CAJ | 학술논문

目的探讨长骨干粉碎性骨折游离骨折块移位距离对骨折愈合的影响. 方法在120只新西兰大白兔右桡骨中部截取楔形骨块,制成实验模型,用2枚克氏针将骨块复位固定并使之与主骨存有一定的间距,并分为五组:A组(原位固定)、B组(骨块与骨干间距为桡骨干直径1/5)、C组(桡骨干直径2/5)、D组(桡骨干直径3/5)、E组(桡骨干直径4/5).每组动物分别于术后2,4,6,8周分批处死,摄X线片观察各组骨折愈合情况,用改进Gary X线评分标准评分;取材HE染色,观察骨折愈合的组织形态学变化,免疫组化测定BMP-2的表达. 结果 (1)X线摄片显示:A、B组骨折愈合无差异,C、D组骨折愈合延迟,E组骨块吸收骨不连.(2)组织形态学观察:A、B组骨折局部形态学变化相同,而其他各组与A组相比,骨痂出现及改建的时间明显较晚,呈延迟愈合和不愈合的表现.(3)BMP-2表达:2周时BMP-2表达B组与A组差异无统计学意义(P＞0.05),C、D、E组与A组比较差异有统计学意义(P＜0.01),4周时只有E组与A组差异有统计学意义(P＜0.01);6周和8周时各组之间差异无统计学意义(P＞0.05). 结论游离骨折块移位距离会影响骨折的愈合,移位距离越大,对骨折愈合产生的影响越明显,当游离骨折块移位距离达到其骨干直径的2/5以上时,骨折将发生愈合障碍.
목적 탐토장골간분쇄성골절유리골절괴이위거리대골절유합적영향. 방법 재120지신서란대백토우뇨골중부절취설형골괴,제성실험모형,용2매극씨침장골괴복위고정병사지여주골존유일정적간거,병분위오조:A조(원위고정)、B조(골괴여골간간거위뇨골간직경1/5)、C조(뇨골간직경2/5)、D조(뇨골간직경3/5)、E조(뇨골간직경4/5).매조동물분별우술후2,4,6,8주분비처사,섭X선편관찰각조골절유합정황,용개진Gary X선평분표준평분;취재HE염색,관찰골절유합적조직형태학변화,면역조화측정BMP-2적표체. 결과 (1)X선섭편현시:A、B조골절유합무차이,C、D조골절유합연지,E조골괴흡수골불련.(2)조직형태학관찰:A、B조골절국부형태학변화상동,이기타각조여A조상비,골가출현급개건적시간명현교만,정연지유합화불유합적표현.(3)BMP-2표체:2주시BMP-2표체B조여A조차이무통계학의의(P＞0.05),C、D、E조여A조비교차이유통계학의의(P＜0.01),4주시지유E조여A조차이유통계학의의(P＜0.01);6주화8주시각조지간차이무통계학의의(P＞0.05). 결론유리골절괴이위거리회영향골절적유합,이위거리월대,대골절유합산생적영향월명현,당유리골절괴이위거리체도기골간직경적2/5이상시,골절장발생유합장애.
Objective To study the influence of the distance of displaced fragment on the union of diaphysis fracture. Methods A wedge-shaped bone fragment was taken from central radial of the right forelimb of 120 New Zealand white rabbits for estabhshment of experimental animal model. The bone fragment was fixed to the main bone with two Kirschner wires, with certain space between bone fragment and the main bone. Then, the rabbits were divided into five groups, ie, Group A (in situ fixation),Group B (the space was 1/5 diameter of the radial shaft), Group C (the space was 2/5 diameter of the radial shaft), Group D (the space was 3/5 diameter of the radial shaft), Group E (the space was 4/5 diameter of the radial shaft). The animals were killed at 2, 4, 6, 8 weeks after operation. X-ray photos were taken to observe the fracture healing and the improved Gary X-ray used for scoring. HE staining after tissue section was employed to observe the histomorphological changes of fracture healing. Immunohistochemical method was used to determine expression of BMP-2. Results X-ray findings showed insignificant statistical difference between Group A and Group B, delayed union in Groups C and D and nonunion of bone absorption in Group E. Morphological observation showed same change in fracture site in Groups A and B lout significant late in emergence, formation and remodeling of the callus in the other groups compared with Group A, mainly with delayed fracture union or nonunion. There was no statistical difference in expression of BMP-2 between Group B and Group A (P ＞ 0. 05), but there was statistical significance in Groups C, D and E compared with Group A at 2 weeks (P ＜0.01). There was statistical difference between Group E and Group A at 4 weeks (P ＜0. 01) but no statistical difference at 6 and 8 weeks between either two groups (P ＞ 0. 05). Conclusions The distance of displaced fragment will influence fracture healing. The larger distance of the displaced fragment will beget more obvious influence on fracture healing. When the distance is more than 2/5 diameter of the bone shaft, the fracture will present union disorder.