内固定对带蒂筋膜瓣稳定性影响及其促超临界骨缺损成骨作用的观察  

EFFECT OF INTERNAL FIXATION ON STABILITY OF PEDICLED FASCIAL FLAP AND OSTEOGENESIS OF EXCEED CRITICAL SIZE DEFECT OF BONE

作　　者：杨新明[1] 张瑛[1] 孟宪勇[1] 赵御森[2] 王海波[2] 

机构地区：[1]河北北方学院附属第一医院骨科河北张家口,075000 [2]河北北方学院解剖学系

出　　处：《中国修复重建外科杂志》2013年第3期358-364,共7页Chinese Journal of Reparative and Reconstructive Surgery

基　　金：河北省卫生厅医学科学研究重点课题计划(20100481);张家口市科学技术与发展指令计划(0711045D-10);河北北方学院校级科研指令计划(2009007)~~

摘　　要：目的通过影像学及组织学观察,评价内固定对带蒂筋膜瓣稳定性影响及其促超临界骨缺损(exceedcritical size defect,ECSD)成骨作用,为临床应用提供理论依据。方法取32只4～5月龄新西兰大白兔右侧尺骨制备长1 cm的骨-骨膜ECSD模型,随机分为A、B组,每组16只。A组将自体红骨髓(autologous red bone marrow,ARBM)接种于含BMP的骨诱导活性材料上制备组织工程骨,植入骨缺损区,在邻近骨缺损区制备一带蒂深筋膜瓣将其包裹作为对照组;B组在A组基础上行微型钛板内固定作为实验组。术后2、4、6、8周分别行X线片检查、大体观察及组织学观察,并对植入的组织工程骨骨再生修复情况行影像学4分评分法和组织学修复区内骨形态计量分析。结果实验动物均存活至实验完成。X线片示,从组织工程骨的骨纹理、骨断端间隙、材料吸收降解的影像学变化,以及新骨再生、骨干结构形成、髓腔再通方面,B组均优于A组;术后各时间点B组X线片评分均大于A组,差异有统计学意义(P<0.05)。大体及组织学观察示,从筋膜瓣的稳定性、组织工程骨吸收替代速度、外骨痂形成、新生软骨细胞与成熟骨细胞数量和分布,以及新生骨小梁构建、成熟板层骨形成和骨髓腔相通等成骨现象,B组均优于A组;术后各时间点B组新生骨小梁面积占修复区面积比值均大于A组,差异有统计学意义(P<0.05)。结论加强内固定后膜结构及骨缺损区的稳定性均提高,与单纯带蒂筋膜瓣促ECSD成骨作用相比,具有加快组织工程骨再生新骨速度、缩短骨缺损修复时间、提高成骨质量等优点。Objective To evaluate the effect of internal fixation on the stability of pedicled fascial flap and the osteogenesis of exceed critical size defect （ECSD） of bone so as to provide theory for the clinical application by the radiography and histology observation. Methods The ECSD model of the right ulnar midshaft bone and periosteum defect of 1 cm in length was established in 32 New Zealand white rabbits （aged 4-5 months）, which were divided into group A and group B randomly （16 rabbits in each group）. The composite tissue engineered bone was prepared by seeding autologous red bone marrow （ARBM） on osteoinductive absorbing material （OAM） containing bone morphogenetic protein and was used repair bone defect. A pedicled fascial flap being close to the bone defect area was prepared to wrap the bone defect in group A （control group）. Titanium miniplate internal fixation was used after defect was repair with composite tissue engineered bone and pedicled fascial flap in group B （experimental group）. At 2, 4, 6, and 8 weeks, the X-ray films examination, morphology observation, and histology examination were performed; and the imaging 4-score scoring method and the bone morphometry analysis was carried out. Results All rabbits survived at the end of experiment. By X-ray film observation, group B was superior to group A in the bone texture, the space between the bone ends, the radiographic changes of material absorption and degradation, osteogenesis, diaphysis structure formation, medullary cavity recanalization. The radiographic scores of group B were significantly higher than those of group A at different time points after operation （P 〈 0.05）. By morphology and histology observation, group B was superior to group A in fascial flap stability, tissue engineered bone absorption and substitution rate, external callus formation, the quantity and distribution area of new cartilage cells and mature bone cells, and bone formation such as bone trabecula construction, mature lamellar bone formatio

关 键 词：超临界骨缺损 内固定 带蒂筋膜瓣 膜引导骨再生 兔 

分 类 号：R687.3[医药卫生—骨科学]