Читать книгу Fractures in the Horse - Группа авторов - Страница 161

Because of limited availability and morbidity associated with cancellous bone grafts in humans, bone substitutes are commonly used [76].

Calcium sulphate (plaster of Paris) has been used in horses principally because it can be implanted with antimicrobials. Like many bone substitutes, it is osteoconductive, biodegradable and can be combined with autogenous bone graft at a defect site. Calcium phosphate ceramic (CPC) has also been used and can be modified to a calcium hydroxyapatite implant that has some indication of stimulating bone healing. These have some potential but are rarely used in horses. Exogenous hydroxyapatite has been used in humans. It is osteoconductive and stimulates osteointegration with mechanical properties similar to cancellous bone. The implant has good porous characteristics to enhance cell migration and bone remodelling. TCP is more porous and degradable than hydroxyapatite which increase vascular invasion. There are reports of TCP use for osteochondral repair [79]. BCP is a combination of hydroxyapatite and TCP mixture, and CPC is an injectable form that has been used to enhance healing. Bioglass is a silicate‐based implant that has been shown to enhance binding to host bone. Hydroxyapatite coatings have been shown to enhance osteoprogenitor cells and protein binding. Polymethylmethacrylate (PMMA) has been used as a spacer in staged healing in humans. In horses, it is the most commonly used delivery vehicle for antimicrobials [80].