同种异体肋骨重建兔胸壁缺损的实验研究

An experimental study of chest wall reconstruction with allogenous ribs in rabbits

目的:胸壁缺损重建方法较多,目前以人工材料重建方法为主,实验重点观察同种异体肋骨在兔胸壁缺损重建中的作用,为同种异体骨临床应用提供相关理论依据。方法:深冻法制备兔同种异体肋骨备用。建立20只3 cm×3cm胸壁骨性缺损的兔动物模型,其中10只兔采用同种异体骨进行重建(实验组),另10只兔采用自体肋骨移植进行重建(对照组),观察2种方法重建胸壁的愈合情况,术后第1、2、4、6、8、10、12周抽血行血生化检验,每月拍胸片行影像学检查,第1、2月每组各处死1只动物,第3月处死剩余动物,取重建部位组织进行组织学观察。结果:所有兔均无手术死亡和围手术期死亡,术后均无胸壁塌陷、反常呼吸、感染及其他并发症,胸壁稳定坚固,两组血清碱性磷酸酶(ALP)及钙磷乘积(calcium-phosphorus product)变化均无统计学意义(P(0.05),胸片示肋骨断端处骨增生明显,骨折线模糊,周围组织将移植物包裹紧密,组织学检查见骨增生活跃,骨小梁生成。结论:自体肋骨及同种异体肋骨移植重建胸壁均可有效阻止反常呼吸,提供骨性支撑。同种异体骨来源丰富,可作为骨性材料重建胸壁缺损。

Objective： Many methods especially prosthetic materials are used in chest wall reconstruction. This experiment focus on observation the contributions of allogenous ribs in chest wall reconstruction in rabbits, and provide a theoretical basis for the clinical application. Methods： We prepared deep-frozen allogenous ribs and established a model of chest wall defect including partial 3 ribs （3 cm × 3 cm） in 20 rabbits. Chest wall reconstruction was performed with allogenous ribs in 10 of rabbits （test group） and with autogenous ribs in the other 10 （control group）. The state of the implanted chest wall prosthesis, the progress of the postoperative regeneration of the chest wall tissues, and the changes of blood biochemical parameters and pathology were observed dynamically. Results： There was neither perioperative death nor postoperative chest wall subsidence, infection and paradoxical respiration. No significant changes were observed in serum alkaline phosphatases and calcium-phosphorus products （P = 0.113 and P = 0. 799） in either of the groups. X-ray and histological examinations revealed significant regeneration. Conclusion： Both allogenous and autogenous ribs can provide effective support, and the former can be used as a prosthesis, in chest wall reconstruction.