CAJ | 학술논문

目的研究带蒂筋膜瓣为引导性骨再生技术屏障膜的促成骨作用及其作用方式．方法50只成年新西兰大白兔，雌雄不限，尺骨造2cm骨缺损模型，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（带蒂筋膜瓣），使其包裹由自体骨髓基质干细胞与含骨形态发生蛋白的骨诱导活性材料构建的非细胞型组织工程骨并充填骨缺损，A组为单纯非细胞型组织工程骨组（对照组），B组为带蒂筋膜瓣包裹非细胞型组织工程骨组（实验组），术后第4、8、12、16周进行骨修复区x射线检查、大体观察和组织学检查、骨形态计量分析，第8、12、16周进行生物力学测定分析．结果x线片、骨形态计量分析，植入物内部骨小梁及软骨组织形成的数量和速度、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，B组均明显优于A组．术后4、8、12、16周新生骨小梁面积占修复总面积比值比较，以及B组内不同时间点比较差异均有统计学意义（P〈0．05）．生物力学测定分析显示，术后8、12、16周两组间比较及同组内各时间点间比较差异均有统计学意义（P〈0．05）．结论以带蒂筋膜瓣为引导性骨再生技术屏障膜具有明显促成骨作用，其促成骨作用具有明显的引导骨再生作用特点．
목적연구대체근막판위인도성골재생기술병장막적촉성골작용급기작용방식．방법50지성년신서란대백토，자웅불한，척골조2cm골결손모형，이용현미외과기술재골결손린근제비일개대유무명혈관체소속모세혈관망적근막판（대체근막판），사기포과유자체골수기질간세포여함골형태발생단백적골유도활성재료구건적비세포형조직공정골병충전골결손，A조위단순비세포형조직공정골조（대조조），B조위대체근막판포과비세포형조직공정골조（실험조），술후제4、8、12、16주진행골수복구x사선검사、대체관찰화조직학검사、골형태계량분석，제8、12、16주진행생물역학측정분석．결과x선편、골형태계량분석，식입물내부골소량급연골조직형성적수량화속도、성숙골결구적형성、골간결구적중소、골수강적재통、식입물적흡수강해，B조균명현우우A조．술후4、8、12、16주신생골소량면적점수복총면적비치비교，이급B조내불동시간점비교차이균유통계학의의（P〈0．05）．생물역학측정분석현시，술후8、12、16주량조간비교급동조내각시간점간비교차이균유통계학의의（P〈0．05）．결론이대체근막판위인도성골재생기술병장막구유명현촉성골작용，기촉성골작용구유명현적인도골재생작용특점．
Objective To study the curative effect and osteogenesis in process of critical size bone defect repair using pedieal faseial flap with vessels as membrane material and bone regeneration technique. Methods 50 New Zealand rabbits with 5-month-old were used to prepare hibateral periosteum-including bone defect models in the middle of ulna and the length of defect was 2era. Autologous red bone marrow was implanted in osteoinductive absorbing material to prepare tissue engineering bone. The prepared uncellular tissue engineering compound was implanted in bone defect area and those whose defects were not wrapped by anything were divided into Group A while those whose defects were wrapped by pedical fascial flap with blood supply were divided into Group B. In weeks 4, 8, 12, and 16 after operation, rabbits in each group were examined by the radiograph （X-ray）, light density measurement, gross morphology and histological inspection, bone shape measurement was analyzed in junctional zone. In weeks 8, 12, 16 they were examined by biomechanics determination. The data were analyzed Statistically to check the difference of bone defect repair. Results The indexes in gross morphology and histological inspection, radiograph, bone shape measurement analysis, quantity and forming speed of bone trabecula and cartilagi nous tissue, formation of mature bone structure, remodeling of diaphysis, recanalization of cavum ossis and absorption and degradation of implant group of pedical fascial flap with blood supply, Group B was superior to that of Group A obviously. By comparision of light density measurement and biomechanics determination, the difference between two groups in weeks 12, 16 after operation and the difference of the same group at each time point all bad statistical significance （P d0.05）. In weeks 4, 8, 12, 16 after the operation the ratio between new bone trabecular area and total area had significant difference （ P〈 0.05）. Conclusion The pedical fascial flap with vessels can be used in guided bone regeneration technique. And it has obvious effect in promoting the process of bone defect repair.