胫骨横向骨搬移微血管重建技术改进的实验研究  

Experimental study on the improvement of Ilizarov transverse tibial bone transport and microcirculation reconstruction technique

作　　者：曹鑫杰 贾中伟 郭秀生 王晓东 余建平 牛佳伟 刘建友 魏杰 Cao Xinjie;Jia Zhongwei;Guo Xiusheng;Wang Xiaodong;Yu Jianping;Niu Jiawei;Liu Jianyou;Wei Jie(Shanxi Medical University,Taiyuan 030001,China;Department of Orthopedics,People’s Hospital of Shanxi Province,Taiyuan 030012,China)

机构地区：[1]山西医科大学,太原030001 [2]山西医科大学附属人民医院骨科,太原030012

出　　处：《中华医学杂志》2019年第45期3592-3596,共5页National Medical Journal of China

基　　金：山西省教育厅研究生联合培养基地人才培养项目(2017JD20)。

摘　　要：目的观察胫骨横向骨搬移传统术式与改良术式对家犬下肢微血管再生的情况.方法10只实验犬全身麻醉后,双侧胫骨分别施行传统和改良的胫骨横向骨搬移术,对照组采用传统方法(骨瓣骨膜完全游离),实验组采用改良方法(保留开窗骨瓣腓侧骨膜).均于术后5d开始每天以1 mm速度向外分次牵拉,搬移1周后间隔3 d进行回搬1周.观察伤口及双下肢活动情况,并于不同时期经股动脉进行数字减影血管造影(DSA)、局部组织切片测量血管内皮细胞密度等方法观察血管新生情况.手术前后数据比较采用配对设计t检验.结果10只实验犬的手术皆顺利完成,且所有伤口均于术后1周左右愈合.所有实验犬双下肢活动未见明显异常.下肢DSA小腿中段周围血管面积:2组术后4周和8周血管面积分别为(5.9±0.4)mm^2、(6.2±0.6)mm^2和(6.9±0.6)mm^2、(8.0±0.6)mm^2,均较术前[分别为(5.0±0.4)mm2和(4.9±0.4)mm^2]显著改善(F=446.457、829.192,均P<0.05),但术后4周两组血管面积差异无统计学意义(t=1.216,P=0.240);术后8周两组血管面积差异有统计学意义(t=4.423,P=0.000).术后8周2组搬移区和足背区血管内皮细胞占镜下染色细胞百分比分别为4.42%±0.28%、5.35%±0.26%和5.63%±0.53%、7.18%±0.25%,均较术前显著提高,组间差异均有统计学意义(t=7.35、8.30,均P<0.05).结论胫骨横向骨搬移微血管网再生技术可重建家犬小腿以下微血管,术中将开窗截骨方式改进为"门"形开窗,保留胫骨嵴外侧骨膜,微血管网再生更为丰富.Objective To observe the effect of traditional and modified Ilizarov transverse tibial bone transport on microvascular regeneration of lower limbs in dogs.Methods After general anesthesia on 10 experimental dogs,traditional and modified transverse tibial bone transport were performed on both tibias respectively.The control group was treated with the traditional method(the periosteum and bone flap were completely isolated),while the experimental group was treated with the modified method(the fibular periosteum of the open window bone flap was retained).All the external fixators were pulled outwards at a speed of 1 mm every day from 5 days after operation;after one week,the external fixators were moved back every 3 days for one week.The situation of wounds and activity of lower limbs were observed.Simultaneously,the angiogenesis was observed by digital subtraction angiography(DSA)through femoral artery at different stages,and the density of vascular endothelial cells measured by local tissue sections.The data before and after the operation were compared with paired t test.Results The operation was successfully completed in 10 experimental dogs,and all wounds healed about 1 week after the operation.There was no significant abnormality in lower limb movements in all dogs.Peripheral blood vessel area in middle leg of lower limb in 4 weeks and 8 weeks after operation was(5.9±0.4)mm^2 and(6.9±0.6)mm^2 in control group and it was(6.2±0.6)mm^2 and(8.0±0.6)mm^2 in experimental group,respectively;all were significantly improved than those before the operation((5.0±0.4)mm2,(4.9±0.4)mm2,respectively)(F=446.457,829.192,both P<0.05).There was no significant differences in vessel area between the two groups at the 4th week after operation(t=1.216,P=0.240),but there was significant difference at the 8th week after operation between the two groups(t=4.423,P=0.000).The percentage of vascular endothelial cells in stained cells under endoscopy was 4.42%±0.28%and 5.63%±0.53%in the control group at the 8th week;and in the exper

关 键 词：骨搬移 血管再生 糖尿病足 ILIZAROV 

分 类 号：R68[医药卫生—骨科学]