自体红骨髓复合自体松质骨填充同种异体皮质骨环重建兔颈椎(英文)

Reconstruction of rabbit cervical vertebrae with the compound of humeral cortical ring allograft packed with red bone marrow and autogenous cancellous bone

背景:国内外不少学者运用异体骨移植椎间融合进行椎体切除与重建,骨融合时间优于单纯自体骨移植,其在融合早期能提供支撑稳定作用,但制备异体骨移植材料时,易破坏基质中的骨诱导因子,不利于骨质生长。目的:课题创新性设计并验证自体红骨髓复合自体松质骨填充同种异体皮质骨环重建兔颈椎的能力。设计、时间及地点:随机对照动物实验,于2004-10/2006-03在武汉大学人民医院骨科实验室完成。材料:健康成年新西兰大耳白兔60只,雌雄不限,体质量2.0～2.5kg。其中12只兔用于同种异体皮质骨环的制备;剩余48只兔随机分为3组,每组16只。自体红骨髓于髂前上棘穿刺抽取红骨髓;自体松质骨从兔髂嵴处取得三面皮质骨。将自体红骨髓与自体松质骨复合,填充在自制的同种异体皮质骨环中。方法:3组兔采用第4颈椎切除模拟肿瘤切除模型。联合移植组植入同种异体皮质骨环-自体红骨髓-自体松质骨复合物;自体骨移植组植入自体骨;同种异体皮质骨环移植组植入同种异体皮质骨环。主要观察指标:以X射线检查、组织形态学检查、血清碱性磷酸酶及扫描电镜观察各组重建颈椎的效果。结果:术后8周,联合移植组、自体骨移植组植骨材料与上下颈椎融合,有大量骨痂,同种异体皮质骨环移植组可见少量骨痂生长,融合不牢。各组血清碱性磷酸酶开始均升高,4周时联合移植组、自体骨移植组血清中碱性磷酸酶浓度都高于同种异体皮质骨环移植组(P<0.01),联合移植组、自体骨移植组血清中碱性磷酸酶浓度差异无显著性意义(P>0.05)。8周时,3组碱性磷酸酶比较差异无显著性意义(P>0.05)。组织学观察联合移植组、自体骨移植组形成大量成熟骨基质,骨小梁及骨髓腔。扫描电镜观察示联合移植组、自体骨移植组有大量新骨形成。结论:联合自体红骨髓+自体松质骨+同种异体皮质骨环移植和自体骨移植均有效地重建颈椎,自体红骨髓与自体松质骨复合填充的同种异体皮质骨环可明显促进同种异体皮质骨环重建椎体的作用,可以作为有效椎体重建材料。

BACKGROUND： Many scholars adopt allograft interbody fusion for vertebral body resection and reconstruction, bone fusion time is better than autologous bone graft＇s, and its integration provides an early support and stabilizing, but the preparation of allogeneic bone graft material is easy to destroy bone-inducing factor in matrix, which is not conducive to bone growth. OBJECTIVE： To innovatively design and verify the ability of reconstructing rabbit cervical vertebrae with the compound of humeral cortical ring allograft （HCA） packed with red bone marrow （RBM） and autogenous cancellous bone （ACB）. DESIGN, TIME AND SETTING： Randomized controlled animal experiment was performed at the laboratory of Orthopedic Department in Renmin Hospital of Wuhan University, between October 2004 and March 2006. MATERIALS： Sixty healthy adult New Zealand white rabbits, of either sex, body mass of 2.0-2.5 kg, were involved in this study. Twelve rabbits were used for HCA preparation, while the remaining 48 rabbits were randomly divided into 3 groups with sixteen rats in each group. Autologous RBM was extracted from the anterior superior lilac spine through puncture; ACB was obtained from tri-cortical bone of rabbit lilac crest. Autologous RBM and ACB were compounded and filled in the self-made HCA. METHODS： Models of the fourth cervical vertebrae defect were created by surgery to simulate tumor resection in New Zealand white rabbits, which were divided into 3 groups randomly. Combined transplant group was treated with the compound of RBM＋ACB＋HCA; autologous bone transplant group with autogenous lilac crest; HCA transplant group with HCA. MAIN OUTCOME MEASURES： Vertebral reconstructions were evaluated by X-ray, histopathological observation and scanning electron microscope, as well as measurement of serum alkaline phosphates at different periods postoperatively. RESULTS： Eight weeks post-surgery, graft materials fused with the upper and lower cervical fusion, a large number of bone callus were observed in combined transplant group and autologous bone transplant group; HCA transplant group was present with a small amount of callus growth and poor fusion. Serum alkaline phosphatase levels were elevated in all groups, significantly higher in combined transplant group and autologous bone transplant group compared with HCA transplant group （P 〈 0.01）. There were no significant differences of serum alkaline phosphatase levels between combined transplant group and autologous bone transplant group at 4 weeks or among 3 groups 8 weeks （P 〉 0.05）. Histological analysis exhibited numerous mature bone matrix, bone trabecula and bone marrow cavity formed in combined transplant group and autologous bone transplant group. Scanning electron microscopy showed that many new bone formations in combined transplant group and autologous bone transplant group. CONCLUSION： The compound of RBM＋ACB＋HCA and autogenous lilac crest transplantation can efficiently reconstruct cervical vertebrae, RBM＋ACB can improve the reconstruction efficiency of HCA, and could use as a material in cervical reconstruction.