生物材料人工胸壁结构设计及其评价

Frame construction of artificial chest wall with biomaterials:its design and evaluation

目的通过生物材料的筛选和优化组合及特殊工艺制备新型人工胸壁结构,并探讨其应用于大块胸壁缺损重建的可行性。方法根据胸壁重建需要,筛选出适宜的可降解高分子生物材料,通过特殊工艺制成三种不同结构的人工胸壁(聚对二氧杂环己酮纤维网、甲壳素纤维增强聚己内酯板、甲壳素纤维增强聚己内酯肋条)。建立犬大块胸壁缺损动物模型,应用所研制的人工材料进行动物实验,通过动态观察及组织学检查评价其效果。结果聚对二氧杂环己酮网重建胸壁与组织结合良好,可有效减轻反常呼吸,网状材料24周内完全降解吸收,被自体再生组织取代,胸壁长期稳定性和胸廓外形满意。甲壳素纤维增强聚己内酯板重建胸壁可获得良好的胸壁固定,肋条可有效防止反常呼吸,同时具有更佳的组织相容性。甲壳素纤维增强聚己内酯材料植入24周无明显变化。结论聚对二氧杂环己酮网及甲壳素纤维增强聚己内酯材料具有良好的组织相容性,可有效防止反常呼吸,在胸壁重建中各具特点,具有一定的临床应用价值。

Objective To design and prepare a new prosthesis of chest wall by selecting and integrating the appropriate biodegradable materials, and to evaluate the efficiency and safety of the prepared prosthesis in order to explore the feasibility of reconstruction of an extensive chest wall defect. Methods Three types of chest wall prostheses, polydioxanone （PDO） mesh, chitin fiber reinforced polycaprolactone （CFRP） plate and CFRP strip, were designed and prepared to fulfill the function of chest wall. A canine model of the chest wall resection and reconstruction was reproduced to evaluate these porstheses. 15 adult mongrel dogs were subjected to extensive resection of anteriot-lateral chest wall and reconstruction with chest wall prosthesis. Chest wall stability, the degradative process of the prosthetic materials and regeneration of the chest wall tissue postoperatively were recorded dynamically by macroscopic inspection and histopathologic examinations, so as to provide valuable scientific data for improving chest wall prosthesis, Results The implanted PDO mesh was well integrated with autogenous connective tissue 8 weeks after operation, degraded gradually and reabsorbed completely within 24 weeks. It provided adequate support to the chest wall and achieved satisfy cosmetic and functional repair. CFRP plate was the best in chest wall stabilization among the three groups, and paradoxical respiratory movement was efficiently relieved with CFRP rib, and it had a better biological compatibility. There was no obvious morphological change in the CFRP material after it was implanted for 24 weeks. Conclusion The synthetic prostheses developed here showed excellent biocompatibility, and they fulfilled the function in providing chest wall stabilization. Each prosthesis has its respective favorable properties in chest wall reconstruction, and all of them are valuable in clinic application in the management of complicated chest wall defects.