带血供脂肪筋膜瓣对骺板缺损骨桥形成的预防作用  

Prevention of bone bridge formation after epiphysea defect with vascularized fat-fascia flap

作　　者：张克勇 余国荣[2] 余黎[2] 张桃根[2] 陶圣祥[2] 

机构地区：[1]湖北省大冶市人民医院骨科,435100 [2]武汉大学中南医院骨科

出　　处：《中华实验外科杂志》2011年第11期1973-1975,共3页Chinese Journal of Experimental Surgery

基　　金：湖北省黄石市重点攻关项目（2009A218）

摘　　要：目的制作未成年兔的股骨远端中心型骺板缺损模型，观察带血供脂肪筋膜瓣充填骺板缺损后对骨桥形成的预防作用。方法用3．5mm克氏针造成兔一侧股骨远端中心型骺板缺损，另一侧作正常参照。实验动物分为3组，A组用带血供脂肪筋膜瓣填塞骺板缺损；13组用游离脂肪筋膜瓣填塞；C组不做任何填塞，为单纯缺损组。20周后，取3组手术侧股骨长度、膝关节外翻角与健侧的差值进行比较，评价股骨的畸形。并通过组织学的方法观察骨桥形成及骺板自身修复情况。结果3组的手术侧股骨长度较对侧正常股骨短，A、B、C组短缩的程度分别为（1．73±1．37）、（3．89±1．49）、（6．52±1．62）mm，3组之间差异有统计学意义（P〈0．05）；3组手术侧股骨与健侧对比均有不同程度的外翻畸形，外翻角的差异分别为A组（3．73±3．41）°，B组（6．34±6．07）°，C组（18．38±10．65）°，C组外翻畸形明显，而A、13两组之间无统计学意义（P〉0．05）。组织学观察，A组脂肪筋膜瓣未被吸收，并有较规则的骺板再生；B组脂肪筋膜瓣大部分吸收，与骺板之间有骨桥形成，骺板再生不规则；C组有明显骨桥形成。结论带血供脂肪筋膜瓣对中心型骺板缺损后的骨桥形成有明显的预防作用，且能减小骺板缺损后股骨的畸形程度。Objective To investigate the prevention results of bone bridge formation after epiphy- sea defect, by building the model of distal physeal femoral center defect in juvenile rabbit and filling the defect with vascularized fat-fascia flap. Methods One side of distal physeal femoral center defect in juvenile rabbit was made by a 3.5 mm Kirschner wire, and the other side limb was normal reference. Experimental animals were divided into three groups： The physeal defect of group A was filled with vascularized fat-fascia flap; Group B was filled with free fat-fascia flap; Group C was the simple defect group without any fillings. After 20 weeks, the differences of femur length and knee valgus angle between the operated side and the normal side were used to evaluate the degree of femoral deformity. Results the lengths of operative femur in the three groups were shorter than the contralateral femur, and the shortening lengths of group A, B and C were （1.73 ±1.37） mm, （3.89 ±1.49） mm, （6. 52 ±1.62） mm respectively. The difference between the three groups was significantly. Comparing with the contralateral femur, three were different degrees of knee valgus deformity in the operative femur of the three groups. Valgus angle differences of group A was （3.73 ±3.41 ） °, group B was （6. 34 ±6. 07）° and group C was （18.38 ±10. 65） °. The valgus deformity of group C was obvious, and there was no significant difference between group A and group B. Histology, fat-fascia flap of group A fat was not absorbed, and there was regular epiphyseal regeneration around the flap ; the most part of fat-fascia flap in group B was not absorbed, some bone bridges formatted between the epiphyseal plate and the flap, and regeneration of epiphyseal plate was irregular; There was significantly bone bridge formation in group C. Conclusion The vascularized fat-fascia flap can prevent the bone bridge formation after the central type of epiphyseal defect significantly, and reduce the deformities of femur after epiphyseal d

关 键 词：骺板缺损 骨桥 脂肪筋膜瓣 血供 

分 类 号：R726.8[医药卫生—儿科]