高压氧辅助带蒂筋膜瓣为膜诱导骨修复兔尺骨缺损的实验研究

Experimental study on fascial flap with membrane-induced bone repair of rabbit ulna defect with hyperbaric oxygen as an accessory treatment

目的 研究高压氧辅助带蒂筋膜瓣为膜诱导的非细胞型组织工程化骨修复骨缺损的效果,为临床应用提供依据.方法 研究对象为24只成年新西兰大白兔左侧尺骨造骨缺损模型.取白体红骨髓与含BMP的骨诱导活性材料混合成非细胞型组织工程骨,利用显微外科技术在骨缺损邻近制备一个带有无名血管蒂所属毛细血管网的筋膜瓣,使其包裹组织工程骨并充填骨缺损,术后将造模兔按数字随机表随机分为对照组（A组）与实验组（B组）各12只,A组术后呼吸常压空气,B组术后高压氧治疗,术后4、8、12周进行X线检查、大体形态观察、组织学检查、修复区内骨形态计量分析和交界区血管图像分析.结果 X线片、大体形态观察和组织学切片多种方法,检测2组各时间段同一时间点植入物内部血管的长入、骨小梁及软骨组织形成的数量和速度,成熟骨结构的形成、骨干结构的重塑、骨髓腔的再通、植入物的吸收降解,并对修复区内骨形态计量分析,发现2组差异有统计学意义（P＜0.05）,B组体内成骨的能力和修复骨缺损的效果明显优于A组.交界区血管图像分析仪动态测量2组各时间段同一时间点单位面积内血管的数量及质量,经统计学比较差异均有统计学意义（P＜0.05）,B组较A组有明显的优势,提示高压氧对组织工程骨构建血管化进程有明显的促进作用.结论 高压氧辅助带蒂筋膜瓣为膜诱导的非细胞型组织工程化骨修复骨缺损,具有促进膜诱导骨再生和血管化双重作用,对缩短骨缺损修复时间,提高成骨的质和量有显著效果.

Objective To study the effect of fascial flap with membrane -induced bone repair on rabbit ulna defect with hyperbaric oxygen as an accessory treatment,and to provide the basis for further clinical application. Methods An animal model of bone defect in the left ulnar bone of the adult New Zealand rabbits was established. Autogenetic red bone marrow was taken and mixed with bone -induced active material containing BMP to form a noncellular tissue engineering complex. Then,through microsurgery,an innominatal fascial flap with vessels belonging to a capillary network was prepared,and had the tissue engineering complex wrapped up and the bone defect filled up. After surgery,the rabbits were randomly divided into two groups： the experimental group （ Group A） and the control group （Group B）,each having 12 animals. The rabbits in Group A breathed normal air while those in Group B were given hyperbaric oxygen treatment. Radiography （X-ray）,macroscopic observation,histological examination,dosimetric analysis of bone shape in the prosthetic area and also analysis of vascular image in the junctional area were performed some time later. Results From X-ray films,macroscopic observation,histological examination,marked statistical differences could be seen not only in the aspects of the growth of blood vessels in the implant and the rate and quantity of bone trabecula and cartilage tissue formation,but also in the aspects of the development of mature bone structure,the remolding of shaft structure,the reopening of marrow cavity,the absorbance and degradation of the implant,as well as morphological changes in the prosthetic area,between the two groups at the same time point within the same period （P 〈0.05）. Experiments showed that Group B was superior to Group A in the capability of ossification in vivo and the effect on the recovery of bone defect. Statistical analysis indicated that significant differences could be noted in the quantity and quality of blood vessels per unit area at the same time point within the same period （P〈0.05） between the two groups through dynamic measurement with the vessel image analyzer in the junctional area. The fact that Group B was superior to Group A might be an indication that HBO could enhance the vascularization of the newly -formed engineered bone. Conclusions Fascial flap with membrane- induced bone repair of rabbit ulna defect with hyperbaric oxygen as an accessory treatment seemed to have dual effects of membrane. - induced bone regeneration and vascularization and had significant effects on the quantity and quality of ossification.