经皮注射骨形态发生蛋白和自体红骨髓修复兔骨缺损与骨不连

Reparation of bone defect and nonunion by percutaneous injection of bone morphogenetic protein andred bone marrow in rabbits

目的：评价骨形态发生蛋白（BMP）与自体红骨髓复合经皮注射在修复骨缺损与骨不连中的作用．方法：20只成年新西兰大白兔，双侧挠骨中上段截去15mm，包括骨膜，每10个缺损为一组，随机分为4组，分别植人（sc）骨形态发生蛋白（BMP）／自体红骨髓（RBM）／聚乙烯毗咯烷团（PVP）一A组，BMP／PVP-B组，RBM／PVP-C组和PVP-D组，植人后2wk～8wk做X线检查、组织学检查及生物力学试验．结果：植入后A组在2wk时可见有骨及软骨再生，B、C组在4wk时可见骨痴形成，A组8wk时在形态特征、组织学特性和生物力学性质均类似于正常骨，其成骨速度及成骨量均明显优于B、C组，已完成骨性连接、髓腔再通及板层骨改建．对照组D只在两截骨端有少量软骨细胞及稀少编织骨形成，缺损区为结缔组织填充，从组织切片中发现BMP／RBM／PVP植人后，骨髓内的定向性骨祖细胞（DOPC）及诱导性骨祖细胞（IOPC）在BMP作用下，以多个软骨、骨岛样骨化中心成骨，逐步连成一体，最后与两端骨痴连接而完成骨缺损的修复．结论：MBP／RBM／PVP经皮注射植人在修复骨缺损及骨不连时，具有较强的骨再生能力，有广泛的临床应用前景．

AIM: To evaluate the percutaneous injection ofbone morphogenetic protein (BMP ) and red bone marrow(RBM) in repairing bone defects and nonunion. METHODS:Twenty Newzeland rabbits aged I -- 1. 5 years were randomlydivided into four groups. A fifteen--millimeter radial bone defect was created based on the established model of bonenonunion in rabbits. One group was injected withpolyvinylpyrrolidone (PVP) as control (group D). The others were injected respectively with BMP/RBM/PVP (groupA), BMP/PVP (group B) and BM/PVP (group C ). Thebone repair was assessed by serial roentgenographic and histological studies and biomechanical tests from two to eightweeks after the injection. RESULTS: New bone was inducedin all groups except the control group. In group A, the newlyformed bone highly resembled the normal bone morphologically and histologically. In group D, the cut end of the radiusbecame ossified and the bone marrow canal was blocked. Thehistologic study revealed that seven of the eight defects ingroup A were united with massive bone formation and thebone marrow canal was recanalized eight weeks postoperatively. CONCLUSION: The results of this study suggest thatthe percutaneous injection of BMP/RBM/PVP has great potentials for clinical use in repairing bone defects andnonunion.