CAJ | 학술논문

目的：利用大白兔股骨节段性缺损模型研究磷酸钙骨水泥（ CPC）柱骨愈合能力，比较肌肉和骨膜分别包绕对CPC柱成骨和吸收的影响。方法：CPC柱固化后行扫描电镜观察微结构，X线衍射分析固相成分。60只新西兰大白兔随机分成4组，股骨中段截骨15 mm，8孔钢板置于股骨外侧，上下分别以3枚皮质骨螺钉固定，制备骨缺损模型。 A组切除骨膜、B组保留骨膜、C组肌肉包绕CPC、D组骨膜包绕CPC。分别于第4、8、12周处死，取标本行X线检查、生物力学及HE染色组织学分析。结果：水泥表面分布不规则颗粒状晶体，微孔分布均匀，直径10μm左右。固相分析主要为羟基磷灰石衍射峰。 X线片示A组4周少量斜形骨痂相向性生长；8周3只骨连接；12周4只骨连接。 B组4周较多骨痂生长；8周4只骨连接；12周均骨连接。 C组4周CPC和股骨界面清晰；8周界面模糊，部分骨痂从CPC旁侧生长；12周4只在CPC旁侧形成连续性骨痂，1只被新生骨痂包裹。 D组4周CPC和股骨界面模糊；8周有较多骨痂从CPC旁侧生长；12周CPC被新生骨痂包裹。 CPC柱均保持植入轮廓，无破碎或溶解。股骨抗弯曲强度测试术后8、12周的抗弯曲强度明显增高， A、B2组和C、D2组组间差异有统计学意义（ p ＜0．01）。组织学观察A、B组术后4周骨缺损为纤维组织填充，第8、12周骨愈合标本的骨小梁排列规则。 C组4周股骨两端与CPC界限清楚，肌肉包绕，8周CPC表面有新骨形成。第12周新骨和CPC接触较紧密，少量骨组织长入CPC；D组4周两端股骨与CPC界面可辨，骨膜包绕，中间区未见新骨，第8周新骨形成增多，CPC内有少量新骨长入，第12周新骨和CPC界面模糊，新骨长入增多。结论：植入兔股骨节段缺损的CPC柱骨愈合反应好，吸收有限。 CPC填充股骨的机械强度比正常骨愈合后股骨的强度弱。目的：利用大白兔股骨節段性缺損模型研究燐痠鈣骨水泥（ CPC）柱骨愈閤能力，比較肌肉和骨膜分彆包繞對CPC柱成骨和吸收的影響。方法：CPC柱固化後行掃描電鏡觀察微結構，X線衍射分析固相成分。60隻新西蘭大白兔隨機分成4組，股骨中段截骨15 mm，8孔鋼闆置于股骨外側，上下分彆以3枚皮質骨螺釘固定，製備骨缺損模型。 A組切除骨膜、B組保留骨膜、C組肌肉包繞CPC、D組骨膜包繞CPC。分彆于第4、8、12週處死，取標本行X線檢查、生物力學及HE染色組織學分析。結果：水泥錶麵分佈不規則顆粒狀晶體，微孔分佈均勻，直徑10μm左右。固相分析主要為羥基燐灰石衍射峰。 X線片示A組4週少量斜形骨痂相嚮性生長；8週3隻骨連接；12週4隻骨連接。 B組4週較多骨痂生長；8週4隻骨連接；12週均骨連接。 C組4週CPC和股骨界麵清晰；8週界麵模糊，部分骨痂從CPC徬側生長；12週4隻在CPC徬側形成連續性骨痂，1隻被新生骨痂包裹。 D組4週CPC和股骨界麵模糊；8週有較多骨痂從CPC徬側生長；12週CPC被新生骨痂包裹。 CPC柱均保持植入輪廓，無破碎或溶解。股骨抗彎麯彊度測試術後8、12週的抗彎麯彊度明顯增高， A、B2組和C、D2組組間差異有統計學意義（ p ＜0．01）。組織學觀察A、B組術後4週骨缺損為纖維組織填充，第8、12週骨愈閤標本的骨小樑排列規則。 C組4週股骨兩耑與CPC界限清楚，肌肉包繞，8週CPC錶麵有新骨形成。第12週新骨和CPC接觸較緊密，少量骨組織長入CPC；D組4週兩耑股骨與CPC界麵可辨，骨膜包繞，中間區未見新骨，第8週新骨形成增多，CPC內有少量新骨長入，第12週新骨和CPC界麵模糊，新骨長入增多。結論：植入兔股骨節段缺損的CPC柱骨愈閤反應好，吸收有限。 CPC填充股骨的機械彊度比正常骨愈閤後股骨的彊度弱。
목적：이용대백토고골절단성결손모형연구린산개골수니（ CPC）주골유합능력，비교기육화골막분별포요대CPC주성골화흡수적영향。방법：CPC주고화후행소묘전경관찰미결구，X선연사분석고상성분。60지신서란대백토수궤분성4조，고골중단절골15 mm，8공강판치우고골외측，상하분별이3매피질골라정고정，제비골결손모형。 A조절제골막、B조보류골막、C조기육포요CPC、D조골막포요CPC。분별우제4、8、12주처사，취표본행X선검사、생물역학급HE염색조직학분석。결과：수니표면분포불규칙과립상정체，미공분포균균，직경10μm좌우。고상분석주요위간기린회석연사봉。 X선편시A조4주소량사형골가상향성생장；8주3지골련접；12주4지골련접。 B조4주교다골가생장；8주4지골련접；12주균골련접。 C조4주CPC화고골계면청석；8주계면모호，부분골가종CPC방측생장；12주4지재CPC방측형성련속성골가，1지피신생골가포과。 D조4주CPC화고골계면모호；8주유교다골가종CPC방측생장；12주CPC피신생골가포과。 CPC주균보지식입륜곽，무파쇄혹용해。고골항만곡강도측시술후8、12주적항만곡강도명현증고， A、B2조화C、D2조조간차이유통계학의의（ p ＜0．01）。조직학관찰A、B조술후4주골결손위섬유조직전충，제8、12주골유합표본적골소량배렬규칙。 C조4주고골량단여CPC계한청초，기육포요，8주CPC표면유신골형성。제12주신골화CPC접촉교긴밀，소량골조직장입CPC；D조4주량단고골여CPC계면가변，골막포요，중간구미견신골，제8주신골형성증다，CPC내유소량신골장입，제12주신골화CPC계면모호，신골장입증다。결론：식입토고골절단결손적CPC주골유합반응호，흡수유한。 CPC전충고골적궤계강도비정상골유합후고골적강도약。
Objective:To investigate the bone healing capacity of calcium phosphate cement ( CPC) cylinder in a rabbit femur seg-mental defect model by comparing the influence of muscle or periosteum as wrapping material.Methods: Pre-hardened CPC cylinder was prepared.Three specimens were analyzed by scanning electron microscopy and X-ray diffraction to characterize its microstructure and chemical composition.Sixty adult rabbits were randomly assigned to four groups,then received a defect size of 15 mm osteotomy within the femurs.The 8-hole plate was fixed with three screws in the proximal and distal part of the defect, respectively.In group A, the fem-oral defects were left alone;in group B, the defects with retained periosteum; in group C, the defects were grafted with CPC cylinder wrapped by muscle;and in group D, the defects were grafted with CPC cylinder wrapped by periosteum.Five rabbits from each group were sacrificed at 4, 8 and 12 weeks postoperatively.The samples were evaluated with radiological, biomechanical and histological meth-ods.Results:Irregular particles were seen on the surface of specimens, the pore size was approximately 10 μm.The peak locations for the hydroxyapatite were seen in the X-ray diffraction patterns of the specimens.Group A showed a few radiographic evidence of new bone formation within the boundary of the defect at 4 weeks.Three bone defects bridged at 8 weeks and 4 bone defects bridged at 12 weeks. Group B showed radiographic evidence of new bone formation at 4 weeks.Four bone defects bridged at 8 weeks and 5 bone defects bridged at 12 weeks.Group C showed discernable interface between the CPC cylinder and both femoral cut ends at 4 weeks, which became invisi-ble at 8 weeks.Defects bridged by continuous callus beside the CPC cylinder in 4 rabbits and completely surrounded in 1 rabbit at 12 weeks.Group D showed better quality of new bone formation, the CPC cylinders were surrounded by new bone at 12 weeks.However, all CPCs retained their cylindrical shapes.A significant difference in flexural strength between Group A and B, Group C and D at 8 and 12 weeks were detected, respectively (p<0.01).Histological analyses showed that the defect site was filled with organized fibrous tissue at 4 weeks, and bridging of the defect occurred by regular bone formation at 8 and 12 weeks in Group A and B.Direct contact between CPC and the proximal and distal femoral bone was limited in Group C and D at 4 weeks.New bone formation was observed at the surface of CPC, with limited bone ingrowth at 8 and 12 weeks in Group C.In contrast to Group C, more new bone formation and bone ingrowth were observed in Group D at 8 and 12 weeks, respectively.Conclusion:The pre-hardened CPC cylinder showed good bone healing response and limited absorption after implantation in rabbit femurs.The mechanical strength of the reconstruction femur was less than that of normal bone bridged femur.