钻孔复合浓缩骨髓对兔结构性骨移植愈合的影响

Effect of perforation plus condensed bone marrow on healing of structural bone allografts in rabbits

目的观察异体骨钻孔并复合自体浓缩骨髓移植对兔骨缺损的修复和重建能力，为临床结构性骨移植提供新方法。方法将36只日本大耳白兔随机分成三组，每组12只，制成左侧股骨中段3cm缺损，分别采用不同方式处理过的同种异体骨进行移植，A组：植入未打孔异体骨＋骨泥；B组：植入打孔异体骨＋骨泥；C组：植入打孔异体骨＋骨泥浓缩骨髓复合物。术后3个月分别行X线片、组织学观察、骨密度测定和生物力学测试。结果①放射学检查：A组仅在供一宿结合部可见有骨痂包绕，异体骨周围无明显骨痂；B组及C组整个移植骨段周围均可见明显骨痂，C组骨痂延伸范围更广。②组织学观察：三组异体骨供一宿结合部均完全吸收，被大量骨痂取代且塑形良好；中间横断面A组异体骨周围可见少量内骨痂，B组可见少量内骨痂及外骨痂且被大量纤维结缔组织所分隔；C组异体骨可见大量内外骨痂生长，髓腔内充满骨母细胞，外骨痂骨小梁已相互融合形成编织网状骨，但与异体骨间仍被纤维结缔组织间断分隔。③平均骨密度值测定：C组高于A、B组及对侧正常股骨，差异有统计学意义（P〈0．05）。④力学性能检测：A、B、C三组间最大载荷比较，差异无统计学意义（P〉0．05），A、B、C组均低于对侧正常股骨（P〈0．05）。结论 钻孔并复合浓缩骨髓能促进大段移植骨的早期活化，提高新骨产量。

Objective To observe the efficacy of repairing and reconstructing large femoral defects in rabbits with large perforated allografts of cortical hone plus condensed host hone marrow. Methods Thirty-six Japanese rabbits were randomly divided into 3 equal groups. A hone defect of 3 cm was created by surgical resection of the middle region of left femur in each animal. The defect was filled with a large fragment of cortical hone allograft and cancellous hone powder in group A, with a perforated large fragment of cortical hone allograft and cancellous bone powder in group B, and with a perforated large fragment of cortical hone allograft and cancellous bone powder mixed with condensed host hone marrow in group C. Three months after transplantation, bone samples were harvested for histological analysis, radiological examination, hone density measure and biomechanical test. Results Rediological examination： In group A, little callus was found in the allograft except some callus in the donor-host interface. Much callus was found in groups B and C, and callus extended significantly wider in group C. Histological analysis： Allografts at the donor-host interface were completely absorbed and replaced by much well-remodeling callus in all groups. At the transverse section, little endosteal callus was seen in group A and some endosteal and periosteal callus was seen in group B which was separated by fibrous tissue. In group C, much endosteal and periosteal callus formed in the hone graft, and a great deal of osteoblasts filled the medullary cavity. Periosteal callus in group C was found to have transformed into cancellous architecture and been separated by fibrous tissue. Bone density measure： The density in group C was greater than that in groups A and B and contralateral normal femur （ P 〈 0.05） . Biomechanical test： No significant difference was found in the maximum three-point bending load among groups A, B and C （ P 〉 0. 05）, but the load in all groups was lower than that of the contralateral normal femur （ P 〈 0. 05）. Condusion Perforation plus condensed bone marrow can promote early incorporation of large fragments of hone allograft and improve new bone formation.