磷酸三钙结合富血小板血浆修复股骨头坏死的研究

EXPERIMENTAL STUDY ON THE TREATMENT OF FEMUR HEAD NECROSIS WITH TRICALCIUM PHOSPHATE AND PLATELET RICH PLASMA

目的 研究磷酸三钙 (tricalcium phosphate,TCP)和富血小板血浆 (platelet- rich plasma,PRP)混合物(TCP/PRP)修复兔股骨头无菌性坏死的作用机制。 方法 成年新西兰大白兔 4 8只 ,采用液氮冷冻兔股骨头制成股骨头坏死模型 ,再随机分成 2组 ,每组 2 4只 ,实验组植入 TCP/PRP,对照组植入 TCP。分别于术后 2、4、8和 12周取材 ,行X线片、组织学检查、电镜观察和计算机图像处理。 结果 X线片示术后 2周 ,两组股骨头密度无明显差异 ;4周 ,两组骨密度均降低 ,对照组下降更明显 ;8和 12周时骨密度均升高 ,实验组升高更明显。组织学检查 :术后 2周光镜显示 ,实验组肉芽增生多于对照组 ;4周时股骨头变平 ,凹陷缺损 ,实验组少于对照组 ;8和 12周股骨头纤维增生 ,骨小梁增粗 ,实验组修复较对照组多。电镜 :术后 2周实验组成骨细胞内线粒体和粗面内质网较多 ;4周实验组成骨细胞和胶原纤维明显比对照组多 ,细胞器比对照组成熟 ;8周时实验组的成骨细胞向骨细胞转化较多 ,雏形板层骨较多。计算机图像处理 :术后 4、8和 12周实验组骨小梁体积分别为 36 .6 5 %± 7.2 2 %、38.2 9%± 4 .2 8%和 39.2 4 %± 3.4 2 % ,明显多于对照组(P<0 .0 5 )。 结论 TCP/PRP不仅为成骨细胞爬行提供支架 ,并能促进新骨形成和股?

Objective To study the mechanism of compound of calcium phosphate(TCP) and platelet rich plasma(PRP) in the treatment of femoral head necrosis. Methods The left femoral heads of 48 New Zealand white rabbits were frozen by liquid nitrogen as to make the model of femoral head necrosis.Twenty four rabbits were randomly chosen as the experimental group and their femoral heads were filled with TCP/PRP. The other 24 rabbits were used as the control group and their femoral heads were filled only with TCP. They were sacrificed at 2, 4,8,12 weeks after operation. The specimens were examined with X ray and histological study. Results At 2 weeks after operation,there was no significant difference in femoral head density between the two groups. Four weeks after operation, femoral head density decreased in both groups, while it decreased more in the control group. At 8,12 weeks after operation, the density of the femoral heads in both groups increased, and it was higher in the experimental group. Histology examination showed that there was no difference between the two groups 2 weeks after operation. The head became flat at 4 weeks. Control group had more defects. At 4,8,12 weeks, more repairs were observed in the experimental group than that in the control group. The amount and maturity of osteogenesis in experimental group were much more greater than those in control group.Bone histomorphometry showed that the volum of the trabecular was larger in the experimental group (36 65%±7 22%,38 29%±4 28%,39 24%±3 42%) than that of control group ( P< 0 05) . Conclusion TCP/PRP does not only provide osteoblasts scaffold, but also promotes bone formation and the head repair. TCP/PRP is a good biomaterial for the treatment of femur head necrosis.