一期开放松质骨植骨治疗感染性骨缺损的实验研究

Experimental observation of open cancellous bone graft in treatment of infected fracture nonunion

目的明确感染性骨折不愈合清创术后一期开放松质骨植骨的可行性,了解在感染的环境条件下,开放松质骨植骨愈合的组织病理变化过程。方法新西兰白兔62只,制备双侧桡骨中段骨折,骨折端注射金黄色葡萄球菌制作感染性骨折模型,4周后经过X线片、病理、细菌培养来确定是否为感染。将确认为感染性骨折的47只兔,一侧桡骨行清创术并制造长度为1cm骨折端骨缺损,一期行自体松质骨植骨,伤口开放不闭合。另一侧桡骨不植骨为对照组。于第3、7天,第2、4、6、8、10、12周摄X线片,取材行EDTA脱钙,常规HE染色观察局部组织学变化。术后14周处死剩余兔取材行EDTA脱钙,常规HE染色组织病理检查及统计学分析。结果植骨术后第3、7天病理示绝大部分植骨条坏死。2周显示有新生骨痂生长。4周骨折愈合率:植骨组为20%,对照组为7%。6周骨愈合率分别为60%和20%。8～12周骨折愈合率分别为87%和67%。组织病理学显示在骨折愈合的不同阶段均可见缺损部位的炎症灶内有新骨形成和对松质骨条的替代过程。感染率:植骨组为13%,对照组为7%。骨痂面积:治疗组明显优于对照组(P<0.01)。结论一期开放植骨是治疗感染性骨缺损的一种简便、有效的方法。

Objective To determine the feasibility of open cancellous bone grafting at one stag e to treat infected fracture nonunion and obse rve the histological changes during the process of healing.Methods Standard infected fracture nonunion models were made in bilateral middle radial s hafts of each of the 47New Zealand rab bits with confirmed infected fracture.T he bone defect at one shaft was treate d with cancellous bone grafting and t he wound was left open,while the bone defect a t the other shaft was treated without cancellous bone grafting as the cont rol.After the procedure,at the 3rd and 7t h days,2nd,4th,6th,8th,10th and 12th weeks,X-ray examinati ons were taken and 4rabbits were sacrificed e ach time for histological observati on.The computer-assisted image device was used tocalculate the callous formation area.Results Some new bone formation was found whi le almost cancellous chips were dead at the 3rd and 7th days.The bone formation and substitutio n of cancellous chips occurred at eve ry stage after the procedure.The group of open cancellous bone grafting had a better callous formation than the c ontrol group.The union rates at different t imes were:in the grafting group,20%at 4weeks,60%at 6weeks and 87%at8weeks;while in the control group,7%at 4weeks,20%at 6weeks and 67%at 8w eeks respectively.Con-clusion Open cancellous bone grafting at one stage to treat infected fracture non union is a simple and effective method.[