隐血管骨膜瓣预防骺板损伤后骨桥形成的实验研究  

Saphenous vascular periosteal flap in prevention of bone bridge formation after epiphyseal plate injury:An experimental study

作　　者：邓玲珑[1] 邓凯[1] 余黎[1] DENG Linglong;DENG Kai;YU Li(Department of Orthopaedic Trauma and Microsurgery,Zhongnan Hospital of Wuhan University,Wuhan 430071,China)

机构地区：[1]武汉大学中南医院创伤与显微骨科,武汉430071

出　　处：《中华显微外科杂志》2022年第4期431-436,共6页Chinese Journal of Microsurgery

基　　金：中央高校基本科研业务费专项资金资助项目(303274012);武汉大学研究学分课程建设项目(413100076)。

摘　　要：目的建立未成年兔骺板损伤模型, 探究隐血管骨膜瓣预防骺板损伤后骨桥形成的效果。方法 2017年7月至2018年1月, 将30只新西兰幼兔随机分为A、B、C组(每组10只), 解剖其膝关节血管, 设计隐血管骨膜瓣。用直径为3.0 mm克氏针损伤幼兔单侧股骨远端骨骺, 建立骺板损伤的模型, 为实验侧, 另一侧作为对照侧。对损伤的骨骺分别进行以下处理:A组实验侧切取与C组实验侧相同大小的骨膜并舍弃;B组实验侧在损伤区填充不带血管蒂的骨膜瓣;C组实验侧在损伤区填充隐血管蒂的骨膜瓣。术后24周测量股骨标本的长度及内外翻角, 评估骺板损伤对骨骼生长的影响, 并通过脱钙标本的剖面观、苏木素-伊红(HE)染色和甲苯胺蓝染色, 评估隐血管骨膜瓣预防骨桥形成的效果。计量资料以均值±标准差(Mean±SD)表示, 组内及组间数据比较采用单因素方差分析(ANOVA), P<0.05为差异有统计学意义。结果 A、B两组实验侧股骨均较对照侧表现出明显短缩与外翻畸形, 组内两侧股骨长度与外翻角差异有统计学意义(P<0.05),C组实验侧股骨长度及外翻角与对照侧相比差异无统计学意义(P>0.05)。剖面观显示A组骨骺损伤区出现骨桥, 与周围骺板界限清楚;B组损伤区骨膜瓣被吸收, 以纤维组织填充为主, 伴有少许浅白色骨组织形成, 与周围骺板界限清楚;C组损伤区由与骺板色泽相同的乳白色透明软骨组织填充, 与骺板界限不清。HE及甲苯胺蓝染色发现,A组损伤区填充大量的骨组织, 未见软骨组织;B组损伤区主要为纤维组织, 可发现少量的骨组织;C组沿着损伤区隧道有大量透明软骨组织形成, 且与正常骺板连接紧密。结论骺板损伤后隐血管骨膜瓣填充可预防骨桥形成, 避免患肢出现短缩及成角畸形。Objective To establish a model of epiphyseal plate injury in juvenile rabbits and explore the effect of periosteum flap with saphenous artery on preventing the formation of bone bridge after epiphyseal plate injury.Methods From July 2017 to January 2018,30 young New Zealand immature rabbit were randomly grouped into 3 groups(group A,B and C,with 10 rabbits per group).The blood vessels of knee joint were dissected and a periosteum flap with saphenous artery were designed.A model of distal femoral epiphyseal plate injury was established in immature rabbits with a 3.0 mm Kirschner wire on one side of the distal femoral epiphyseal plate as experimental side,and the other side of the distal femoral epiphyseal plate was assigned as control side.The injured epiphysis were prepared and described as follow:in experimental side of group A,a piece of periosteum with the same size as that in group C was resected and discarded.In experimental side of group B,a periosteal flap without vascular pedicle was filled in the injured area.And in experimental side of group C,a periosteum flap with saphenous artery was filled in the injured area.The length and varus angle of femur specimens of length and varus angle of femur specimens wihthin groups were measured at 24 weeks after surgery to evaluate the effect on bone growth in epiphyseal plate injury.The effect of the periosteum flap with saphenous artery on preventing a formation of bone bridge was assessed by section view of decalcified specimens,HE staining and toluidine blue staining.The measured data were expressed as Mean and standard deviation(Mean±SD),and data were compared within and between the groups using one-way analysis of variance(ANOVA).P<0.05 was considered as statistically significant.Results The femur of experimental side of group A and B showed obvious short with valgus deformity compared with that of control side,and the difference of length and varus angle of femur specimens wihthin groups was statistically significant(P<0.05).There were no significant differen

关 键 词：骺板 隐血管蒂 骨膜瓣 骨桥 兔 

分 类 号：R687.3[医药卫生—骨科学]