CAJ | 학술논문

背景：当儿童四肢骨折涉及骨骺和干骺端骨折时，治疗方法多种多样。针对不同的治疗方法，对骺板生长发育影响的研究也较多。但多局限于不同直径克氏针或空心螺钉内固定对骺板发育的影响，而钢板置入跨越骺板内固定，对骺板生长发育影响及影响程度目前国内外文献报道较少。目的：制备幼兔骺板周围骨折模型，观察跨骺板钢板置入内固定以及取出内固定物后对骺板生长发育的影响。方法：建立幼年家兔右股骨远端骺板上方5 mm横断骨折模型60只，应用相同型号“L”型钢板和4枚螺钉跨骺板及骺板周围骨折线钢板内固定。造模后2，4，8，12周处死8只，取出股骨标本，测量股骨长度、骺板总厚度及单位柱内肥大细胞计数，观察组织形态学和特殊软骨染色中肥大细胞及骺板厚度的变化；另外7只取出内固定，继续养殖2周后处死，再次观察以上指标。左股骨远端骺板作为对照组。结果与结论：钢板组在造模后2周上述观察指标与对照组对比，差异无显著性意义(P >0.05)。钢板组在造模后4，8，12周上述观察指标与对照组对比，差异有显著性意义(P <0.05或<0.001)。造模后2，4周取下钢板，继续观察2周，发现股骨长度、骺板总厚度及单位柱内肥大细胞计数等观察指标都有不同程度恢复，与对照组比较差异无显著性意义(P>0.05)。但造模后8，12周取下钢板，继续观察2周，发现股骨长度、骺板总厚度短缩，单位柱内肥大细胞个数明显减少，与对照组比较，差异有非常显著性意义(P <0.001)。提示跨骺板钢板内固定初期(2周内)，在内固定物不伤及骺板的前提下，适当压应力作用对骺板生长发育未见显著影响；但持久过度钢板限制(>4周)将导致骺板生长部分或者完全阻滞，主要引起肢体成角畸形及骺板发育阻滞。跨骺板分别固定2，4，8，12周后，取出内固定继续观察2周，发现在第2，4周两个时间点取出内固定后，股骨长度、骺板总厚度、单位柱内肥大细胞计数等观察指标都有不同程度恢复或者接近正常值。而在第8，12周两个时间点取出内固定后，继续观察2周，上述观察指标与正常值存在显著差异，说明增殖层和肥大层软骨细胞细胞核失去分化增殖能力，股骨长度和骺板厚度很难恢复到正常的程度。揹景：噹兒童四肢骨摺涉及骨骺和榦骺耑骨摺時，治療方法多種多樣。針對不同的治療方法，對骺闆生長髮育影響的研究也較多。但多跼限于不同直徑剋氏針或空心螺釘內固定對骺闆髮育的影響，而鋼闆置入跨越骺闆內固定，對骺闆生長髮育影響及影響程度目前國內外文獻報道較少。目的：製備幼兔骺闆週圍骨摺模型，觀察跨骺闆鋼闆置入內固定以及取齣內固定物後對骺闆生長髮育的影響。方法：建立幼年傢兔右股骨遠耑骺闆上方5 mm橫斷骨摺模型60隻，應用相同型號“L”型鋼闆和4枚螺釘跨骺闆及骺闆週圍骨摺線鋼闆內固定。造模後2，4，8，12週處死8隻，取齣股骨標本，測量股骨長度、骺闆總厚度及單位柱內肥大細胞計數，觀察組織形態學和特殊軟骨染色中肥大細胞及骺闆厚度的變化；另外7隻取齣內固定，繼續養殖2週後處死，再次觀察以上指標。左股骨遠耑骺闆作為對照組。結果與結論：鋼闆組在造模後2週上述觀察指標與對照組對比，差異無顯著性意義(P >0.05)。鋼闆組在造模後4，8，12週上述觀察指標與對照組對比，差異有顯著性意義(P <0.05或<0.001)。造模後2，4週取下鋼闆，繼續觀察2週，髮現股骨長度、骺闆總厚度及單位柱內肥大細胞計數等觀察指標都有不同程度恢複，與對照組比較差異無顯著性意義(P>0.05)。但造模後8，12週取下鋼闆，繼續觀察2週，髮現股骨長度、骺闆總厚度短縮，單位柱內肥大細胞箇數明顯減少，與對照組比較，差異有非常顯著性意義(P <0.001)。提示跨骺闆鋼闆內固定初期(2週內)，在內固定物不傷及骺闆的前提下，適噹壓應力作用對骺闆生長髮育未見顯著影響；但持久過度鋼闆限製(>4週)將導緻骺闆生長部分或者完全阻滯，主要引起肢體成角畸形及骺闆髮育阻滯。跨骺闆分彆固定2，4，8，12週後，取齣內固定繼續觀察2週，髮現在第2，4週兩箇時間點取齣內固定後，股骨長度、骺闆總厚度、單位柱內肥大細胞計數等觀察指標都有不同程度恢複或者接近正常值。而在第8，12週兩箇時間點取齣內固定後，繼續觀察2週，上述觀察指標與正常值存在顯著差異，說明增殖層和肥大層軟骨細胞細胞覈失去分化增殖能力，股骨長度和骺闆厚度很難恢複到正常的程度。
배경：당인동사지골절섭급골후화간후단골절시，치료방법다충다양。침대불동적치료방법，대후판생장발육영향적연구야교다。단다국한우불동직경극씨침혹공심라정내고정대후판발육적영향，이강판치입과월후판내고정，대후판생장발육영향급영향정도목전국내외문헌보도교소。목적：제비유토후판주위골절모형，관찰과후판강판치입내고정이급취출내고정물후대후판생장발육적영향。방법：건립유년가토우고골원단후판상방5 mm횡단골절모형60지，응용상동형호“L”형강판화4매라정과후판급후판주위골절선강판내고정。조모후2，4，8，12주처사8지，취출고골표본，측량고골장도、후판총후도급단위주내비대세포계수，관찰조직형태학화특수연골염색중비대세포급후판후도적변화；령외7지취출내고정，계속양식2주후처사，재차관찰이상지표。좌고골원단후판작위대조조。결과여결론：강판조재조모후2주상술관찰지표여대조조대비，차이무현저성의의(P >0.05)。강판조재조모후4，8，12주상술관찰지표여대조조대비，차이유현저성의의(P <0.05혹<0.001)。조모후2，4주취하강판，계속관찰2주，발현고골장도、후판총후도급단위주내비대세포계수등관찰지표도유불동정도회복，여대조조비교차이무현저성의의(P>0.05)。단조모후8，12주취하강판，계속관찰2주，발현고골장도、후판총후도단축，단위주내비대세포개수명현감소，여대조조비교，차이유비상현저성의의(P <0.001)。제시과후판강판내고정초기(2주내)，재내고정물불상급후판적전제하，괄당압응력작용대후판생장발육미견현저영향；단지구과도강판한제(>4주)장도치후판생장부분혹자완전조체，주요인기지체성각기형급후판발육조체。과후판분별고정2，4，8，12주후，취출내고정계속관찰2주，발현재제2，4주량개시간점취출내고정후，고골장도、후판총후도、단위주내비대세포계수등관찰지표도유불동정도회복혹자접근정상치。이재제8，12주량개시간점취출내고정후，계속관찰2주，상술관찰지표여정상치존재현저차이，설명증식층화비대층연골세포세포핵실거분화증식능력，고골장도화후판후도흔난회복도정상적정도。
BACKGROUND:There are various therapies for children limb fractures involving the epiphysis or the metaphysis. According to the different methods, studies on the growth of the epiphyseal plate are a lot, most of which focus on the effects of Kirschner wires with different diameters or holow screw internal fixation on the development of epiphyseal plate. However, there are rare studies on the influence of cross-epiphyseal plate internal fixation on the growth of epiphyseal plate as wel as the influence level. OBJECTIVE:To prepare a peri-epiphyseal fracture model in young rabbits and to observe the effects of cross-epiphyseal plate implantation and removal on the growth of epiphyseal plate. METHODS: Traverse fracture models were made 5 mm above the right femoral distal epiphyseal plate of 60 young rabbits, and then fixed with suitable “L” steel plate and four screws across the epiphyseal plate and peri-epiphyseal fracture line. The left side served as control. Eight rabbits were kiled and observed at 2, 4, 8, 12 weeks after modeling, respectively, to take out the femoral specimens for measurement of femoral length, thickness of the epiphyseal plate, and number of mastocytes per unit column. Histopathology observation was done and changes in mastocytes and thickness of the epiphyseal plate were detected. Another seven rabbits were selected to remove the metal plate, continued to feed for 2 weeks and finaly executed to observe the above-mentioned indexes. RESULTS AND CONCLUSION: (1) There were significant differences in the above indexes between the plate and control groups at 4, 8, 12 weeks after modeling (P < 0.05 orP< 0.001) but not at 2 weeks after modeling (P> 0.05). These findings indicate that within 2 weeks after cross-epiphyseal plate internal fixation, proper pressue has no remarkable influence on the growth of epiphyseal plate; but after persistent internal fixation (> 4 weeks), the growth of epiphyseal plate can be partialy or completed retarded. (2) At 2 and 4 weeks after modeling, the plate was removed, and 2 weeks later, the femoral length, thickness of the epiphyseal plate and mastocyte counting per unit column were improved to different extents, and there were no differences between the plate and control group (P > 0.05). At 8 and 12 weeks after modeling, the plate was removed, and 2 weeks later, the femoral length and thickness of the epiphyseal plate were shortened, and the number of mastocytes per unit column was decreased obviously, which significantly differed from the control group (P < 0.001). These findings indicate that the chondrocytes in the proliferative and hypertrophy layers lose the differentiation and proliferation abilities, and the femoral length and epiphyseal plate thickness are difficult to recover.