同种异体复合椎体重建颈椎的生物学研究

Biological study of allogenic compound on the reconstruction of cervical vertebrae

目的探讨同种异体皮质骨环(HCA)、自体红骨髓(RBM)及自体松质骨(CAB)复合椎体材料重建颈椎的能力,为临床应用提供理论依据。方法取39只新西兰大耳白兔,切除第4颈椎制成椎体缺损模型并分为3组,A组植入HCA-RBM-CAB复合物,B组植入自体髂骨,C组植入HCA-RBM-丙烯酸树脂骨水泥(Acrylic Bone Cem ent,ABC)。在术后不同时间分别对实验动物进行大体标本、组织学、X线片、扫描电镜观察,生物力学测试,检测其血清中碱性磷酸酶(ALP)活性及钙、磷浓度,比较三组对实验动物修复骨缺损的能力。结果术后各组血清ALP均开始升高,在2周及4周时各组内差异有显著性(P(0.01)。A组和B组血清中ALP及磷均高于C组(P(0.01),A组和B组血清中ALP及钙,磷浓度差异无显著性(P>0.05)。术后2个月X线片及大体标本观察示,A组与B组植骨材料与上下颈椎融合,有大量骨痂;C组示,未完全融合,只有少量骨痂生长。术后1个月组织学观察,A组与B组可见有散在骨岛及骨小梁形成;术后2个月A组与B组形成大量成熟骨基质,骨小梁及骨髓腔。扫描电镜观察示,A组有大量新骨形成。术后2个月生物力学测试结果表明,A组与B组力学指标无显著性差异(P>0.05)。结论HCA-RBM-CAB复合物具有较强的成骨能力,可作为有效的椎体重建材料。

Objective To explore the effect of the compound of humeral cortical ring allograft（HCA） pocked with red bone morrow（RBM） and cancellous autogenous bone（CAB） on reconstructing cervical vertebrae, and to provide some evidence for clinical practice. Methods The animal models with the defect of the fourth cervical vertebrae were made by resection in 39 white rabbits from New Zealand, which were divided into 3 groups. Group A was implanted with the compound of HCA, RBM and CAB, Group B with autogenous iliac bone, and Group C with HCA, RBM and Acrylic Bone Cement. At different times after operation, 3 groups were respectively observed by gross, X-rays, histology and scanning electron microscope （SEM） and measured in biomechanics, the activity of alkaline phosphatase（ALP） and concentrations of calcium, phosphorus in serum. From these, to Compare the ability of repairing bone defect in 3 groups. Results The activity of ALP in serum increased after operation in 3 groups, and there were significantly differences at 2nd and 4th week in each group（ P〈0.01 ）. The contents of ALP and phosphorus in serum of Group A and B were significantly higher than those in Group C（ P〈0.01 ）. There was no significant difference in the contents of ALP, calcium and phosphorus in serum between Group A and B （ P〉0.05 ）. Observations by gross and X-rays at 2nd month showed that cervical vertebral fusion was found in Group A and B, but not found in Group C. Histological observation showed scattered bone island and bone trabecula were formed at 1st month, and a lot of mature bone matrix, bone trabecula and bone marrow cavity were formed at 2nd month. By SEM much new bone formarion could be found in Group A. The measurement results of biomechanics at 2nd month showed that there was nO significant difference between Group A and B （ P〉0.05 ）. Conclusion The compound of HCA, RBM and CAB has a better abilityfor bone formation, which can be an effective material for vertebral reconstruction.