带蒂深筋膜瓣促大段组织工程骨成骨效果的观察

Observation of large tissue engineered bone of osteogenesis effects accelerated by pedicle deep fascia flap

目的 研究带蒂筋膜瓣包裹大段组织工程骨的长期成骨效果.方法 新西兰大白兔36只,每只兔双侧桡骨制作1.5 cm骨缺损,将组织工程骨植入骨缺损处,左侧用带蒂筋膜瓣将之包裹作为实验组,右侧不用带蒂筋膜瓣包裹作为对照组.术后早期2、4、6、8、12周行X线、ECT、组织学等手段检测;远期在术后6、12个月行X线及组织学检查,评价骨缺损修复情况.结果 术后早期标本的大体观察和组织学观察看,在各个时间段,实验组的骨痂生成和血管化成度均优于对照组,从X线片和ECT可以看出,术后2周实验组和对照组比较差异无统计学意义,以后的各个时间段,实验组的骨修复效果均明显优于对照组;远期X线和组织学显示组织工程骨与兔桡骨牢固愈合,并开始塑形且出现髓腔再通,β-TCP在体内逐渐被吸收,自身架构消失.结论 早期采用筋膜瓣包裹的方法能够显著提高组织工程骨修复大段骨缺损的能力,远期组织工程骨可以完全修复兔大段骨缺损,形成正常骨组织并发挥功能.

Objective To investigate the long-term osteogenesis effects of large tissue engineered bone wraped up by blood supplied fascia. Methods Thirety -six New Zealand rabbits were subjected to operations to induce a 1.5 cm defect in rabbit' s two radiuses, which was filled subsequently with tissue engineered bone. The tissue engineering bone were wraped up by blood supplied fascia in rabbit's left radius, as the experimental group, the treatment wasn' t done to right radius, as the control group. At 2,4,6,8and 12 weeks after operation, X-ray examination, radionuclide bone scan and histological examination, were carried out to judge the osteogenesis effects. The repaired defects were evaluated by X-ray and histological examination at 6th , 12th month postoperation. Results In the early stage, gross observation and histology showed batter osteotylus generation and revascularization within 12 weeks postop-eratively experimental group than that in control group. Postoperative 2 weeks, X-ray and ECT displayed experiment group and control group do not have obvious difference, in each time later, the osteogenesis effects of the experiment group repairs was obviously superior to the control group. Longterm follow -up were performed by X -ray examination and histology at 6th, 12th month postoperatively revealed moulding of the new bones and medullary cavity recanalization, and the structure of β- TCP disappeared and gradually integrated into the new bones. Conclusions Early observation showed blood supplied fascia flap can accelerate the osteanagenesis process of tissue engineered bone. Long-term observation displayed tissue engineered bone is capable of total repair of large bone defect in rabbits by forming normal functional new bones.