CAJ | 학술논문

目的构建生物材料人工胸壁并重建犬巨大胸壁骨性缺损,对照传统的"三明治"重建法来探讨人工胸壁重建胸壁骨性缺损的可行性和有效性.方法 (1)对猪膜性及骨性材料进行组织处理及表面改性,制备出人工胸膜及人工肋骨并构建成人工胸壁用于术中重建.(2)以中国杂种犬5只制备成胸壁巨大缺损模型(缺损>5 cm×5 cm).(3)实验组3只以生物材料人工胸壁进行修复重建,对照组2只采用传统的"三明治"法修复,随访观察两组术后3,6,12个月的重建效果及置入后的排斥反应.结果实验组3只犬围术期及术后随访12个月均存活,未见植入后排斥反应,重建后的胸壁外形正常,修复重建区域无塌陷,胸廓活动度好,未见反常呼吸.术后3,6,12,24个月X线检查显示重建后胸廓完整性良好,无变型,人工肋骨对位好且无移位,未见胸壁反常运动.对照组2只术后随访见重建处胸壁外形尚正常,局部有轻微塌陷,无明显反常呼吸.胸部X线检查显示"三明治"中的骨水泥移植体不透X线,且随呼吸有轻度的反常运动.各组术后血常规及免疫球蛋白5项均未见异常.结论生物材料人工胸壁重建犬胸壁骨性缺损安全、有效,无急性及慢性排斥反应发生,修复重建效果良好.
목적 구건생물재료인공흉벽병중건견거대흉벽골성결손,대조전통적"삼명치"중건법래탐토인공흉벽중건흉벽골성결손적가행성화유효성.방법 (1)대저막성급골성재료진행조직처리급표면개성,제비출인공흉막급인공륵골병구건성인공흉벽용우술중중건.(2)이중국잡충견5지제비성흉벽거대결손모형(결손>5 cm×5 cm).(3)실험조3지이생물재료인공흉벽진행수복중건,대조조2지채용전통적"삼명치"법수복,수방관찰량조술후3,6,12개월적중건효과급치입후적배척반응.결과 실험조3지견위술기급술후수방12개월균존활,미견식입후배척반응,중건후적흉벽외형정상,수복중건구역무탑함,흉곽활동도호,미견반상호흡.술후3,6,12,24개월X선검사현시중건후흉곽완정성량호,무변형,인공륵골대위호차무이위,미견흉벽반상운동.대조조2지술후수방견중건처흉벽외형상정상,국부유경미탑함,무명현반상호흡.흉부X선검사현시"삼명치"중적골수니이식체불투X선,차수호흡유경도적반상운동.각조술후혈상규급면역구단백5항균미견이상.결론 생물재료인공흉벽중건견흉벽골성결손안전、유효,무급성급만성배척반응발생,수복중건효과량호.
Objective To build a bio-material artificial chest wall and discuss its feasibility and efficiency in reconstruction of huge bony defects of chest wall in mongrels in comparison with traditional "sandwich" procedure. Methods (1) The procine osteal and membranate tissues were treated with epoxy cross linking method and their surfaces were modified with amino acid solutions at various concen-trations and at different temperatures to obtain an artificial pleura and artificial ribs for construction of the artificial chest wall. (2) The huge bony defects (5 cm×5 cm) were created in chest wall of five Chinese mongrels. (3) Three mongrels in test group was repaired with artificial chest wall, while two mongrels in control group was repaired with traditional "sandwich" complex. A follow-up was carried out to observe reconstruction effect and rejection in both groups at 3,6 and 12 months after implantation. Results There was no death found during the perioperative period and at 12 month follow-up in test group, with abnormal contour of chest wall and good thoracic activity after reconstruction. In the meantime, there found no rejection, collapse in the repaired region or paradoxical respiration. The postoperative X-rays at 3,6,12 and 24 months showed a good integrity of the thorax, with no collapse, deformation or abnormal movement. Meanwhile, the follow-up of control group showed a normal contour but slight collapse, with no paradoxical respiration. The Chest X-ray examination revealed that the bone cement in" sandwich" complex was X ray opaque and showed mild abnormal movement with breathing. The common blood test and immune items showed no abnormal. Conclusions The bio-material artificial chest wall is a safe and effective reconstruction technique for bony defects of thoracic wall in mongrels, with no acute or chronic rejection.