吻合血管同种异体骨移植术后供骨的转归

Outcome of donor bone after vascularized allograft bone transplantation

目的:观察免疫调控下吻合血管的同种异体骨移植术后供骨的转归趋势。方法:实验于2002-12/2004-03在武汉大学医学院显微外科研究所完成。日本大耳兔雄性21只为供体,雌性42只为受体。受体分为实验组21只和对照组21只。①对不同性别日本大耳白兔进行吻合血管同种异体大段股骨干移植。②实验动物分为使用环孢素A(口饲25mg,1/d,3周)的实验组及未使用任何免疫抑制剂的对照组。③术后1,4,9个月进行X射线和组织学检查,并对移植骨进行Sry半定量聚合酶链反应分析。结果:42只兔全部进入结果分析。①两组兔移植术后不同时间点X射线表现:实验组在术后不同时期的X射线表现为典型的骨折愈合模式;对照组表现为移植骨密度增高,被大量骨痂包绕。②两组兔术后的组织学表现:实验组术后不同时期表现为典型的骨折愈合模式,9个月后髓腔由骨髓组织充填,皮质内外缘平整,哈弗斯管已恢复其正常大小,骨陷窝内存在骨细胞,皮质外周由纤维组织包绕;对照组表现为排斥反应的炎症细胞浸润,髓腔内骨髓坏死、纤维组织形成,骨陷窝内骨细胞缺失,移植骨被受体形成的编织骨包绕。③Sry半定量聚合酶链反应分析结果:Sry半定量聚合酶链反应分析显示移植骨内的雄性DNA比值与术后时间呈正相关,实验组术后9个月其比值接近100%,而对照组术后9个月其比值只达到11.8%。结论:吻合血管的同种异体骨移植在免疫调控下,移植骨与受体能达到早期愈合,且移植骨能较快地被受体所替代。

AIM： To observe the outcome of donor bone after vascularized allograft bone transplantation under immunoregulation. METHODS： The experiment was conducted at the Microsurgery Institute, Medical College, Wuhan University from December 2002 to March 2004. Totally 21 male flap-eared Japanese rabbits were selected as donor and 42 female ones as recipients, Recipients were composed of 21 rabbits in the experimental group and 21 rabbits in the control group. ①Anastomotic vascularized massive shaft of femur allograft was performed in Japanese flap-eared rabbits of either sex. ②The experimental animals were assigned into experimental group （treated with ciclosporin A, 25 mg orally, once a day, for 3 weeks） and control group （no any immunosuppressive agent）, ③X-ray and histology examinations ware performed at months 1, 4 and 9 after operation. Bone grafts ware analyzed with Sry semi-quantitative polymerase chain reaction. RESULTS： A total of 42 rabbits were involved in the result analysis. ①X-ray manifestation at different time points after rabbit transplantation in the two groups： X-ray showed typical fracture healing mode at different phases after operation in the experimental group, whereas the increase of bone graft density, and around by a mass of bony callus in the control group. ②Histology manifestation of rabbits in the two groups after operation： At different time phases it showed typical fracture healing mode in the experimental group after operation, and 9 months later the marrow cavity was filled with myeloid tissues, and the internal and external cortex was flat; Haversian canal had revered to the normal size： Bone cells appeared in the bone lacuna; Peripheral cortex was wrapped with fibrous tissues. In the control group, it showed inflammatory cell infiltration with rejection, bone marrow necrosis in marrow cavity, formation of fibra tissues, bone cell loss in bone lacuna, and the bone grafts were wrapped with woven bone that was from recipients. ③Outcome of Sry semi-quantitative PCR analysis： The Sry semi-quantitative PCR analysis showed that the relation between the ratio of male DNA and the postoperative period was positive; the ratio of experimental group at month 9 postoperative was near to 100%, while control group only reached 11.8%. CONCLUSION： Under the immunoregulation, bone graft can unite with the recipient bone in an earlier postoperative period and replace by recipient bone rapidly in vascularized allograft bone transplantation.