18341属棒的g5191均g4636g7366g5390度是10Ng22109m，g13792g1166g14119骨的g5191均g4636g7366g5390度是8.012.5Ng22109m10。Hackingg125735通过g10368的髋g14288置入g8181型g16789明钽g18341属g1867有良好的骨g5353导作用，能g994g4499g1039骨组织良好g3332g13864结g13792g1147g10995g17817g17907的骨长入和固g4462。g2490外，由g1122g4439的g5389g5627g8181量和骨相g17829，g2499g19489g1314应g2159g17986g6389。g4439为结g7512g5627g7460g7021，成g2709的置入物g1867有g17287g3827g6227g2475g10995理负g14667的g5390度。g2490外Welldong125736学者通过g13466g14002培g1871指g1998成骨g13466g14002g994g13443钽g18341属有结g2524反应，g16789实g1114钽是一g12193g1867有长期g10995物相g4493g5627的g18341属，所以g1075有g1166g12228g1055为骨g4579g7765g18341属。Browng1257313g2058作g1114股骨头坏死g8181型，并进g15904g10995物g2159学测g16809来评估多孔钽g18341属棒g4557g17731骨g991骨g7507的g6915持g5390度和有g6940g5627，结果显示g1563体置入g2530g17731骨g991骨g7507骨g13582g6451g5191均减g458129，g1563体g7424g17535的g5390度是置入股骨头g2530所g2475压g2159的9.3g1505，g1000经g2475g13154g1505g1122体质量的g11142g2183实验。因g8504，多孔钽g18341属棒置入是相g5415g4445全g451有g6940的。骨科g5132用g18341属内置物表g19766g13466g14752g21667附实验表明，g13443钽g21667附g13466g14752的量和质均明显g1314g1122g19055g451不g19164g19062g12573g5132用g7460g7021，因异物导致g5875g7591的g8022g10587g1075较g131411,16。多孔钽棒治疗g7101期股骨头坏死的g1260g21951415,1920g311g1867有髓芯减压的g1260g9869，减轻患者的g1032g5214症状，g6524g17843全髋置g6454的g7114g19400。g312多孔钽棒g1563体和g12239g7905骨在股骨头内的应g2159和应g2476是相同的，g994骨的g5389g5627g8181量一致。g313g3698g2164g15192g5381的g17731骨g991骨的g7438械g6915g6757，g19462g8502股骨头塌陷，延缓股骨头坏死的进g12255。3.2本文结果分析实验结果g16789明，多孔钽棒g2499以通Figure2Imagingofbilateralfemoralheadbeforeandaftertantalumrodimplantation图2单侧股骨头坏死钽棒置入前后影像学表现aBeforeimplantationbAfterimplantationFigure3MRI,DRandimagingbeforeandafterbilateraltantalumrodimplantation图3双侧股骨头坏死术前MRI，DR片及行双侧钽棒置入后影像学表现aMRIbeforeimplantationbDRbeforeimplantationcDRafterimplantation张治宇，等.骨小梁金属AVN重建棒在早期股骨头坏死中的应用2年45髋临床观察P.O.Box1200,Shenyang110004cn.zglckf.com7298www.CRTER.orgCRTER杂志骨科植入物研究栏目关于假体松动作用机制的热点选题本刊学术部过微创g6228g7427g4445全有g6940的置入g2011g2487仅为2cm，创伤g4579，并发症g4581，置入g2530第2天g2375g2499g5214上g4636伸活动，3dg2375g2499扶拐不负重g15904走，6周内避免完全负重。治疗体会g311多孔钽g18341属棒在置入过g12255中应g2164g5390g7427中g17891g16282，提g20652髓芯孔道和g1563体位置准g11842g5627。如g1563体旋入和最g2530就位g7114g2159g13459不良，g2499g6451坏g1563体的尾端，及多孔钽g18341属棒g2499能没有放g2052坏死病g2476g2318g3507g17731骨g991g7507的理想位置。g312g1563体的置入过g12255中尽g2499能采用手动工g1867，避免g1363用g20652g17907g11017动工g1867，g19462g8502通道周围的骨坏死。g313g1563体头端的置入位置贴g17829负重g2318g17731骨g9915mm为宜，g1000g7053g2533尽量g1122骨g4579g7765g5191g15904，从g13792最大限度的g6915g6757g17731骨g991g7507。g314较大囊g5627病g2476的g2318g3507g2499g13864g2524采用自体骨g6122同g12193异体骨g12239g7905。⑤g1563体尾端尽量避免g19718g1998股骨g11394质外，g19462g8502g17731组织g6717g6842，g5353起置入g2530疼痛。3.3提供临床借鉴的价值g7101期股骨头坏死髓芯减压g2164多孔钽置入g2499在微创g6228g7427g991完成，g7092供g2318病g6451，以及g5468g4581发g10995g994器械有g1863的并发症。g4557g7101期病g2476的患者，课题组g11752g12362的中期g1032g5214结果显示，采用多孔钽置入物治疗股骨头坏死，g1867有令g1166鼓舞的g10995存g10587，g2499延缓g6122g20056g19462g1863g14422g17731骨的逐渐塌陷。4参考文献1AldridgeJM3rd,UrbaniakJR.Avascularnecrosisofthefemoralheadetiology,pathophysiology,classification,andcurrenttreatmentguidelines.AmJOrthopBelleMeadNJ.2004337327332.2LiebermanJR,BerryDJ,MontMA,etal.Osteonecrosisofthehipmanagementinthe21stcentury.InstrCourseLect.200352337355.3MontMA,CarboneJJ,FairbankAC.Coredecompressionversusnonoperativemanagementforosteonecrosisofthehip.ClinOrthopRelatRes.1996324169178.4BobynJD,StackpoolGJ,HackingSA,etal.Characteristicsofboneingrowthandinterfacemechanicsofanewporoustantalumbiomateri.JBoneJointSurgBr.1999815907914.5HackingSA,BobynJD,TohK,etal.Fibroustissueingrowthandattachmenttoporoustantalum.JBiomedMaterRes.2000524631638.6WelldonKJ,AtkinsGJ,HowieDW,etal.Primaryhumanosteoblastsgrowintoporoustantalumandmaintainanosteoblasticphenotype.JBiomedMaterResA.2008843691701.7SmithSW,FehringTK,GriffinWL,etal.Coredecompressionoftheosteonecroticfemoralhead.JBoneJointSurgAm.1995775674680.8MontMA,EinhornTA,SponsellerPD,etal.Thetrapdoorprocedureusingautogenouscorticalandcancellousbonegraftsforosteonecrosisofthefemoralhead.JBoneJointSurgBr.19988015662.9BerendKR,GunnesonEE,UrbaniakJR.Freevascularizedfibulargraftingforthetreatmentofpostcollapseosteonecrosisofthefemoralhead.JBoneJointSurgAm.200385A6987993.10VaritimidisSE,DimitrouliasAP,KarachaliosTS,etal.Outcomeaftertantalumrodimplantationfortreatmentoffemoralheadosteonecrosis26hipsfollowedforanaverageof3years.OrthopClinNorthAm.2004353273283,viiviii.11SchildhauerTA,RobieB,MuhrG,etal.Bacterialadherencetotantalumversuscommonlyusedorthopedicmetallicimplantmaterials.JOrthopTrauma.2006207476484.12LiQ,LuoXZ,WangZY,etal.ZhonghuaGukeZazhi.20011221721725.李强,罗先正,王志义,等.人工髋关节置换术后评估方法的研究J.中华骨科杂志,2001,1221721725.13ConzemiusMG,BrownTD,ZhangY，etal.Anewanimalmodeloffemoralheadosteonecrosisonethatprogressestohumanlikemechanicalfailure.JOrthopRes.2002202303309.14VaritimidisSE,DimitrouliasAP,KarachaliosTS,etal.Outcomeaftertantalumrodimplantationfortreatmentoffemoralheadosteonecrosis26hipsfollowedforanaverageof3years.ActaOrthop.20098012025.15VeilletteCJ,MehdianH,SchemitschEH,etal.Survivorshipanalysisandradiographicoutcomefollowingtantalumrodinsertionforosteonecrosisofthefemoralhead.JBoneJointSurgAm.200688Suppl34855.16CostelloMJ,EscaigJ.Preparationofthin,finegrained,tantalummetalreplicasforfreezefractureelectronmicroscopy.ScanningMicroscSuppl.19893189199discussion199200.17GovaersK,MeermansG,BortierH,etal.Endoscopicallyassistedcoredecompressioninavascularnecrosisofthefemoralhead.ActaOrthopBelg.2009755631636.18LimpaphayomN,WilairatanaV,PrasongchinP.Outcomeofsixmillimeterscoredecompressioninavascularnecrosisofthefemoralhead.JMedAssocThai.200992Suppl5S1216.19BabhulkarS.OsteonecrosisoffemoralheadTreatmentbycoredecompressionandvascularpediclegrafting.IndianJOrthop.20094312735.20FernándezFairenM,MurciaA,IglesiasR,etal.Osteointegrationofporoustantalumstemsimplantedinavascularnecrosisofthehip.ActaOrtopMex.200822421521.Spanish.○RANK/RANKL在假体松动中的分子机制○TFE抑制TNFα分泌的机制以及关节假体无菌性松动防治○假体松动应力遮挡引起的骨质重新塑形○钛颗粒刺激巨噬细胞而释放的肿瘤坏死因子对人工关节松动的作用○磨损颗粒引发假体周围骨溶解的机制及药物治疗进展○RANKL/RANK/OPG系统造成人工关节假体无菌性松动的机制○聚甲基丙烯酸甲酯颗粒诱导假体周围骨溶解的实验研究○人工关节置换假体传导压力培养环境对兔骨髓基质干细胞增殖的影响○人工关节假体无菌性松动的机制及药物预防的研究进展○UHMWPE在人工髋关节中的磨损机制及改性研究○以airpouch模型大鼠进行磨损微粒造成无菌性松动机制分析的可行性○假体周围骨溶解发生的细胞、分子生物学机制及早期诊断和药物治疗○假体周围骨质溶解细胞分子生物学研究○磨损颗粒刺激巨噬细胞引起人工关节松动的作用机制○细胞凋亡与假体无菌性松动○人工关节磨损钛微粒诱导破骨的分子生物学机制○超高分子聚g4025烯颗粒对成骨细胞基因g950g1234的影响○成g3736g3611细胞与人工关节周围骨溶解ISSN16738225CN211539/R2010年版权归中国组织工程研究与临床康复杂志社所有