纤维蛋白胶对骨骺损伤后骨桥形成的预防作用

Prevention of growth arrest after physeal injury with fibrin interposition

目的利用未成熟大鼠制作胫骨近端骨骺损伤模型，比较不同方法修复生长板损伤的治疗效果，评价纤维蛋白胶作为一种新型生物材料应用于微创治疗方法的可行性。方法实验动物分为4组，A组为未损伤组，作为正常对照；B组为单纯损伤组，按照模型损伤后未予特殊处理；C组为脂肪组织填充治疗组，按照模型损伤后取自体腹股沟区脂肪组织填充损伤区，骨蜡封闭骨洞；D组为纤维蛋白胶填充治疗组，按照模型损伤后以预先配置好的纤维蛋白胶（广州倍绣生物技术有限公司）填充损伤区，骨蜡封闭骨洞。通过组织化学染色观察损伤模型的建立、损伤愈合过程以及骨桥形成情况。取材后先进行显微CT检查，再行组织学检测。比较纤维蛋白胶、脂肪作为填充材料预防治疗大鼠胫骨近端骨骺损伤后骨桥形成的情况，以及大鼠胫骨长度和近端角度的变化。结果组织学检查显示，纤维蛋白胶和脂肪填充组损伤区域逐渐被纤维组织替代，单纯损伤组损伤区域逐渐被骨桥组织替代。纤维蛋白胶填充治疗组在避免损伤区出现不可逆的骨桥方面，与脂肪填充治疗组效果接近（P〉0．05）。纤维蛋白胶填充组与单纯损伤组之间存在明显差异（P〈0．05），脂肪填充组与单纯损伤组之间存在显著性差异（P〈0．01）。结论显微CT可以用于骨骺损伤后骨桥形成的观察研究中。纤维蛋白胶制作来源广泛，术中应用简便，效果与传统的脂肪填充治疗接近，因而推测可能作为一种新的治疗方法引入临床，预防骨骺损伤后的骨桥形成。

Objective To evaluate the effects of fibrin graft interposition in proximal tibia transphyseal injury in murine model. Methods The growth plate injury model was generated in 56 skeletally immature rats. In 28 rats,a bilateral physeal injury was created with the defect of the left tibia filled with autogenously adipose tissue and the right tibia filled with fibrin. Micro CT was performed postoperatively to evaluate morphological and micro-structural features. Histology of the bone bridge was then carried out to compare the bony bridge formation effects of different grafted growth plate injuries. The length and angle of the grafted tibia were also compared. Results The BMD of the bone bridge in the epiphysis and metaphysis of the proximal tibias were significantly different between grafted tibias and non-grafted tibias at 4, 16 and 24 weeks postoperatively （P〈0. 01 ）. There was no significant difference between fibrin-graft and fat graft tibias （P〉0. 05）. Histological findings showed the grafted area was replaced by fibrous connective tissue,and physeal defects of the control animals were filled with mature marrow with trabecular bone formation. The deformity angle and medial length of the tibia were significantly different between grafted tibias and non-grafted tibias at 4,16 and 24 weeks postoperatively （P〈0. 01 ）. There was no significant difference between fibrin-graft and favgraft tibias （P〉0. 05）. Conclusions Both fat and fibrin graft interposition were useful in reducing growth disturbance in growth plate injury.