重组人BMP-2/多孔磷酸钙人工骨/自体骨结合富血小板血浆在Masquelet技术修复兔大段骨缺损中的应用研究  

Recombinant human bone morphogenetic protein 2/porous calcium phosphate cement/autologous bone and combination of platelet-rich plasma in repairing of large bone defects in rabbits by Masquelet technique

作　　者：丛雨轩 张斌飞[1] 付亚辉[1] 魏星[1] 王虎[1] 邓洪利 庄岩[1] 张堃[1] 雷金来[1] CONG Yuxuan;ZHANG Binfei;FU Yahui;WEI Xing;WANG Hu;DENG Hongli;ZHUANG Yan;ZHANG Kun;LEI Jinlai(Department of Orthopedic Trauma,Honghui Hospital,Xi'an Jiaotong University,Xi'an Shaanxi,710054,P.R.China)

机构地区：[1]西安交通大学附属红会医院创伤骨科,西安710054

出　　处：《中国修复重建外科杂志》2022年第10期1288-1295,共8页Chinese Journal of Reparative and Reconstructive Surgery

基　　金：陕西省社会发展项目(2019SF-170)。

摘　　要：目的探讨使用Masquelet技术修复大段骨缺损时,使用重组人BMP-2(recombinant human BMP-2,rhBMP-2)复合多孔磷酸钙人工骨(porous calcium phosphate cement,PCPC)与自体骨作为植骨材料具有最佳成骨能力时的混合比例;并评估在最佳混合比例下联合应用富血小板血浆(platelet-rich plasma,PRP)对骨缺损愈合的影响。方法取54只新西兰大白兔建立尺骨2 cm长骨缺损模型,利用Masquelet技术进行治疗,在Masquelet技术第二阶段进行两部分实验。首先取36只已造模实验动物,根据植入自体骨及rhBMP-2/PCPC质量比不同随机分为4组(n=9)。A组:自体骨(100%);B组:25%自体骨+75%rhBMP-2/PCPC;C组:50%自体骨+50%rhBMP-2/PCPC;D组:75%自体骨+25%rhBMP-2/PCPC。术后4、8、12周处死动物行大体观察、影像学检查、组织学观察(HE染色)、ALP活性检测及生物力学检测(三点弯曲试验)评估成骨能力,确定自体骨和rhBMP-2/PCPC最佳混合比例。然后取18只已造模实验动物随机分为2组(n=9),对照组植入最佳混合比例自体骨+rhBMP-2/PCPC,实验组植入最佳混合比例自体骨+rhBMP-2/PCPC+自体PRP。术后4、8、12周同上法进行各项指标观测。结果术后各组大体观察到缺损断端骨痂形成至骨皮质连接的骨愈合过程;影像学检查可见新骨生成、与宿主骨形成桥接以及骨质重塑至正常骨密度;组织学观察可见术后形成新的编织骨、新生毛细血管、骨髓腔等结构;各组ALP活性随时间延长均逐渐增加(P<0.05),术后各时间点A组ALP活性显著高于其余3组,C、D组高于B组(P<0.05),C、D组间差异无统计学意义(P>0.05);生物力学检测表明各组三点弯曲试验最大载荷随时间延长均逐渐增加(P<0.05),术后各时间点A、D组最大载荷显著高于B、C组(P<0.05),A、D组间差异无统计学意义(P>0.05)。根据上述检测结果得出最佳混合比例为75%自体骨+25%rhBMP-2/PCPC。后续实验大体观察、影像学检查及组织学观察均观察到�Objective To investigate the optimal mixing ratio of recombinant human bone morphogenetic protein 2(rhBMP-2)with porous calcium phosphate cement(PCPC)and autologous bone as bone grafting material for the repair of large bone defects using Masquelet technique.The effect of platelet-rich plasma(PRP)on the healing of bone defects was evaluated under the optimal ratio of mixed bone.Methods Fifty-four New Zealand White rabbits were taken to establish a 2 cm long bone defect model of the ulna and treated using the Masquelet technique.Two parts of the experiment were performed in the second phase of the Masquelet technique.First,36 modeled experimental animals were randomly divided into 4 groups(n=9)according to the mass ratio of autologous bone and rhBMP-2/PCPC.Group A:autologous bone(100%);group B:25%autologous bone+75%rhBMP-2/PCPC;group C:50%autologous bone+50%rhBMP-2/PCPC;group D:75%autologous bone+25%rhBMP-2/PCPC.The animals were executed at 4,8,and 12 weeks postoperatively for general observation,imaging observation,histological observation(HE staining),alkaline phosphatase(ALP)activity assay,and biomechanical assay(three-point bending test)were performed to assess the osteogenic ability and to determine the optimal mixing ratio.Then,18 modeled experimental animals were randomly divided into2 groups(n=9).The control group was implanted with the optimal mixture ratio of autologous bone+rhBMP-2/PCPC,and the experimental group was implanted with the optimal mixture ratio of autologous bone+rhBMP-2/PCPC+autologous PRP.The same method was used to observe the above indexes at 4,8,and 12 weeks postoperatively.Results The bone healing process from callus formation to the cortical connection at the defected gap could be observed in each group after operation;new bone formation,bridging with the host bone,and bone remodeling to normal bone density were observed on imaging observation;new woven bone,new capillaries,bone marrow cavity,and other structures were observed on histological observation.The ALP activity of each grou

关 键 词：骨缺损 Masquelet技术 重组人BMP-2 多孔磷酸钙人工骨 富血小板血浆 兔 

分 类 号：R687.3[医药卫生—骨科学]