磷酸三钙植骨治疗跟骨骨折的疗效和组织学观察

The clinical efficacy and histological observation of tricalcium phosphate bone graft in the treatment of calcaneal fracture

目的:观察多孔磷酸三钙治疗跟骨骨折的疗效及骨细胞生长情况。方法:85例跟骨骨折患者中,采取传统切口钢板内固定57例,小切口空心钉内固定28例,其中75例使用磷酸三钙植骨治疗,观察临床疗效。骨折愈合后二次手术取内固定,并在原植骨区取极少量骨组织标本再次行组织学观察,比较骨细胞的生长情况。结果:传统切口钢板内固定和小切口内固定植骨患者临床疗效明显优于小切口内固定未植骨患者(P<0.01)。植骨后新生骨组织中成骨细胞增生活跃,骨细胞分化成熟,密度增大,骨小梁密度增宽,骨小梁间纤维组织增生伴毛细血管增生。结论:多孔磷酸三钙具有良好的生物相容性、生物力学强度和骨传导作用,其降解效应与骨组织的改建塑形基本同步,降解速度适中,骨愈合后接近与正常骨组织,性能稳定,组织学照片显示新骨生成良好,与原骨组织相似。

Objective：To observe the clinical efficacy and bone cell growth of porous tricalcium phosphate in the treatment of calcaneal fracture. Methods：Eighty-five patients with calcaneal fractures were treated with steel plate internal fixation under traditional incision（57 cases） and cannulated screw internal fixation under small incision（28 cases）. Seventy-five patients were treated with tricalcium phosphate bone graft,the clinical efficacy of which was observed. The internal fixation was removed after fracture healing. The bone specimens from the original graft area were harvested,the histological feature of which was observed,and the growth of bone cells was analyzed. Results：The clinical effects of patients treated with steel plate internal fixation under traditional incision and internal fixation with bone graft under small incision were significantly better than that in patients treated with internal fixation without bone graft under small incision（P 〈0. 01）. In new bone tissue,osteoblasts active proliferating,mature bone cell differentiating,bone density increasing,bone trabecula density broadening and the fibrous tissue among bone trabecula complicated with capillary hyperplasia were detected. Conclusions：Porous tricalcium phosphate has good bio-compatibility,biomechanical strength and bone conduction effect,the biological degradation effect of which is synchronized with bone tissue reconstruction. The new bone tissue after fracture healing is similar to the normal bone. The growth of new bone is good,which is similar to the original bone tissue.