带血供自体骨和重组异种骨移植修复骨缺损效应中血管内皮细胞生长因子的表达

EXPRESSION OF VASCULAR ENDOTHELIAL GROWTH FACTOR IN REPAIRING BONE DEFECT WITH VASCULARIZED BONE GRAFT-RECONSTITUTED BONE XENOGRAFT

目的探讨带血供自体骨和重组异种骨(reconstitutedbonexenograft,RBX)移植修复骨缺损的疗效,以及受体血清血管内皮细胞生长因子(vascularendothelialcellgrowthfactor,VEGF)的表达状况。方法将1998年1月～2002年12月随机收集入院的骨缺损27例,分为A组:带血供自体骨和RBX移植修复组(n=9);B组:带血供自体骨移植修复组(n=10);C组:RBX移植修复组(n=8)。以术后3、6及12个月随访的X线片判断骨缺损修复情况、骨愈合时间与是否再吸收;3组分别在术前,术后2、4、6和8周,采用免疫定量分析血清VEGF的表达。结果X线片显示:术后3个月A组8例、B组6例和C组3例达临床骨愈合;6个月A组1例、B组与C组各3例骨愈合;12个月B组1例、C组2例发生骨移植区部分再吸收,未愈合。3组术后2、4周血清VEGF值均较术前呈显著性升高,4周A组和B组分别与C组比较差异有统计学意义(P<0.05),但各组间差异无统计学意义(P>0.05)。术后6周和8周3组的血清VEGF值术前、术后及各组间比较差异均无统计学意义(P>0.05)。结论带血供自体骨和RBX移植修复骨缺损,其移植早期受体血清VEGF表达明显增高,且表达水平可作为骨生长、愈合状况的生物分子指标。

Objective To study efficiency of vascularized bone graft combining with reconstituted bone xenograft (RBX) in repairing bone defect and the expression of the vascular endothelial growth factor (VEGF) in serum. Methods From January 1998 to December 2002, 27 cases of bones defects were treated and randomly divided into 3 groups according to different repair materials: group A (the vascularized bone graft- RBX group, n=9), group B (the vascularized bone graft group, (n=10)) and group C(the RBX group, n=8). The bone defect repair, the bone healing time and the bone graft resorption were observed by radiograph after 3 months, 6 months and 12 months of operation, and the expression of VEGF in serum was assayed with lumino-enzyme immunoassay before operation and after operative 2 weeks, 4 weeks, 6 weeks and 8 weeks respectively. Results The X-ray films showed that the bone healing was achieved in 8 cases of group A, in 6 cases of group B and in 3 cases of group C after 3 months; in 1 case of group A, respectively in 3 cases of both group B and group C after 6 months. The bone graft resorption was observed in 1 case of group B and in 2 cases of group C after 12 months. The serum VEGF values after operative 2 weeks and 4 weeks were higher than those before operation in all of 3 groups(P<0.05), and the VEGF values of groups A and B were higher than that group C(P<0.05) after 4 weeks. There were no significant differences (P>0.05) in serum VEGF level between postoperative 6, 8 weeks and preoperation in 3 groups. Conclusion The expression of serum VEGF obviously increase in the early period of bone transplanting, it is value of clinical evaluation of reparative efficiency of bone defect.