磷酸氢钙/胶原复合人工骨与羟基磷灰石/胶原复合人工骨修复大段骨缺损的比较

Calcium hydrogen phosphate/collagen composite versus hydroxyapatite/collagen composite for repair of massive bone defects

背景:羟基磷灰石及与其他成分的复合体已成为国际通用的骨修复材料,广泛用于临床治疗及实验研究,其生物相容性已得到充分验证,但其可降解性能差及诱导骨缺损再生能力有限也为大家公认。作者认为用羟基磷灰石作为骨诱导材料只是机械地模仿天然骨的成分,用其他钙磷盐作为无机成分有可能突破现有科研思维的定势,为人工骨的研发代来新的突破。目的:比较磷酸氢钙/胶原复合人工骨和羟基磷灰石/胶原复合人工骨的骨传导性和骨诱导性。方法:使用15只新西兰大白兔作为实验动物,制备左侧尺骨1cm全缺损,分别植入磷酸氢钙/胶原复合人工骨、标准羟基磷灰石/胶原复合人工骨和合成羟基磷灰石/胶原复合人工骨。术后92d拍X射线片后处死动物进行解剖观察及组织学观察。结果与结论:磷酸氢钙/胶原复合人工骨组动物术后92d的X射线照片显示缺损处由于骨组织增生完全愈合,处死动物进行解剖可见缺损处修复与未手术部位外观接近。组织切片可见缺损处形成骨板并完全骨化,骨单位明显,尚未形成明显的层状骨板,散布的骨窝中有骨细胞,中央管可见新生血管,未见人工骨残留,人工骨被彻底降解吸收。标准羟基磷灰石/胶原复合人工骨组植入92d愈合处成骨较差,易折断。合成羟基磷灰石/胶原复合人工骨组植入92d不愈合。实验表明南京脉迪森医药科技有限公司生产的磷酸氢钙/胶原复合人工骨(仿松质骨生物活性人工骨)的骨传导性和骨诱导性能明显优于羟基磷灰石/胶原复合人工骨。

BACKGROUND：Hydroxyapatite or the complex with other components has become the international standard materials for bone repair,which has been widely used in clinical and experimental research.Their biocompatibility has been fully verified,but poor performance of degradability and limited ability to induce bone regeneration are also recognized.We believe that hydroxyapatite as a bone induction material is only to mechanically mimic the composition of natural bone,other calcium phosphate salts as inorganic components of bone composites may lead to breakthrough the fixed current scientific thinking and provide a new aspect of artificial bone development.OBJECTIVE：To compare the osteo-conductivity and osteo-inductivity of calcium hydrogen phosphate/collagen（DCP/CO）composite with hydroxyapatite/collagen（HA/CO）composite.METHODS：Fifteen New Zealand rabbits were used in this experiment to prepare a 10-mm bone defect at left ulnas,and then implanted with DCP/CO composite,standard HA/CO composite and synthesized HA/CO composites.The rabbits were killed at 92 postoperative days after the completion of X-ray photography,and processed into anatomical observation and histological examination.RESULTS AND CONCLUSION：X-ray photography showed that,the defects were completely healed owing to bone hyperblastosis in the DCP/CO composite group at 92 days after surgery,anatomical observation demonstrated that the repaired defects were similar to the appearance of non-surgical site.Histological sections showed the bone lamella formed at the defect site and fully ossified,with obvious osteon,there was no remarkable layered bone lamella,osteocytes were visible in the scattered absconsiones,and new vessels in central canal,without artificial bone residue.The artificial bone was completely biodegraded and absorbed.At 92 days after surgery,the defects of ulnas in standard HA/CO group were broken easily,indicating poor ossification;in HA/CO group the defect remained unrpaired.DCP/CO composite（imitating cancellous bone bioactive bone）,produced by Nanjing Medicine Science Technology Co.,Ltd.,has a superior osteo-conductivity and osteo-inductivity than HA/CO composite.