CAJ | 학술논문

背景:骨缺损的修复一直是骨科治疗的难点,寻找有效修复骨缺损的骨移植替代材料是目前骨缺损治疗的研究方向.目的:探讨珊瑚多孔羟基磷灰石(coralline hydroxyapatite porous,CHAP)、纤维蛋白(fibrin sealant,FS)及金葡液(staphylococcus aureus injection,SAI)复合物修复骨缺损的作用及其作为人工骨移植替代材料的可行性.设计:随机对照的试验研究.单位:中山大学附属第三医院骨科.材料:实验在中山大学动物实验室和解放军第一军医大学全军生物力学中心完成.羟基磷灰石,纤维蛋白,金葡液.方法:采用新西兰大白兔54只在兔双侧桡骨制备骨缺损模型后分成实验组、对照组及空白组.将CHAP-FS-SAI复合物植入骨缺损处作为实验组,以自体骨植入作为对照组,空白组不植入任何物质.在2,4,8和12周分别进行大体标本观察,组织学,X射线片观察及生物力学测试,比较各组修复骨缺损的能力.主要观察指标:动物一般情况,大体标本,X射线片,组织学,生物力学测定.结果:实验组术后2周见植入物与骨端形成紧密的纤维性连接,镜下可见CHAP周围大量成纤维细胞、软骨细胞及细胞钙化.12周实验组和对照组均见大量成熟的骨细胞及板层骨;实验组见植入物完全骨化,塑形完全,CHAP未完全降解.空白组12周骨缺损区为纤维瘢痕组织填充.镜下主要为大量成纤维细胞.X射线片:2周实验组与对照组有骨痂影.4周骨痂影增多.8周实验组骨缺损消失,CHAP分散在骨痂中;对照组骨折线消失,髓腔开始形成.12周实验组和对照组骨皮质连续,髓腔复通,塑形完全.空白对照组12周骨缺损区无骨性连接.生物力学测试最大扭矩及抗扭刚度在术后4,8,12周复合物组和自体骨组差异无显著性意义(P＞0.05).但术后2周,最大扭距实验组为(0.140±0.032)N·m,对照组为(0.105±0.035)N·m,抗扭刚度两组分别为(0.401±0.050),(0.311±0.050)N·m/rad,实验组高于对照组,差异有显著性意义(t=2.087 0,3.600 0,P＜0.05).结论:CHAP-FS-SAI复合物具有较强的成骨能力和良好的生物相容性,能作为自体骨移植的一种替代物修复骨缺损. 揹景:骨缺損的脩複一直是骨科治療的難點,尋找有效脩複骨缺損的骨移植替代材料是目前骨缺損治療的研究方嚮.目的:探討珊瑚多孔羥基燐灰石(coralline hydroxyapatite porous,CHAP)、纖維蛋白(fibrin sealant,FS)及金葡液(staphylococcus aureus injection,SAI)複閤物脩複骨缺損的作用及其作為人工骨移植替代材料的可行性.設計:隨機對照的試驗研究.單位:中山大學附屬第三醫院骨科.材料:實驗在中山大學動物實驗室和解放軍第一軍醫大學全軍生物力學中心完成.羥基燐灰石,纖維蛋白,金葡液.方法:採用新西蘭大白兔54隻在兔雙側橈骨製備骨缺損模型後分成實驗組、對照組及空白組.將CHAP-FS-SAI複閤物植入骨缺損處作為實驗組,以自體骨植入作為對照組,空白組不植入任何物質.在2,4,8和12週分彆進行大體標本觀察,組織學,X射線片觀察及生物力學測試,比較各組脩複骨缺損的能力.主要觀察指標:動物一般情況,大體標本,X射線片,組織學,生物力學測定.結果:實驗組術後2週見植入物與骨耑形成緊密的纖維性連接,鏡下可見CHAP週圍大量成纖維細胞、軟骨細胞及細胞鈣化.12週實驗組和對照組均見大量成熟的骨細胞及闆層骨;實驗組見植入物完全骨化,塑形完全,CHAP未完全降解.空白組12週骨缺損區為纖維瘢痕組織填充.鏡下主要為大量成纖維細胞.X射線片:2週實驗組與對照組有骨痂影.4週骨痂影增多.8週實驗組骨缺損消失,CHAP分散在骨痂中;對照組骨摺線消失,髓腔開始形成.12週實驗組和對照組骨皮質連續,髓腔複通,塑形完全.空白對照組12週骨缺損區無骨性連接.生物力學測試最大扭矩及抗扭剛度在術後4,8,12週複閤物組和自體骨組差異無顯著性意義(P＞0.05).但術後2週,最大扭距實驗組為(0.140±0.032)N·m,對照組為(0.105±0.035)N·m,抗扭剛度兩組分彆為(0.401±0.050),(0.311±0.050)N·m/rad,實驗組高于對照組,差異有顯著性意義(t=2.087 0,3.600 0,P＜0.05).結論:CHAP-FS-SAI複閤物具有較彊的成骨能力和良好的生物相容性,能作為自體骨移植的一種替代物脩複骨缺損.
배경:골결손적수복일직시골과치료적난점,심조유효수복골결손적골이식체대재료시목전골결손치료적연구방향.목적:탐토산호다공간기린회석(coralline hydroxyapatite porous,CHAP)、섬유단백(fibrin sealant,FS)급금포액(staphylococcus aureus injection,SAI)복합물수복골결손적작용급기작위인공골이식체대재료적가행성.설계:수궤대조적시험연구.단위:중산대학부속제삼의원골과.재료:실험재중산대학동물실험실화해방군제일군의대학전군생물역학중심완성.간기린회석,섬유단백,금포액.방법:채용신서란대백토54지재토쌍측뇨골제비골결손모형후분성실험조、대조조급공백조.장CHAP-FS-SAI복합물식입골결손처작위실험조,이자체골식입작위대조조,공백조불식입임하물질.재2,4,8화12주분별진행대체표본관찰,조직학,X사선편관찰급생물역학측시,비교각조수복골결손적능력.주요관찰지표:동물일반정황,대체표본,X사선편,조직학,생물역학측정.결과:실험조술후2주견식입물여골단형성긴밀적섬유성련접,경하가견CHAP주위대량성섬유세포、연골세포급세포개화.12주실험조화대조조균견대량성숙적골세포급판층골;실험조견식입물완전골화,소형완전,CHAP미완전강해.공백조12주골결손구위섬유반흔조직전충.경하주요위대량성섬유세포.X사선편:2주실험조여대조조유골가영.4주골가영증다.8주실험조골결손소실,CHAP분산재골가중;대조조골절선소실,수강개시형성.12주실험조화대조조골피질련속,수강복통,소형완전.공백대조조12주골결손구무골성련접.생물역학측시최대뉴구급항뉴강도재술후4,8,12주복합물조화자체골조차이무현저성의의(P＞0.05).단술후2주,최대뉴거실험조위(0.140±0.032)N·m,대조조위(0.105±0.035)N·m,항뉴강도량조분별위(0.401±0.050),(0.311±0.050)N·m/rad,실험조고우대조조,차이유현저성의의(t=2.087 0,3.600 0,P＜0.05).결론:CHAP-FS-SAI복합물구유교강적성골능력화량호적생물상용성,능작위자체골이식적일충체대물수복골결손.
BACKGROUND: The restoration of bone defect is always difficult in the treatment of orthopaedics. To find an effective replacement material of bone transplantation to repair bone defect is the direction of the researches in bone defect therapy at present.OBJECTIVE: To investigate the effects of coralline hydroxyapatite porous (CHAP), fibrin sealant(FS) and staphylococcus aureus injection(SAI)compound in bone defect restoration and the feasibility of the compound to be used as replacement material in artificial bone transplantation.DESIGN: A randomized controlled trial.SETTING: Third Hospital affiliated to Sun Yat-sen University.MATERIALS: The study was accomplished in the Animal Laboratory of Sun Yat-sen University and the Institute of Biomechanics of First Military Medical University of Chinese PLA. Materials were CHAP, FS and SAI.METHODS: Fifty-four New Zealand rabbits were randomly divided into study group, control group and bone defect model group after the establishment of bone defect model in the radius on both sides. CHAP-FS-SAI compound was transplanted in the bone defect in rabbits of the study group and autologous bone was transplanted in the rabbits of the control group, nothing was transplanted in rabbits of bone defect model group. Gross specimens observation, histology, X-ray film observation and biomechanics test were conducted at 2, 4, 8 and 12 weeks respectively to compare the ability in bone defect restoration among each group.MAIN OUTCOME MEASURES: General condition, gross specimens,X-ray, histology, and biomechanical testRESULTS: At two weeks after operation, compact fibrous union between graft and bone end was formed in the study group. It could be seen under microscope that CHAP was surrounded by a lot of fibroblast, chondrocyte,and cellular calcification. At 12 weeks, quantities of mature osteoblasts and lamellar bones could be seen in both study group and control group. Graft in the study group was completely ossified with complete moulding but CHAP did not completely degrade. The bone defect area was filled with fibrous scarring tissue at 12 weeks in bone defect model group, in which most of them were fibroblasts under microscope. X-ray films: callus could be seen in both study group and control group at 2 weeks, which increased at 4 weeks. Bone defect disappeared at 8 weeks in the study group and CHAP scattered in the callus. Bone fracture line disappeared and the medullary cavity started to form in control group. Cortical bone was continuous and the medullary cavity re-connected at 12 weeks in both study group and control group with complete moulding. No osseous union was found in bone defect area at 12 weeks in bone defect model group. Biomechanical test: there were no significant differences in maximum torque and anti-torque stiffness at 4, 8 and 12 weeks after operations between the study group and control group( P＞ 0. 05) . However, at 2 weeks after operation, the maximum torque was in control group ( t = 2. 087 0, 3. 600 0, P ＜ 0.05 ).CONCLUSION: CHAP-FS-SAI compound has relative powerful osteogenetic ability and favourable biocompatibility, which can be used as material to replace autologous bone transplantation in bone defect restoration.