自行设计微创植骨器修复骨缺损的疗效观察

Observation of curative effect of self-made minimally invasive bone grafting instruments on bone defects plerosis

目的:应用自行设计的微创植骨器进行微创植骨术修复骨缺损的生物力学和组织学观察。方法:实验于2004-04/10在上海第二医科大学附属仁济医院动物实验中心完成。将12只新西兰大白兔双侧桡骨截骨制成骨缺损模型,随机把每只兔双侧前肢分为两组:开放植骨术组沿原切口切开20mm长皮肤进入,开放桡骨髓腔,植入金世植骨灵骨块。微创植骨术组应用自行设计的微创植骨器进行植骨。分别在术后第4,8周,各随机取6只兔进行生物力学检查及组织学观察,比较两组家兔桡骨骨缺损修复情况。结果:12只兔均进入结果分析。①两组兔桡骨生物力学检查结果:第4周开放植骨术组和微创植骨术组分别有2根和5根桡骨可以进行生物力学检查,微创植骨术组桡骨的抗弯曲破坏应力值大于开放植骨术组[(69.58±34.99),(12.83±20.41)N,P<0.05];第8周开放植骨术组和微创植骨术组均有6根桡骨可以进行生物力学检查,微创植骨术组桡骨的抗弯曲破坏应力值大于开放植骨术组[(220.97±33.79),(186.73±29.84)N,P<0.05]。②两组兔桡骨组织学观察结果:第4周微创植骨术组骨缺损区骨小梁密度(比值)大于开放植骨术组[(67.07±4.56),(51.29±5.95),P<0.01];第8周,微创植骨术组骨缺损区骨小梁密度小于开放植骨术组[(40.82±6.37),(50.81±7.51),P<0.05],骨小梁改建形成板层骨比开放植骨术组早。结论:通过生物力学检查及组织学观察,微创植骨术修复骨缺损的疗效优于开放植骨术。

AIM： To observe the biomechanies and histology of minimally invasive bone grafting in the plerosis of bone defects with self-made minimally invasive bone grafting instrument. METHODS： The experiment was conducted in the center of experimental animals of Renji Hospital, Shanghai Second Medical University from April to October 2004. Bone defect models were established by bilateral osteotomy in shaft of radius in 12 New Zealand white rabbits. All rabbits were then randomized into two groups： The rabbits in the open bone grafting group were cut along the original cut as 20 mm, opening the radius medullary cavity, grafting with the bone block of RBX. The rabbits in the minimally invasive bone grafting group were grafted with the self-made instruments. Six rabbits were gained at the 40^th and 80^th weeks after operation, respectively by random to perform the examination of biomechanics and observation of histology. The plerosis status of the rabbits in the two groups on the bone defection of radius was compared. RESULTS： Totally 12 rabbits were involved in the result analysis. ① Check result of biomechanics on the radius of the rabbits in the two group： At the 4th week the biomechanics of 2 pieces and 5 pieces of radius in the open bone grafting group and the minimally invasive bone grafting group, respectively could be detected. The values of demolish stress of anti-curvature were higher in the minimally invasive bone grafting group than that in the open bone grafting group [（69.58±34.99）, （12.83±20.41） N, P〈 0.05]. At the 8^th week 6 pieces of radius in the open bone grafting group and the minimally invasive bone grafting group could be used to perform the biomechanics examination. The values of demolish stress of anti-curvature were higher in the minimally .invasive bone grafting group than that in the open bone grafting group {（220.97±33.79）, （186.73±29.84） N, P 〈 0.05]. ② The observation result of histology on the radius of the rabbits in the two groups： The trabecular density in bone grafting areas in minimally invasive bone grafting group was higher than that in the open bone grafting group [（67.07±4.56）, （51.29±5.95）, P 〈 0.01] at the 4^th week. The trabecular density in bone grafting areas in minimally invasive bone grafting group was lower than that in the open bone grafting group [（40.82±6.37）, （50.81±7.51）, P 〈 0.05] at the 8^th week. The formation of lamellar bone induced by the reconstruction of bone trabecula occurred earlier than that in the open bone grafting group. CONCLUSION： Minimally invasive bone grafting has better curative effect on bone defects than open bone grafting by means of biomechanical examination and histological observation.