引导膜的稳定性提高后对其修复超临界骨缺损成骨作用的影响

Study of the Effect of the Pedicle Fascial Flap to the Promotion of Osteogenesis of Supercritical Bone Defect

目的:将带蒂筋膜瓣作为引导膜,研究它的稳定性对其促超临界骨缺损成骨作用的影响。方法:30只新西兰大白兔,制备双侧尺骨中段连同骨膜1 cm骨缺损模型,将自体红骨髓接种于含骨形态发生蛋白(BMP)的骨诱导活性材料上制备非细胞型组织工程骨,并植入双侧骨缺损区,利用显微外科技术在双侧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(带蒂筋膜瓣),左侧采用单纯带蒂筋膜瓣包裹,设为A组(对照组),右侧采用带蒂筋膜瓣包裹后行微型钛板内固定术,设为B组(实验组)。术后对实验动物行一般情况观察,两组均于在第4、8、12、16周后进行实验动物大体形态观察,尺骨X射线检查,修复区组织学检查,修复区内骨形态计量分析,并在12、16周行生物力学测定分析。结果:通过实验动物大体形态观察、X线片、组织学检查、骨形态计量分析检测,发现植骨区骨痂形成、植入物内部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,B组均明显优于A组。术后4、8、12、16周新生骨小梁面积占修复总面积比值及B组内不同时间点比较差异均有统计学意义(P<0.05)。生物力学测定分析显示,术后12、16周两组间比较及同组内各时间点间比较差异均有统计学意义(P<0.05)。结论:通过比较提高带蒂筋膜瓣的稳定性前后其包裹非细胞型组织工程骨修复超临界骨缺损的成骨效果,证明提高引导膜结构的稳定性有利于超临界骨缺损的修复。

Objective：To study the effect of the stability of the pedicle fascial flap to the promotion of osteo- genesis of supercritical bone defect. Methods： Constructed a one centimetre long bone defect model with perios- teum in the middle of both ulnas of 36 New Zealand rabbits. Prepared the uncellular tissue engineering bone by implanting the autologous red bone marrow to the osteoinduction active material （OAM） with hone morpho- genetic protein （BMP） and filled the bone defect of both sides with it. Prepared a pedicle fascial flap, which was a fascial flap with capillary network originating from an anonymous vessel stem, close to the bone defect area of both sides by mierosurgical technique. The left side was wrapped by pedicle fascial flap merely as Group A （con- trol）, and the internal fixation with miniature titanium board was performed in the right side besides the pedicle fascial flap wrapping as Group B （experimental group）. The general state of health was observed after the opera- tion in both groups. The morphology observation, X - ray examination of the ulna, histology examination and bone morphology quantitive analysis in the repair area were performed on the 4th, 8th, 12th and 16th week after the operation. The biomechanics test was performed on the 12th and 16th week after the operation meanwhile. Results： Group B was superior to Group A in all of the aspects of the general state of health observation, X - ray film, bone morphology quantitive analysis, the quantity and formative speed of the bone trabecula and cartilagi- nous tissue in the implants, mature bone formation, backbone structure remodeling, the bone marrow cavity re- canalization and the absorption and degradation of the implants. Comparing the new trabecular bone area for re- pair of total area ratio on the 4th, 8th, 12th and 16th week after the operation and those at different time points in Group B, all the differences had statistical significance（P 〈 0.05）. The biomechanics test analysis showed that all the differences had statistical significance（P〈 0.05） by comparing Group A and Group B and the same group at different time points. Conelmiort： It is beneficial to the repair of supercritical bone defect that promoting the stability of the pedicle fascial flap, increasing the space under the membrane and sustaining the bone grafting area well, comparing the stability of the pedicle fascial flap and the effect of the uncellular tissue engineering bone wrapped by the pedicle fascial flap repairing supercritical bone defect.