筋膜瓣修复骨缺损时血管化与膜诱导促成骨作用的量化对比研究

Quantified comparison of vascularization osteogenesis and membrane-induced osteogenesis in bone defect repair with fascia flap

目的 比较不同时期筋膜瓣修复骨缺损时血管化与膜诱导促成骨作用,为临床干预骨缺损治疗提供依据.方法 使用含重组人骨形成蛋白2（BMP-2）的骨诱导吸收材料（OAM）与兔骨髓干细胞（BMSC）构建非细胞型组织工程骨,制作兔尺骨骨缺损模型（n=75）并进行组织工程骨移植修复骨缺损.实验兔分为3组：A组（n=25）单纯植入组织工程骨；在骨缺损邻近区域制备1个带蒂筋膜瓣,B组（n=25）植入无蒂筋膜瓣包裹的组织工程骨,C组（n=25）植入带蒂筋膜瓣包裹的组织工程骨.术后第4、8、12、16周行骨修复区内成骨区与空曝区吸光度比测量、骨形态计量分析和血管图像计量分析；术后第8、12、16周进行放射性核素骨显像检查,腋动脉注入墨汁观察修复区血管再生情况.结果 与A组、B组比较,术后第4、8周C组骨修复区内成骨区与空曝区吸光度比、新生骨小梁面积占镜下修复区面积的比值、单位面积内血管再生面积和放射性核素骨显像感兴趣区（ROI）摄取比值均显著增加（均P＜0.05）.与术后第8周比较,术后第16周3组骨修复区内成骨区与空曝区吸光度比、新生骨小梁面积占镜下修复区面积的比值均增加（均P＜0.05）.术后第8周A组、B组、C组骨修复区单位面积内血管再生面积分别为（7.20±0.23）％、（7.75±0.57）％、（24.75±1.58）％,放射性核素骨显像ROI摄取比值分别为（7.17±0.01）％、（10.12±0.02）％、（29.37±0.04）％；术后第16周A组、B组、C组骨修复区单位面积内血管再生面积分别为（4.31±0.13）％、（4.69±0.12）％、（9.98±0.74）％,放射性核素骨显像ROI摄取比值分别为（5.03±0.01）％、（5.16±0.04）％、（12.75±0.03）％,组内比较显示术后第16周各组单位面积内血管再生面积和放射性核素骨显像ROI摄取比值均减少（均P＜0.05）.结论 带蒂筋膜瓣早期以促血管化成骨作用为主,后期以膜诱导成骨作用为主.

Objective To compare vascularization osteogenesis and membrane-induced osteogenesis in bone defect repair with fascia flap at distinct periods,and to offer reference for clinical intervention of bone defect.Methods Non-cellular tissue engineering bone was constructed using osteogenesis absorption material （OAM） containing recombinant human bone morphogenetic protein 2 （BMP-2） and rabbit bone marrow stem cells （BMSCs）,and the prepared rabbit ulnar defect model （n=75） was repaired with tissue engineering bone transplantation.Rabbits were divided into 3 groups.In group A （n=25）,simple tissue engineering bone implantation was performed; A fascia flap with pedicle was prepared in the bone defect neighbouring region,the tissue engineering bone with pedicle-free fascia flap was implanted in group B （n=25）,while the tissue engineering bone with pedicle fascia flap was transplanted in group C （n=25）.Detection of the absorption ratio in osteogenesis region and empty region,bone quantitative morphology analysis,and vascular image quantitative analysis was carried out at week 4,8,12 and 16 after surgical operation.In addition,radionuclide bone imaging examination was performed,and ink was injected into axillary artery at 8,12 and 16 weeks after operation for observing vascular regeneration in repairment region.Results As compared with group A and B,the absorption ratio of osteogenesis region and empty region,proportion of newly-formed bone trabeculae area and microscopic bone repairment region,the area of vascularization per unit as well as the absorption ratio of region of interest （ROI）during radionuclide bone imaging increased significantly（all P〈0.05） in group C at week 4 and 8 after operation.As compared with week 8,there was an increase in absorption ratio of osteogenesis region and empty region as well as the proportion of newly-formed bone trabeculae region and microscopic repairment region （all P〈0.05）at week 16 in all groups.At week 8 after operation,the vascularization area per unit in repairment region was （7.20±0.23） %,（7.75±0.57） % and （ 24.75± 1.58 ） % in group A,B and C,respectively; absorption ratio of ROI during radionuclide bone imaging was （7.17±0.01）%,（10.12±0.02）% and （29.37±0.04）%,respectively.At week 16 after operation,the vascularization area per unit in repairment region was （4.31±0.13 ）%,（4.69±0.12） % and （9.98±0.74）% in group A,B and C,respectively; absorption ratio of ROI during radionuclide bone imaging was （5.03±0.01）%,（5.16±0.04）% and （12.75±0.03）%,respectively.Within-group comparison revealed a reduction in the vascularization area per unit in repairment region as well as absorption ratio of ROI during radionuclide bone imaging（all P〈0.05）.Conclusion Vascularization osteogenesis dominates the early stage,while membrane-induced osteogenesis is dominant in the late phase of fascia flap with pedicle repair.