磷酸钙骨水泥结合自体带血运骨膜修复节段性骨缺损

Calcium phosphate bone cement combined with autologous vascularized periosteum in the repair of segmental bone defects

背景:磷酸钙骨水泥是一种新型骨替代材料,但具有降解慢、力学性能差等缺点。目的:探讨磷酸钙骨水泥结合自体带血运骨膜修复节段性骨缺损的可行性。方法:将72只新西兰大白兔随机数字法均分为4组:保留/不保留骨膜的不用磷酸钙骨水泥修复组、保留/不保留骨膜的磷酸钙骨水泥修复组。修复后4,12,24周取标本进行大体、放射学、组织学及生物力学测试。结果与结论:不用磷酸钙骨水泥修复组:不保留骨膜12周时才开始出现骨痂,24周时骨端硬化,髓腔闭合;保留骨膜后4周时出现少量的骨痂,12周时骨痂增多,24周时形成新生骨。磷酸钙骨水泥修复组:不保留骨膜时4周材料与骨端分界明显,12周时分解模糊,24周时材料与骨端形成骨性连接;保留骨膜4周材料未见降解,12周时材料有降解,24周时材料吸收更多,髓腔再通。24周时磷酸钙骨水泥修复组行三点弯曲生物力学测试,不保留骨膜组最大负荷低于保留骨膜组(P<0.05)。说明磷酸钙骨水泥较好促进骨的生长,自体带血运骨膜的存在有利于磷酸钙的吸收,促进骨的形成。

BACKGROUND： Calcium phosphate bone cement （CPC） is a new-type bone substitute material, but it has slow degradation and poor mechanical properties. OBJECTIVE： To investigate the feasibility of CPC combined with autologous vascu{arized periosteum in repairing segmental bone defects. METHODS： Totally 72 New Zealand rabbits were randomly divided into four groups： non-CPC groups with/without periosteum retention and CPC groups with/without periosteum retention. The specimens were tested by general, radiology, histology and biomechanics tests at weeks 4, 12 and 24 after repair. RESULTS AND CONCLUSION： Non-CPC groups： the callus was found at week 12, as well as bone sclerosis and medullary cavity closure was seen at week 24 in non-periosteum retention group; a spot of calluses was found at week 4, and callus were increased at week 12, as well as oblique new bone was formed at week 24 in periosteum retention group. CPC groups： in the non-periosteum retention group, boundaries between material and bone end were found obviously at week 4, and the fuzzy decomposition was seen at week 12, besides, materials and bone end formed bony connection at week 24; in the periosteum retention group, no degradation in materials was found at week 4 and material degradation were seen at week 12, moreover, material absorption was more and the medullary cavity was recanalized at week 24. CPC groups were performed three point bending biomechanics test at week 24, and the results showed that the maximum load of the non-periosteum retention group was lower than that of the periosteum retention group （P 〈 0.05）. These findings suggest that CPC can promote bone growth effectively, and autologous periosteum is helpful to calcium absorption and promotes bone formation.