骨形态发生蛋白复合带血供肌瓣修复骨缺损成骨过程中骨骼肌的转归(英文)  

Skeletal muscular transformation in osteogenetic process of bone defect repaired with compound vascularized muscle flap with bone morphogenetic protein

作　　者：魏宽海[1] 裴国献[1] 金丹[1] 田雪梅[2] 王珂[1] 陈滨[1] 胡罢生[1] 

机构地区：[1]南方医科大学南方医院创伤骨科,广东省广州市510515 [2]南方医科大学组织胚胎学教研室,广东省广州市510515

出　　处：《中国临床康复》2005年第34期162-164,共3页Chinese Journal of Clinical Rehabilitation

基　　金：国家自然科学基金资助项目(39870881);广东省自然科学基金资助项目(04300723)~~

摘　　要：背景:局部软组织条件不好的难治性骨缺损修复是临床的重大难题和亟待解决的问题。目的:探讨带血供肌瓣作为骨形态发生蛋白载体修复骨缺损成骨过程中骨骼肌的变化。设计:观察对比实验。单位:南方医科大学南方医院实验动物中心。对象:重组人骨形态发生蛋白2;清洁级健康新西兰大白兔20只,1.5～2.5kg,雌雄不拘。方法:实验于2000-01/2002-08在南方医科大学南方医院实验动物中心完成。取10只兔,制作兔桡骨下段15mm骨缺损,将指深屈肌肌瓣去神经后,转位至缺损区,将纤维蛋白与重组人骨形态发生蛋白2复合物植入肌瓣中。分别于1,2,4,6,8周麻醉状态下各处死4只兔,进行骨缺损区肌瓣大体观察、组织学、原位末端标记及超微结构观察。主要观察指标:兔桡骨缺损区肌瓣大体观察、组织学检查、原位末端标记法染色结果及超微结构。结果:20只兔均进入结果分析。①兔桡骨缺损区肌瓣大体观察结果:骨骼肌逐渐发生萎缩,8周时肌纤维几乎完全消失,新生骨组织呈条索状桥接两断端。②兔桡骨缺损区肌瓣组织学检查结果:组织学显示骨骼肌萎缩的同时,部分细胞核出现崩解,并有凋亡小体出现。③兔桡骨缺损区肌瓣细胞凋亡情况:原位末端标记法染色萎缩的骨骼肌纤维内大量显色阳性的细胞核或核碎片。④兔桡骨缺损区肌瓣超微结构:骨骼肌肌丝随时间延长逐渐消失,细胞核出现染色质边集、固缩、碎裂,呈典型的凋亡改变。结论:带血供肌瓣复合骨形态发生蛋白修复骨缺损成骨过程中,肌纤维逐渐发生萎缩、凋亡,最终被骨组织所替代。BACKGROUND： Intraetable repair of bone defect with bad local soft tissues is the essential question in clinic and is expected to deal with. OBJECTIVE： To probe into skeletal muscular changes during osteogenetic process in bone defect repair with vaseularized muscle flap that was taken as the carrier of bone morphogenetic protein （BMP）. DESIGN： Observation and comparison were designed in the experiment. SETTING： Experimental Animal Center of Nanfang Hospital affiliated to Southern Medical University. MATERIALS： rhBMP-2, 20 New Zealand healthy white rabbits of clean grade, weighted varied from 1.5 to 2.5 kg, of either gender. METHODS： The experiment was performed in Experimental Animal Center of Nanfang Hospital affiliated to Southern Medical University from January 2000 to August 2002. Ten rabbits were employed and bone defect was modeled 15 mm long on the lower section of radium. After nerve removed, the muscular flap of deep flexor muscle of fingers was implanted into the defect. In addition, the compound of fihrin and rhBMP-2 was grafted into the muscular flap. Four rahbits were sacrificed in 1, 2, 4, 6 and 8 weeks successively under anesthetization for gross ohservation, histological, TUNEL and uhrastructure examinations of muscular flap on hone defect. MAIN OUTCOME MEASURES： Gross observation, histological, TUNEL and uhrastructure examinations of muscular flap on bone defect in rabbits RESULTS： Twenty rabbits all entered result analysis. ① Gross observation of muscular flap on radial defect in rahbits： Skeletal muscle was atrophic gradually and muscle fiber almost disappeared in 8 weeks and regenerated bone tissues cord-bridged two broken ends.② Histological examination of muscular flap on radial defect in rabbits： It was displayed in histology that while skeletal muscle was atrophic, a part of cell karyon appeared disintegration and apoptotic bodies presented. ③ Cell apoptosis of muscular flap of radial defect in rabbits： It was indicated with TUNEL staining that there were l

关 键 词：骨/损伤 外科皮瓣 骨形态发生蛋白质类 细胞凋亡 重组人骨形态发生蛋白2 骨缺损修复 骨骼肌萎缩 带血供肌瓣 肌瓣修复 成骨过程 

分 类 号：R681[医药卫生—骨科学] R782.4[医药卫生—外科学]