中国组织工程研究与临床康复
中國組織工程研究與臨床康複
중국조직공정연구여림상강복
JOURNAL OF CLINICAL REHABILITATIVE TISSUE ENGINEERING RESEARCH
2009年
50期
9979-9983
,共5页
王钢%明江华%周建林%周剑鹏%周庞虎
王鋼%明江華%週建林%週劍鵬%週龐虎
왕강%명강화%주건림%주검붕%주방호
自体%骨髓%松质骨%同种异体皮质骨环%重建
自體%骨髓%鬆質骨%同種異體皮質骨環%重建
자체%골수%송질골%동충이체피질골배%중건
背景:国内外不少学者运用异体骨移植椎间融合进行椎体切除与重建,骨融合时间优于单纯自体骨移植,其在融合早期能提供支撑稳定作用,但制备异体骨移植材料时,易破坏基质中的骨诱导因子,不利于骨质生长.目的:课题创新性设计并验证自体红骨髓复合自体松质骨填充同种异体皮质骨环重建兔颈椎的能力.设计、时间及地点:随机对照动物实验,于2004-10/2006-03在武汉大学人民医院骨科实验室完成.材料:健康成年新西兰大耳白兔60只,雌雄不限,体质量2.0～2.5 kg.其中12只兔用于同种异体皮质骨环的制备;剩余48只兔随机分为3组,每组16只.自体红骨髓于髂前上棘穿刺抽取红骨髓;自体松质骨从兔髂嵴处取得三面皮质骨.将自体红骨髓与自体松质骨复合,填充在自制的同种异体皮质骨环中.方法:3组兔采用第4颈椎切除模拟肿瘤切除模型.联合移植组植入同种异体皮质骨环自体红骨髓-自体松质骨复合物:自体骨移植组植入自体骨;同种异体皮质骨环移植组植入同种异体皮质骨环.主要观察指标:以X射线检查、组织形态学检查、血清碱性磷酸酶及扫描电镜观察各组重建颈椎的效果.结果:术后8周,联合移植组、自体骨移植组植骨材料与上下颈椎融合,有大量骨痂,同种异体皮质骨环移植组可见少量骨痂生长,融合不牢.各组血清碱性磷酸酶开始均升高,4周时联合移植组、自体骨移植组血清中碱性磷酸酶浓度都高于同种异体皮质骨环移植组(P<0.01),联合移植组、自体骨移植组血清中碱性磷酸酶浓度差异无显著性意义(P>0.05).8周时,3组碱性磷酸酶比较差异无显著性意义(P>0.05).组织学观察联合移植组、自体骨移植组形成大量成熟骨基质,骨小梁及骨髓腔.扫描电镜观察示联合移植组、自体骨移植组有大量新骨形成.结论:联合自体红骨髓+自体松质骨+同种异体皮质骨环移植和自体骨移植均有效地重建颈椎,自体红骨髓与自体松质骨复合填充的同种异体皮质骨环可明显促进同种异体皮质骨环重建椎体的作用,可以作为有效椎体重建材料.
揹景:國內外不少學者運用異體骨移植椎間融閤進行椎體切除與重建,骨融閤時間優于單純自體骨移植,其在融閤早期能提供支撐穩定作用,但製備異體骨移植材料時,易破壞基質中的骨誘導因子,不利于骨質生長.目的:課題創新性設計併驗證自體紅骨髓複閤自體鬆質骨填充同種異體皮質骨環重建兔頸椎的能力.設計、時間及地點:隨機對照動物實驗,于2004-10/2006-03在武漢大學人民醫院骨科實驗室完成.材料:健康成年新西蘭大耳白兔60隻,雌雄不限,體質量2.0～2.5 kg.其中12隻兔用于同種異體皮質骨環的製備;剩餘48隻兔隨機分為3組,每組16隻.自體紅骨髓于髂前上棘穿刺抽取紅骨髓;自體鬆質骨從兔髂嵴處取得三麵皮質骨.將自體紅骨髓與自體鬆質骨複閤,填充在自製的同種異體皮質骨環中.方法:3組兔採用第4頸椎切除模擬腫瘤切除模型.聯閤移植組植入同種異體皮質骨環自體紅骨髓-自體鬆質骨複閤物:自體骨移植組植入自體骨;同種異體皮質骨環移植組植入同種異體皮質骨環.主要觀察指標:以X射線檢查、組織形態學檢查、血清堿性燐痠酶及掃描電鏡觀察各組重建頸椎的效果.結果:術後8週,聯閤移植組、自體骨移植組植骨材料與上下頸椎融閤,有大量骨痂,同種異體皮質骨環移植組可見少量骨痂生長,融閤不牢.各組血清堿性燐痠酶開始均升高,4週時聯閤移植組、自體骨移植組血清中堿性燐痠酶濃度都高于同種異體皮質骨環移植組(P<0.01),聯閤移植組、自體骨移植組血清中堿性燐痠酶濃度差異無顯著性意義(P>0.05).8週時,3組堿性燐痠酶比較差異無顯著性意義(P>0.05).組織學觀察聯閤移植組、自體骨移植組形成大量成熟骨基質,骨小樑及骨髓腔.掃描電鏡觀察示聯閤移植組、自體骨移植組有大量新骨形成.結論:聯閤自體紅骨髓+自體鬆質骨+同種異體皮質骨環移植和自體骨移植均有效地重建頸椎,自體紅骨髓與自體鬆質骨複閤填充的同種異體皮質骨環可明顯促進同種異體皮質骨環重建椎體的作用,可以作為有效椎體重建材料.
배경:국내외불소학자운용이체골이식추간융합진행추체절제여중건,골융합시간우우단순자체골이식,기재융합조기능제공지탱은정작용,단제비이체골이식재료시,역파배기질중적골유도인자,불리우골질생장.목적:과제창신성설계병험증자체홍골수복합자체송질골전충동충이체피질골배중건토경추적능력.설계、시간급지점:수궤대조동물실험,우2004-10/2006-03재무한대학인민의원골과실험실완성.재료:건강성년신서란대이백토60지,자웅불한,체질량2.0～2.5 kg.기중12지토용우동충이체피질골배적제비;잉여48지토수궤분위3조,매조16지.자체홍골수우가전상극천자추취홍골수;자체송질골종토가척처취득삼면피질골.장자체홍골수여자체송질골복합,전충재자제적동충이체피질골배중.방법:3조토채용제4경추절제모의종류절제모형.연합이식조식입동충이체피질골배자체홍골수-자체송질골복합물:자체골이식조식입자체골;동충이체피질골배이식조식입동충이체피질골배.주요관찰지표:이X사선검사、조직형태학검사、혈청감성린산매급소묘전경관찰각조중건경추적효과.결과:술후8주,연합이식조、자체골이식조식골재료여상하경추융합,유대량골가,동충이체피질골배이식조가견소량골가생장,융합불뢰.각조혈청감성린산매개시균승고,4주시연합이식조、자체골이식조혈청중감성린산매농도도고우동충이체피질골배이식조(P<0.01),연합이식조、자체골이식조혈청중감성린산매농도차이무현저성의의(P>0.05).8주시,3조감성린산매비교차이무현저성의의(P>0.05).조직학관찰연합이식조、자체골이식조형성대량성숙골기질,골소량급골수강.소묘전경관찰시연합이식조、자체골이식조유대량신골형성.결론:연합자체홍골수+자체송질골+동충이체피질골배이식화자체골이식균유효지중건경추,자체홍골수여자체송질골복합전충적동충이체피질골배가명현촉진동충이체피질골배중건추체적작용,가이작위유효추체중건재료.
BACKGROUND: Many scholars adopt allograft interbody fusion for vertebral body resection and reconstruction, bone fusion time is better than autologous bone graft's, and its integration provides an early support and stabilizing, but the preparation of allogeneic bone graft material is easy to destroy b0ne-inducing factor in matrix, which is not conducive to bone growth. OBJECTIVE: To innovatively design and verify the ability of reconstructing rabbit cervical vertebrae with the compound of humeral cortical ring allograft (HCA) packed with red bone marrow (RBM) and autogenous cancellous bone (ACB). DESIGN, TIME AND SETTING: Randomized controlled animal experiment was performed at the laboratory of Orthopedic Department in Renmin Hospital of Wuhan University, between October 2004 and March 2006. MATERIALS: Sixty healthy adult New Zealand white rabbits, of either sex, body mass of 2.0-2.5 kg, were involved in this study. Twelve rabbits were used for HCA preparation, while the remaining 48 rabbits were randomly divided into 3 groups with sixteen rats in each group. Autologous RBM was extracted from the anterior superior lilac spine through puncture; ACB was obtained from td-cortical bone of rabbit iliac crest. Autologous RBM and ACB were compounded and filled in the self-made HCA. METHODS: Models of the fourth cervical vertebrae defect were created by surgery to simulate tumor resection in New Zealand white rabbits, which were divided into 3 groups randomly. Combined transplant group was treated with the compound of RBM+ACB+HCA; autologous bone transplant group with autogenous lilac crest; HCA transplant group with HCA. MAIN OUTCOME MEASURES: Vertebral reconstructions were evaluated by X-ray, histopathological observation and scanning electron microscope, as well as measurement of serum alkaline phosphates at different periods postoperatively. RESULTS: Eight weeks post-surgery, graft materials fused with the upper and lower cervical fusion, a large number of bone callus were observed in combined transplant group and autologous bone transplant group; HCA transplant group was present with a small amount of callus growth and poor fusion. Serum alkaline phosphatase levels were elevated in all groups, significantly higher in combined transplant group and autologous bone transplant group compared with HCA transplant group (P < 0.01 ). There were no significant differences of serum alkaline phosphatase levels between combined transplant group and autologous bone transplant group at 4 weeks or among 3 groups 8 weeks (P > 0.05). Histological analysis exhibited numerous mature bone matrix, bone trabecula and bone marrow cavity formed in combined transplant group and autologous bone transplant group. Scanning electron microscopy showed that many new bone formations in combined transplant group and autologous bone transplant group.CONCLUSION: The compound of RBM+ACB+HCA and autogenous lilac crest transplantation can efficiently reconstruct cervical vertebrae, RBM+ACB can improve the reconstruction efficiency of HCA, and could use as a matedal in cervical reconstruction.
