制备幼兔骺板周围骨折模型:跨骺板钢板置入内固定影响骺板的生长发育?  

Preparation of peri-epiphyseal fracture models in young rabbits: cross-epiphyseal plate internal fixation affects epiphyseal growth?

作　　者：崔庆达 刘伟[2] 王鑫[3] 马龙[4] 张世谦[2] 潘琦[2] 毕郑刚[2] 耿硕[2] 

机构地区：[1]青岛市胶州中心医院关节创伤科,山东省青岛市266300 [2]哈尔滨医科大学附属第一医院骨科,黑龙江省哈尔滨市150001 [3]武警黑龙江省总队医院,黑龙江省哈尔滨市150076 [4]解放军黑龙江省军区医院,黑龙江省哈尔滨市150047

出　　处：《中国组织工程研究》2015年第44期7148-7155,共8页Chinese Journal of Tissue Engineering Research

基　　金：黑龙江省教育厅资助项目(12531370)~~

摘　　要：背景:当儿童四肢骨折涉及骨骺和干骺端骨折时,治疗方法多种多样。针对不同的治疗方法,对骺板生长发育影响的研究也较多。但多局限于不同直径克氏针或空心螺钉内固定对骺板发育的影响,而钢板置入跨越骺板内固定,对骺板生长发育影响及影响程度目前国内外文献报道较少。目的:制备幼兔骺板周围骨折模型,观察跨骺板钢板置入内固定以及取出内固定物后对骺板生长发育的影响。方法:建立幼年家兔右股骨远端骺板上方5 mm横断骨折模型60只,应用相同型号"L"型钢板和4枚螺钉跨骺板及骺板周围骨折线钢板内固定。造模后2,4,8,12周处死8只,取出股骨标本,测量股骨长度、骺板总厚度及单位柱内肥大细胞计数,观察组织形态学和特殊软骨染色中肥大细胞及骺板厚度的变化;另外7只取出内固定,继续养殖2周后处死,再次观察以上指标。左股骨远端骺板作为对照组。结果与结论:钢板组在造模后2周上述观察指标与对照组对比,差异无显著性意义(P>0.05)。钢板组在造模后4,8,12周上述观察指标与对照组对比,差异有显著性意义(P<0.05或<0.001)。造模后2,4周取下钢板,继续观察2周,发现股骨长度、骺板总厚度及单位柱内肥大细胞计数等观察指标都有不同程度恢复,与对照组比较差异无显著性意义(P>0.05)。但造模后8,12周取下钢板,继续观察2周,发现股骨长度、骺板总厚度短缩,单位柱内肥大细胞个数明显减少,与对照组比较,差异有非常显著性意义(P<0.001)。提示跨骺板钢板内固定初期(2周内),在内固定物不伤及骺板的前提下,适当压应力作用对骺板生长发育未见显著影响;但持久过度钢板限制(>4周)将导致骺板生长部分或者完全阻滞,主要引起肢体成角畸形及骺板发育阻滞。跨骺板分别固定2,4,8,12周后,取出内固定继续观察2周,发现在第2,4周两个时间点取出内固定后,股骨长度、骺BACKGROUND： There are various therapies for children limb fractures involving the epiphysis or the metaphysis. According to the different methods, studies on the growth of the epiphyseal plate are a lot, most of which focus onthe effects of Kirschner wires with different diameters or hollow screw internal fixation on the development of epiphyseal plate. However, there are rare studies on the influence of cross-epiphyseal plate internal fixation on the growth of epiphyseal plate as well as the influence level. OBJECTIVE： To prepare a peri-epiphyseal fracture model in young rabbits and to observe the effects of cross-epiphyseal plate implantation and removal on the growth of epiphyseal plate. METHODS： Traverse fracture models were made 5 mm above the right femoral distal epiphyseal plate of 60 young rabbits, and then fixed with suitable ＂L＂ steel plate and four screws across the epiphyseal plate and peri-epiphyseal fracture line. The left side served as control. Eight rabbits were killed and observed at 2, 4, 8, 12 weeks after modeling, respectively, to take out the femoral specimens for measurement of femoral length, thickness of the epiphyseal plate, and number of mastocytes per unit column. Histopathology observation was done and changes in mastocytes and thickness of the epiphyseal plate were detected. Another seven rabbits were selected to remove the metal plate, continued to feed for 2 weeks and finally executed to observe the above-mentioned indexes. RESULTS AND CONCLUSION：（1） There were significant differences in the above indexes between the plate and control groups at 4, 8, 12 weeks after modeling（P〈0.05 or P〈0.001） but not at 2 weeks after modeling（P〉0.05）. These findings indicate that within 2 weeks after cross-epiphyseal plate internal fixation, proper pressue has no remarkable influence on the growth of epiphyseal plate; but after persistent internal fixation（ 〉4 weeks）, the growth of epiphyseal plate can be partially or completed retarded.（2） At 2 and 4 weeks a

关 键 词：骨科植入物 骨植入物 骺板周围骨折 跨骺板 钢板内固定 动物实验 

分 类 号：R318[医药卫生—生物医学工程]