可吸收聚酰胺交锁髓内棒治疗长骨干骨折的骨-材料界面特征  

Bone-material interface characteristics of absorbable interlocking intramedullary rods for treatment of long bone shaft fracture

作　　者：杨远良 黄炳生 王波 陈建民 徐栋梁[2] 

机构地区：[1]广州市番禹区人民医院骨一科,广东省广州市511400 [2]中山大学附属第一医院骨科,广东省广州市510080

出　　处：《中国组织工程研究与临床康复》2009年第26期5027-5030,共4页Journal of Clinical Rehabilitative Tissue Engineering Research

基　　金：广东省科技计划项目(200231104)~~

摘　　要：背景:可吸收性骨科植入材料在体内可以降解吸收,无需再次手术取出,且可能具有刺激骨折愈合的作用。目的:观察可吸收交锁髓内棒治疗长骨干骨折骨-材料界面的特征。设计、时间及地点:随机分组设计,对比观察,于2003-03/09在中山医学院动物实验室完成。材料:杂种犬15只,犬龄10～12个月,体质量13～15kg,用于制备胫骨骨干骨折模型。方法:15只杂种犬随机分为2组,实验组(n=9):在距离胫骨平台下斜坡处钻孔入髓腔,用合适钻头扩大髓腔,确认髓腔大小,从胫骨上端开孔插入聚酰胺钉,解剖复位骨折端并使该钉通过骨折处,在距离截骨处2cm处的远近端分别锁上2枚锁钉,锁钉为圆柱形聚酰胺棒,辅助石膏外固定4周;对照组(n=6):同样插入相应直径的、已预钻4孔的梅花形髓内钉截段,在骨折端的近端及远端分别锁2枚螺钉,辅助石膏外固定4周。主要观察指标:术后4,8,12周各组骨折愈合过程中髓腔内骨-材料界面大体及组织学变化情况。结果:实验组4周,聚酰胺棒完整光滑、无脆裂,与骨髓腔内面紧密相贴,无明显间隙,其表面有一层纤维结缔组织,纤维组织下有大量松质骨和红色骨髓组织形成。8周时髓腔内面见一层光滑纤维膜,呈淡红色,跨越骨折端,其外有大量松质骨形成。12周骨折端完全融合,髓腔材料之间无间隙,锁钉无断裂,聚酰胺棒完整,无变软,表面光滑,骨髓腔聚酰胺棒外充满松质骨和骨髓成分。而对照组骨-材料界面在骨折愈合过程中一直存在空隙,且材料周围无明显骨小梁出现。结论:可吸收交锁髓内棒有较好的固定犬胫骨骨折作用,材料与骨髓腔匹配紧密,具有无毒性且刺激新骨生长作用。BACKGROUND： Absorbable orthopedic implant material can be degraded and absorbed in vivo, which avoids second operation to remove it, and may play a role in stimulating fracture healing. OBJECTIVE： To observe bone-material interface characteristics of absorbable interlocking intramedullary rods （AIIRs） for treatment of long bone shaft fracture. DESIGN, TIME AND SETTING： A randomized grouping and comparative observation. The experiment was performed in the Animal Laboratory, Zhongshan Medical School from March to September 2003. MATERIALS： A total of 15 hybrid dogs, aged 10 12 months, weighing 13-15 kg, were used for the animal models of tibial shaft fracture. METHODS： The 15 hybrid dogs were randomly divided into 2 groups. In the experimental group （n=9）, a hole was drilled at the slope beneath the tibial plateau to reach the medullary cavity. The cavity was enlarged by an appropriate drill to confirm the size of the cavity. The absorbable polyamide intramedullary rods were inserted from the hole in tibial superior extremity, and the fracture was anatomically reduced with the rod passing through the fracture. Two locking nails, which were cylinder pofyamide rods, were respectively located 2 cm from the cutting site, in the distal and proximal ends. Auxiliary plaster external fixation was performed for 4 weeks. In the control group （n=6）, quincunx intramedullary nails of the same diameter with 4 pre-drilled holes were accordingly inserted into the cutting segment, and 2 screws were locked in the distal and proximal ends, respectively. Auxiliary plaster external fixation was performed for 4 weeks. MAIN OUTCOME MEASURES： The general and histological changes of the intramedullary bone-material interface were observed 4, 8, 12 weeks after the operation. RESULTS： In the experimental group at 4 weeks, intramedullary rod was intact and smooth, with no embrittlement, closely attaching to the internal surface of medullary cavity, and no obvious gap was observed; there was a layer of fibrous connect

关 键 词：聚酰胺棒 可吸收交锁髓内棒 长骨干骨折 骨-材料界面 

分 类 号：R318[医药卫生—生物医学工程]