复合生物陶瓷喉支架的动物实验研究

Experimental Study on Composite Bio-ceramic Laryngotracheal Framework

目的 探讨应用复合生物陶瓷粉在术中制成所需要的喉支架进行喉重建的可行性。方法 应用复合生物陶瓷粉 [主要为Ca5(PO4) 3 OH、ZrO2 和CaCO3 、AI2 O3 、CaF2 等按一定比例合成 ]与生理盐水按 1∶0 .6的比例调匀成糊状约 30min即可成形硬结。在术中制成所需要的喉支架。选用成年健康杂种家犬 6只作为实验对象 ,均行左侧垂直半喉切除 ,保留甲状软骨外膜作为喉支架的衬里 ,带状肌覆盖喉支架。结果 术后无感染、无呼吸困难 ,1个月均不同程度恢复发声。术后 3、6个月处死观察。结果发现 :喉支架与甲状软骨结合稳固 ,无移位和排出。在光镜和扫描电镜下观察 :3个月时 ,喉支架周围被薄层纤维组织包裹 ,因轻微炎性反应 ,有较多巨噬细胞和个别多核巨细胞存在 ,有钎维组织和血管长入生物陶瓷边缘区域。 6个月时 ,均无炎性反应 ,无巨噬细胞存在。可见少数血管及大量胶原纤维组织长入陶瓷中央 ,将陶瓷分隔 ,未见骨组织、软骨组织形成。本实验结果与以往学者用一般HA行喉气管重建的结果是一致的。结论 复合生物陶瓷具有活性和良好的生物相容性 ,能快速成形硬结 ,可在术中根据需要塑形 ,优于一般HA的陶瓷 ,是较理想的制作喉支架的生物材料。

Objective To investigate the value of using the composite bio-ceramic laryngotracheal framework in the laryngotracheal reconstruction of dogs.Methods Composite bio-ceramic powder consisted of calcium phosphate-based material.When mixed with normal saline in 1∶0.6propertion,it formed a dense paste that would be set within 30 minutes.This material was used to make the laryngotracheal framework intraoperatively.Vertical hemilaryngectomy was performed in six healthy adult hybrid dogs and reconstructed with the laryngotracheal framework,Results No signs of respiratory or wound infection and dyspnea were observed postoperatively.The animals were sacrificed at 3 and 6 months after surgery.The framework was firmly attached to the thyroid cartilages and surrounding tissues,without migration or extrusion.Histologic examination revealed: In each case a layer of fibrous tissue surrounding the framework,a moderate inflammatory response and foreign body reaction were observed at 3 months after surgery.Macrophages and multiclear foreign body gaint cells with multiple ceramic particles were found in the interface between ceramic and the surrounding tissues.There were blood vessels and fibrous tissues extended into the periphery of the bio-ceramic.At 6 months,the inflammatory response and foreign body reaction disappeared.Dense fibrous tissue,rich of collagen,as well as blood vessels were grown into the center of the bio-ceramic.No evidence of bone and cartilage tissue growing into the bio-ceramic was detected at 3and 6 months.Scan electron microscope examination showed:In each case,the surface of the framework facing the lumen was covered by respiratory mucosa composing of one layer of ciliated cells.Conclusion Firstly,the fact that this composite bio-ceramic is a “powder” and can be sculptured to desired shape intraoperatively is a significant advantage over preformed ceramic HA framework. Secondly,this material has good biocompatibility.Finally,the use of this material to reconstruct the larynx is successful.