血管化与膜引导在带蒂筋膜瓣促组织工程复合体修复骨缺损中的作用比较  

Comparison of effect on repair of bone defect using pedicle fascial flap promoting tissue engineering complex guided by membrane and vascularization

作　　者：孟宪勇[1] 杨新明[1] 彭阿钦[2] 苏峰[1] 

机构地区：[1]河北北方学院附属第一医院骨外科,张家口075000 [2]河北医科大学第三医院创伤骨科

出　　处：《中国综合临床》2011年第1期38-44,共7页Clinical Medicine of China

基　　金：河北省科学技术研究与发展计划项目（09276102D-46）;河北省卫生厅医学科学研究重点课题计划项目（20100481）;河北北方学院2009年校级科研课题（2009037）

摘　　要：目的 利用组织工程方法结合显微外科技术在动物体内构建兼有血管化与膜引导作用的非细胞型组织工程复合物,通过与单纯采用膜引导性骨再生技术构建的非细胞型组织工程复合物修复动物体内大段骨缺损的对比研究,观察带蒂筋膜瓣包裹法及单纯生物膜包裹构建的组织工程骨对骨缺,损修复的效果,为临床应用提供实验依据.方法 24只5个月龄新西兰大白兔,制备双侧尺骨中段连同骨膜1 cm骨缺损模型,自体红骨髓（ARBM）接种于含骨形态发生蛋白（BMP）的骨诱导活性材料（OAM）制备组织工程骨.将制成的非细胞型组织工程复合物植入骨缺损区,右侧采用单纯可吸收生物膜包裹（生物膜组）,左侧采用带血运深筋膜瓣包裹（筋膜瓣组）.各组在4、8、12、16周后进行X线检查、吸光度比测量、大体观察和组织学检查、修复区内骨形态计量分析,并在12周行生物力学检测,将数据作统计学处理,用以比较骨缺损修复情况.结果 X线片、大体形态和组织学观察显示,植入物内部血管的长入、骨小梁及软骨组织形成的数量和速度、成熟骨结构的形成、骨干结构的重塑、骨髓腔的再通、植入物的吸收降解,筋膜瓣组均明显优于生物膜组.术后4、8、12、16周的骨小梁面积占修复区面积比值筋膜瓣组为（20.35±2.41）%、（40.21±1.97）%、（66.67±3.44）%、（86.47±3.99）%,生物膜组为（7.46±2.64）%、（20.66±2.28）%、（40.22±1.84）%、（58.18±1.79）%;吸光度值筋膜瓣组为0.636±0.012、0.596±0.062、0.552±0.009、0.451±0.008,生物膜组为0.742±0.032、0.713±0.022、0.655±0.018、0.606±0.015;骨修复交界区单位面积内血管再生面积筋膜瓣组为（18.75 ±2.09）%、（37.41±3.22）%、（53.06±2.18）%、（36.72±4.73）%,生物膜组为（5.34±1.17）%、（9.48±2.%）%、（22.43±2.21）%、（26.27±3.14）%;术后12周生物力学测定筋膜瓣组为26.62±3.Objective The tissue engineering technique and the microsurgery technology is combined to construct the uncellular tissue engineering complex with vascularization and membrane guided dual effect. Through comparing study of using the simple biomembrane guided bone regeneration technique to construct the uncellular tissue engineering complex to repair the large segment bone defect in the animal body,the bone reparative effect of the tissue engineering bone wrapped by pedical fascial flap with vessels and that wrapped by the simple biomembrane was compared, thus to provide experimental evidence for the clinical application. Methods Twenty-four Newzland 5-month-old rabbits were used to build the bilateral periosteumincluded bone defect modelsin the middle piece of the ulna and the length of the defect was 1 cm. Autologous red bone marrow was implanted in the tissue engineering bone which was prepared by osteoinductive absorbing material including BMP. The prepared tissue engineering bone was implanted in the bone defect area. The right side was wrapped by the simple absorbable biomembrane, whereas the left side was wrapped by pedical fascial flap with blood supply. At the fourth, eighth, twelfth and sixteenth week after the operation each group was examined by the radiograph （x-ray）, the light density measurement, gross morphology and histological inspection,bone shape measurement analysis in the repairing area and the biomechanics measurement at the twelfth week. The data was analyzed to test the difference of the bond defect repair. Results The radiograph, gross morphology and histological inspection showed the growth of vessels in the implant area, the quantity and the forming speed of the bone trabecula and, the cartilaginous tissue, the formation of the mature bone structure,remodeling of the diaphysis, recanalization of the cavum ossis and the absorption and the degradation of the implant of the group of pedical fascial flap with blood supply was superior to that of the group of the simple absorbable biomem

关 键 词：骨缺损 带蒂筋膜瓣 膜引导组织再生 自体红骨髓 血管化组织工程骨 

分 类 号：R687.3[医药卫生—骨科学]