中国综合临床
中國綜閤臨床
중국종합림상
CLINICAL MEDICINE OF CHINA
2009年
10期
1013-1017
,共5页
杨新明%石蔚%杜雅坤%牛春雨%孟宪勇%阴彦林%李化光
楊新明%石蔚%杜雅坤%牛春雨%孟憲勇%陰彥林%李化光
양신명%석위%두아곤%우춘우%맹헌용%음언림%리화광
骨缺损%骨移植%带蒂筋膜辩%膜诱导性骨再生
骨缺損%骨移植%帶蒂觔膜辯%膜誘導性骨再生
골결손%골이식%대체근막변%막유도성골재생
Bone defect%Bone grafting%Fascial flap with vessels%Membrane guided bone regenera-tion
目的 研究以带蒂筋膜辨为膜诱导促非细胞型组织工程骨血管化及骨再生修复骨缺损的效果,为临床应用提供依据.方法 将24只成年新西兰大白兔右侧桡骨造骨缺损模型,取自体红骨髓与含骨形成蛋白的骨诱导活性材料混合成非细胞型组织工程复合体.分为2组,对照组12只,仅植入复合物;实验组12只,利用显微外科技术在骨缺损邻近制备一个带有无名血管蒂所属毛细血管网的筋膜瓣,使其包裹组织工程复合体并充填骨缺损.在一定时间内进行X线检查和吸光度比测量、大体观察和组织学检查、修复区内骨形态计量分析和交界区血管图像分析.定量变量组间所得数据比较,采用SPSS 11.5软件行方差分析以及t检验.结果 筋膜瓣机械性地阻碍了纤维结缔组织和周围软组织进入骨缺损部位,保持骨缺损部位有相对稳定的环境;膜下间隙空间本身及充填物的形状和量对骨再生的形状和量起决定作用;在构建组织工程化骨的同时建立其血液供应,2组术后4周的吸光度值[对照组(0.732±0.021)与实验组(0.651±0.018)]相比差异有统计学意义(P<0.05),2组各时间点(术后4、8、12、16周)的骨小梁面积占修复区面积的比值[对照组为(2.32±2.57)%、(8.37±3.52)%、(28.57±2.98)%、(47.24±3.42)%,实验组分别为(19.37±3.52)%、(30.24±3.42)%、(58.76±4.62)%、(88.72±5.84)%]和骨修复交界区单位面积内血管再生面积[对照组为(5.04±1.62)%、(10.37±2.96)%、(18.20±2.12)%、(17.82±2.74)%,实验组为(17.53±2.86)%、(35.24±1.13)%、(48.76±4.62)%、(57.72±5.84))%]比较,差异均有统计学意义(P均<0.05),说明无论植入物内部血管的长入、骨小梁及软骨组织形成的数量和速度,还是成熟骨结构的形成、骨干结构的重塑、骨髓腔的再通、植入物的吸收降解,明显优于无筋膜瓣对照组.结论 以带蒂筋膜瓣为膜诱导,具有促非细胞型组织工程骨血管化和膜引导性骨再生双重作用,对骨缺损有极好的修复作用.
目的 研究以帶蒂觔膜辨為膜誘導促非細胞型組織工程骨血管化及骨再生脩複骨缺損的效果,為臨床應用提供依據.方法 將24隻成年新西蘭大白兔右側橈骨造骨缺損模型,取自體紅骨髓與含骨形成蛋白的骨誘導活性材料混閤成非細胞型組織工程複閤體.分為2組,對照組12隻,僅植入複閤物;實驗組12隻,利用顯微外科技術在骨缺損鄰近製備一箇帶有無名血管蒂所屬毛細血管網的觔膜瓣,使其包裹組織工程複閤體併充填骨缺損.在一定時間內進行X線檢查和吸光度比測量、大體觀察和組織學檢查、脩複區內骨形態計量分析和交界區血管圖像分析.定量變量組間所得數據比較,採用SPSS 11.5軟件行方差分析以及t檢驗.結果 觔膜瓣機械性地阻礙瞭纖維結締組織和週圍軟組織進入骨缺損部位,保持骨缺損部位有相對穩定的環境;膜下間隙空間本身及充填物的形狀和量對骨再生的形狀和量起決定作用;在構建組織工程化骨的同時建立其血液供應,2組術後4週的吸光度值[對照組(0.732±0.021)與實驗組(0.651±0.018)]相比差異有統計學意義(P<0.05),2組各時間點(術後4、8、12、16週)的骨小樑麵積佔脩複區麵積的比值[對照組為(2.32±2.57)%、(8.37±3.52)%、(28.57±2.98)%、(47.24±3.42)%,實驗組分彆為(19.37±3.52)%、(30.24±3.42)%、(58.76±4.62)%、(88.72±5.84)%]和骨脩複交界區單位麵積內血管再生麵積[對照組為(5.04±1.62)%、(10.37±2.96)%、(18.20±2.12)%、(17.82±2.74)%,實驗組為(17.53±2.86)%、(35.24±1.13)%、(48.76±4.62)%、(57.72±5.84))%]比較,差異均有統計學意義(P均<0.05),說明無論植入物內部血管的長入、骨小樑及軟骨組織形成的數量和速度,還是成熟骨結構的形成、骨榦結構的重塑、骨髓腔的再通、植入物的吸收降解,明顯優于無觔膜瓣對照組.結論 以帶蒂觔膜瓣為膜誘導,具有促非細胞型組織工程骨血管化和膜引導性骨再生雙重作用,對骨缺損有極好的脩複作用.
목적 연구이대체근막변위막유도촉비세포형조직공정골혈관화급골재생수복골결손적효과,위림상응용제공의거.방법 장24지성년신서란대백토우측뇨골조골결손모형,취자체홍골수여함골형성단백적골유도활성재료혼합성비세포형조직공정복합체.분위2조,대조조12지,부식입복합물;실험조12지,이용현미외과기술재골결손린근제비일개대유무명혈관체소속모세혈관망적근막판,사기포과조직공정복합체병충전골결손.재일정시간내진행X선검사화흡광도비측량、대체관찰화조직학검사、수복구내골형태계량분석화교계구혈관도상분석.정량변량조간소득수거비교,채용SPSS 11.5연건행방차분석이급t검험.결과 근막판궤계성지조애료섬유결체조직화주위연조직진입골결손부위,보지골결손부위유상대은정적배경;막하간극공간본신급충전물적형상화량대골재생적형상화량기결정작용;재구건조직공정화골적동시건립기혈액공응,2조술후4주적흡광도치[대조조(0.732±0.021)여실험조(0.651±0.018)]상비차이유통계학의의(P<0.05),2조각시간점(술후4、8、12、16주)적골소량면적점수복구면적적비치[대조조위(2.32±2.57)%、(8.37±3.52)%、(28.57±2.98)%、(47.24±3.42)%,실험조분별위(19.37±3.52)%、(30.24±3.42)%、(58.76±4.62)%、(88.72±5.84)%]화골수복교계구단위면적내혈관재생면적[대조조위(5.04±1.62)%、(10.37±2.96)%、(18.20±2.12)%、(17.82±2.74)%,실험조위(17.53±2.86)%、(35.24±1.13)%、(48.76±4.62)%、(57.72±5.84))%]비교,차이균유통계학의의(P균<0.05),설명무론식입물내부혈관적장입、골소량급연골조직형성적수량화속도,환시성숙골결구적형성、골간결구적중소、골수강적재통、식입물적흡수강해,명현우우무근막판대조조.결론 이대체근막판위막유도,구유촉비세포형조직공정골혈관화화막인도성골재생쌍중작용,대골결손유겁호적수복작용.
Objective To study the effect of fascial flap with vessels inducing the vascularization of uncel-lular tissue engingeering complex and the regenration of bone on the repair of bone defect, so as to provide the basis for the clinical application. Methods An animal model of bone defect on adult Newzland rabbits'right radial bone was established .and autologous red bone marrow were taken out and mixed into uncellulax tissue engineering comple-xes with OAM which contained BMP. The experiment animals were divided into two groups : experiment group and control group( n = 12 for each ). The control group was only implanted with complexes, meanwhile, the experiment group had fascial flap with vessels. By microsurgery technology,a non-named fascial flap with vessels was prepared, which belonged to capillary net,around the bone defect,and let it wrap tissue engineering complex,fill up bone de-fect. In a certian time, radiograph(X-ray) and light density measure was conducted, gross morphology and histological inspection was exmained. Bone shape measurement analysis and image of vessel analysis were conducted. All the sta-tistics were analyzed by the SPSS 11.5 software. Results Because of mechanically preventing fiber connective tis-sues and surrounding soft tissues from entering the areas of bone defect by fascial flap, it can keep bone defect having a relative stable environment ;The subfascial space itself, and also the shape and mass of filled-in subject had the de-cisive effect on the results of the regeneration of the bone; Owing to the establishment of blood supply during the con-structing tissue engineering complex. The experiment group was obviously superior to the control group. Compared with control group,the absor bance obviously increased in experiment group [(0. 732 ± 0. 021 ) vs (0. 651± 0.018)] (P < 0. 001 ) four weeks after the operation; also the bone trabecular body was significantly increased [(2.32±2.57)% vs(19.37±3.52)% ,(8.37±3.52)% vs(30.24±3.42)% ,(28.57±2.98)% vs(58.76± 4.62)% ,(47.24±3.42)% vs(88.72±5.84)%] ,and capillary area [(5.04±1.62)% vs(17.53±2.86)%, (10.37 ±2.96)% vs(35.24±1. 13)%,(18.20±2. 12)% vs(48.76±4. 62)%,(17.82 ±2. 74)% vs (57.72 ±5.84)%] (P <0.05) at each time period(4 weeks,8 weeks,12 weeks,and 16 weeks after operation). Despite of growth of implant's internal vessel, the number and speed of forming bone trabecula and cartilaginous tis-sue, even developing of mature bone structure, recreating of diaphysis structure, reconstructing of marrow cavity, ab-sorbing and decomposing of implant, the experiment group was obviously superior to the control group. Conclusions The induction of fascial flap with vessels shows double effects, one of which is the vascularization of uncellular tis-sue engineering complex and the other is membrane guided bone regeneration, So the method has a wonderful effect on the repair of bone defect.
