可控性微动时间对骨折愈合影响的实验研究  

Experimental study of the time effect of controlled micromovement on the influence of the fracture healing

作　　者：向明[1] 胡晓川[1] 林砚铭[2] 邓友章[2] Xiang Ming;Hu Xiaochuan;Lin Yanming;Deng Youzhang(Department of Upper Extremity,Sichuan Orthopaedic Hospital,Chengdu 610041,China;Hospital of Chengdu University of Traditional Chinese Medicine,Chengdu 610041,China)

机构地区：[1]四川省骨科医院上肢科,成都610041 [2]成都中医药大学附属医院,610041

出　　处：《中华骨科杂志》2019年第21期1333-1343,共11页Chinese Journal of Orthopaedics

摘　　要：目的探讨骨折固定后不同时间开始可控性微动对骨折愈合的影响及机制。方法制备兔股骨骨折模型48只,用单边双杆外固定架固定后随机平均分成四组:持续固定组、即刻微动组、1周微动组和2周微动组,每组12只。术后1、2、3和5周摄股骨正、侧位X线片,观察骨痂生长情况。术后5周,测量骨折断端处骨痂的最大载荷、挠度和刚度。术后1、2和3周,观察骨痂的组织学形态,检测骨痂中骨钙素的表达和分布。结果术后5周,1周和2周微动组骨折愈合的X线评分分别为(10.384±0.744)分和(10.412±0.482)分,明显高于持续固定组(7.518±0.536)分。1周和2周微动组外骨痂前后径[(14.3±3.2)mm和(14.0±2.8)mm]和内外径[(14.6±2.1)mm和(15.2±3.1)mm],虽小于持续固定组[(15.3±2.3)mm和(16.7±1.9)mm],但差异无统计学意义。1周和2周微动组骨折处骨密度值[(0.446±0.020)g/cm^2和(0.416±0.021)g/cm2]及比率(1.171%±0.056%和1.143%±0.040%),较持续固定组[(0.376±0.022)g/cm^2和0.912%±0.051%]显著增高。1周微动组和2周微动组骨痂的最大载荷[(415.6±27.2)N和(400.3±28.5)N],均显著高于持续固定组[(329.2±18.4)N]和即刻微动组[(272.8±22.7)N]。骨痂的挠度各组间均无统计学差异。1周微动组骨痂的刚度为(590.4±24.2)N/mm,显著高于其他各组;2周微动组骨痂的刚度为(540.6±22.8)N/mm,显著高于即刻微动组[(152.4±21.7)N/mm]和持续固定组[(174.8±20.6)N/mm]。结论1周和2周开始微动能明显增加骨折处的外骨痂量、骨折线模糊程度,加快桥接骨痂形成;明显增加骨折处外骨痂的骨密度和愈合组织的刚度;软骨细胞成熟、肥大以及矿化加快,使软骨内成骨过程加快;增加破骨细胞数量和密度,明显加快软骨细胞的成熟和矿化;成骨细胞和破骨细胞耦合作用的加强,促进了软骨痂向硬骨痂转化以及硬骨痂的重塑。Objective To explore the influence and mechanism of time effect of the controlled micromovement on fracture healing.Methodse Forty-eight rabbit models of femoral fracture were prepared and fixed with unilateral two-bar external fixator.They were randomly divided into four groups:continuing immobilization group,instant micromovement group,1-week micromovement group and 2-week micromovement group.Postoperative radiographs were taken at 1,2,3 and 5 weeks to observe callus growth.The maximum load,deflection and rigidity of callus at fracture end were measured 5 weeks after operation.At 1,2 and 3 weeks after operation,the histological morphology of callus was observed,and the expression and distribution of osteocalcin(oc)in callus were detected.Results At 5 weeks after operation,the X-ray scores of fracture line in 1-week micromovement group and 2-week micromovement group were 10.384±0.744 mm,10.412±0.482 mm,significantly higher than those in continuing immobilization group(7.518±0.536).The anteroposterior diameter and the exterior and interior diameter of the external callus in 1-week micromovement group and 2-week micromovement group were 14.3±3.2 mm,14.0±2.8 mm and 14.6±2.1 mm,15.2±3.1 mm,which were smaller than those in the continuing immobilization group 15.3±2.3 mm and 16.7±1.9 mm,but there was no significant difference.The bone mineral density value and proportion rate in the fracture site were 0.446±0.020 g/cm^2,0.416±0.021 g/cm^2 and 1.171%±0.056%,1.143%±0.040%in 1-week micromovement group and 2-week micromovement group,which were significantly higher than those in continuing immobilization group which were 0.376±0.022 g/cm2 and 0.912%±0.051%.The maximum load of callus in 1-week micromovement group and 2-week micromovement group was 415.6±27.2 N,400.3±28.5 N,which was significantly higher than that in continuing immobilization group 329.2±18.4 N and instant micromovement group 272.8±22.7 N.There was no difference of the deflection of callus between groups.The rigidity of callus in 1-week mi

关 键 词：骨折 骨折愈合 外固定器 

分 类 号：R68[医药卫生—骨科学]