纳米羟基磷灰石-二氧化锆生物陶瓷材料刀片切割伤口的愈合(英文)

Incision concrescence of a nano-sized hydroxyapatite-zirconia bioceramical scalpel

背景:羟基磷灰石是一种理想的骨和牙齿的外科医用材料,但其强度低且具有一定的脆性;羟基磷灰石和二氧化锆(3%mol氧化钇稳定的立方相二氧化锆)作为骨替代材料,二者复合后制备生物陶瓷材料对伤口愈合的影响值得研究。目的:观察纳米羟基磷灰石-二氧化锆生物陶瓷刀片材料切割伤口后对其愈合的影响。设计:单一样本观察。单位:哈尔滨医科大学附属第二医院骨二科,哈尔滨工业大学。材料:实验于2006-03/05在哈尔滨医科大学附属第二医院实验动物研究室完成,选用54只4月龄SD大鼠,雌雄不限,体质量120～180g。实验所使用的纳米羟基磷灰石粉体为自行制备,Ca(NO3)2·4H2O(天津市博迪化工有限公司),(NH4)2HPO4(天津市石英钟厂霸州化工分厂),氨水(绥化市化学试剂厂),无水乙醇(天津化学试剂厂)。方法:将纳米羟基磷灰石和二氧化锆粉体经充分研磨后得到纳米羟基磷灰石/二氧化锆复合粉体,以质量比按40%羟基磷灰石+60%二氧化锆比例配制,采用热压烧结技术磨削制成具有一定刃形形状的外形,进行伤口切割实验,即用高压灭菌后的生物陶瓷刃部纵行切开大鼠背部皮肤与皮下组织,切口长为2cm,再用1#丝线缝合切口。分别在术后第3,7,14天将动物断颈处死,每次取18只,切取切口处皮肤与皮下、肌肉组织进行大体观察,同时进行切片、苏木精-伊红染色,光学显微镜观察伤口愈合情况。主要观察指标:大鼠背部伤口大体及组织学观察结果。结果:纳入大鼠54只,均进入结果分析,无脱失值。术后3d,大鼠背部伤口边缘可见到表皮撕裂的微细碎屑,切口未愈合,切口边缘有明显的炎性细胞浸润。术后7d,切口边缘仍可见到表皮撕裂的微细碎屑,但已经开始出现修复反应,碎屑减少,切口变平整,开始愈合,切口皮下组织内有明显的炎性细胞浸润。在高倍光学显微镜下观察,创缘开始愈合,可见到新生的胶原纤维充填于切口间,但胶原纤维较疏松,皮下组织内有大量的浸润的白细胞,为组织修复反应相。术后14d,伤口创缘间被致密的胶原纤维充填,皮下组织内的白细胞浸润明显减轻,新生的毛细血管内可见到正常的血细胞,切口间新形成的胶原纤维致密坚强,为正常创伤修复与和组织。结论:纳米羟基磷灰石-二氧化锆生物陶瓷材料具有无毒、无过敏等特点,具有良好的生物活性。

BACKGROUND： Hydroxyapatite is a kind of ideal orthopedic material, but its Iow strength and brittleness need to improve. The research suggested that the improvement of the toughness and strength of bioceramics which composite hydroxyapatite （HAP） and zirconia （3% mol yttria-stabilized cubic zirconia） and fabricated ceramic scalpel possesses of the wound recover faster with smaller side. So it is significant that research on the incision concrescence of nano-sized hydroxyapatite-zirconia bioceramical scalpel.OBJECTIVE： To observe the effects of incision using nano-sized HAP-TZP bioceramics as scalpel.DESIGN： A single sample study.SETTING： Second Department of Orthopaedics, the Second Affiliated Hospital of Harbin Medical University and Harbin Institute of Technology.MATERIALS： The experiment was carried out in the Animal Laboratory of the Second Affiliated Hospital of Harbin Medical University （Provincial Laboratory） from March to May 2006. A total of 54 SD rats, of 4 months old, weighing 120-180 g, of both genders, were selected in this study. The experiment materials included nano-sized hydroxyapatite Quartz Clock Company）, ammonia （Suihua Chemical Reagent Company）, and anhydrous ethanol （Tianjin Chemical Reagent Company）.METHODS： The nano-sized Hydroxyapatite/zirconia composite powder was synthesis by rubbing according to 40% hydroxyapatite ＋ 60% zirconia powders （mass ratio） were mixed and milled. The knife-edge biomaterials, which fabricated by hot pressed sintering, was grinding and used in incision experiment after autoclaving. The back of the rats was shaved and removing a patch of skin under ether anesthesia made a length of 2 cm open excision wound and stitched up the tear by 1# string. The each 18 rats were sacrificed on 3, 7 and 14 days post-wounding and used for analyses respectively. A full-thickness specimen containing the wound was dissected out from each of the surgical sites. The hematoxylin-eosin （HE） staining was applied in the pathological observation.MAIN OUTCOME MEASURES： The tissue sections of back and the results of pathological observation. RESULTS： All 54 rats were involved in the results analysis without any loss. There was long gap with minimal cellular reaction in the scalpel wounds that has not healed on day 3. There was inflamed cells infiltration at the wounded margin edge. By week 1, the tiny detritus which some of them appear the repaired response of epidermis rend were still obviously found in the area of the scalpel wounds where the detritus was found to be significantly less, the wounds changed smooth and started to heal. The optical microscopy observed indicated that there was incomplete epithelialization and hyalinization of dermal collagen at the wounded area. There were obvious inflamed cells to infiltrate in the margin subcutaneous tissue of the wounds where the newborn loose collagenous fibers filled in scalpel wounds was the tissue repairing response phase. There was a great deal of the infiltrated white blood cells in the subcutaneous tissue. The tiny detritus of epidermis by the optical microscopy observed rend could not be found in the area of the scalpel wounds which were healed by week 2. The newborn capillary nets appeared in the newborn repaired collagen fibers tissue. The inflamed cells to be infiltrated were reduced. The compact and strong collagenous fibers filled in scalpel wounds were the normal wound repairing and tissue. The white blood cells infiltrated obvious reduction in the subcutaneous tissue. The normal blood cells in the newborn capillaries could be seen. CONCLUSION： The experiments prove that a HAP-ZTP bioceramic scalpel, which possesses excellent bioactive, is nontoxic, nonallergenic and noncarcinogenic for incisions.