生长期山羊囊内骨折复位术中保留髁突软骨的重要性及组织学研究  

The role of retaining condylar cartilage in open surgery of intracapsular condylar fracture in growing goats:histological analysis

作　　者：冯智强[1,2] 李凌志[1] 周志迎[2] 何冬梅[1] 赖仁发[2] 杨驰[1] 

机构地区：[1]上海交通大学医学院附属第九人民医院·口腔医学院口腔外科,上海市口腔医学重点实验室,上海200011 [2]暨南大学附属第一医院口腔科,广东广州510632

出　　处：《中国口腔颌面外科杂志》2013年第6期459-467,共9页China Journal of Oral and Maxillofacial Surgery

基　　金：上海市科学技术委员会资助项目(08DZ2271100)

摘　　要：目的:通过组织学观察,探讨髁突囊内骨折内固定术中保留和切除髁突软骨对髁突生长发育的影响。方法:6个月龄山羊12只,随机分为实验组(n=8)和对照组(n=4)。实验组双侧髁突造成囊内骨折并同期行手术复位固定,一侧保留髁突软骨,另一侧切除髁突软骨。术后3个月、6个月处死动物,切取髁突标本行石蜡切片和硬组织切片观察骨折愈合和髁突生长情况。结果:实验组髁突骨折愈合良好,钛板被新生骨组织覆盖;HE染色显示,保留髁突软骨组,髁突软骨结构清晰,与正常对照髁突相同,软骨成骨活跃,髁突生长发育正常;切除髁突软骨组,髁突软骨层消失,表面为成熟的骨细胞覆盖,直接与关节盘的纤维组织相连,新生骨组织少见;硬组织切片显示,钛板与骨组织直接结合,未见组织渗出和排异反应。结论:手术复位髁突囊内骨折时保留髁突软骨,不会影响髁突的生长发育;损伤髁突软骨,会造成髁突与关节盘黏连,引起髁突生长发育障碍。PURPOSE： To evaluate the role of retaining and removing condylar cartilage in open reduction and internal fixation （ORIF） of intracapsular condylar fracture （ICF） in growing goats by histological analysis. METHODS： Twelve 6- month-old goats were randomly divided into two groups, experimental group （n=8） and control group （n=4）. ICF was created in bilateral mandibular condyles and then treated with ORIF. One side of the condylar cartilage was retained, while the other side of the condylar cartilage was removed. Condyles in the control group were untouched. The animals were sacrificed at the following intervals, 3 months and 6 months post operatively. Specimens were harvested for paraffin sections and undeealcified histologic sections. RESULTS： Gross specimens showed good healing of condylar fractures. The titanium plate and screws were completely covered by new bone tissue. Paraffin sections of the condyles with the articular cartilage retained showed the tissue structures were clear and no differences from the normal condylar tissue. Osteogenie activity in cartilage layer and normal growth and development of condyle were found. The basic structures of cartilage layer of the condyle with articular cartilage removed disappeared. Articular surfaces were mostly mature bone cells and new bone tissue was rare. The surface of mature bone tissue of the condyle directly connected with fibrous tissue of the articular disc. Undecalcified histologic sections showed that bone tissue directly contacted with titanium and no tissue fluid exudation and cellular rejection were noted. CONCLUSION： The intracapsular condylar fractures with the articular cartilage treated with ORIF will not interfere with condylar growth. Full-thickness articular cartilage removal can lead to articular disc adhesion and condylar growth arrest, resulting in the decreased mandibular ramus heights. Supported by Research Fund of Science and Technology Committee of Shanghai Municipality （08DZ2271100）.

关 键 词：髁突囊内骨折 开放性复位固定 生长期山羊 组织学研究 

分 类 号：R782.4[医药卫生—口腔医学]