带肌蒂移植骨成骨活动的实验研究

Experimental Study about the Osteogenic Activity of the Muscle Pedicle Bone Graft

目的 探索带肌蒂骨瓣移植后骨瓣的变化。方法 采用成年体健家犬 9条 ,切取带缝匠肌的髂骨块 ,将骨瓣游离后用医用硅胶膜包裹后固定于大腿外侧 ,术后 2、 4、 6、 8周取下骨块。以组织学、放射性核素扫描 ,生物力学测试等方法 ,观察肌蒂移植骨存活范围 ,成骨活动形式以及生物力学性能改变。结果 ①带缝匠肌髂骨瓣为一部分存活骨 ,在距肌蒂 1 2～ 1 7cm处开始出现骨组织坏死 ;②带缝匠肌髂骨瓣 ,存活骨的骨髓组织被纤维肉芽组织及新生毛细血管替代 ,远端死骨则是由近端存活骨向其“爬行替代” ;③组织学检查显示 2周时死骨内有少许纤维肉芽组织和新生毛细血管 ,6周时出现原始骨小梁 ,8周时部分骨小梁恢复正常形态 ,骨母细胞明显减少 ;④生物力学显示带缝匠肌髂骨瓣生物力学性能较对照侧为低 ,但在 8周时其抗压力学性能恢复较快。结论 组织学观察、ECT检查证实 。

Objective Searching for the survival range of muscle pedicle graft bone,and the way of osteogenic activity,and the change of biomechanical property of muscle pedicle bone during different period.Methods Nine mature and healthy dogs were divided into 4 groups randomly.The left ilium was the experimental site,where the bone piece with sartorius muscle attached was cut from os ilium.The right side was served as control.The graft bone from os ilium was wrapped up with silica gel,then fixed subcutaneously.The pedicled bone piece was retrieved in 2th,4th,6th,8th week after surgery,and the graft bone from two sides was equal in size.Survival range,osteogenic formation and change of biomechanics of muscle pedicle bone were examined by histology,radioistoope detection and biomechanical measures.Results ①The part of bone attached by the sartorius survived,but osteonecrosis was observed at the location of 1 2～1 7 cm from atttached point of muscle;②In the proximal portion,The medullary tissue was replaced by fibro granulation tissue and newly formal capilliaries.The distal dead portion showed signs of“creeping substitution”coming from the proximal survival portion.③In dead bone small amount of fibrogranulation tissue and new capillaries were observed in the second week,primary bony trabculae was observed in 6th week,and some trabeculae recovered their appearance and osteoblast cell reduced remarkedly in eighth week.④Compared to the control side,biomechanical property of muscl pedicled bone graft was reduced,however,its anticompression property recovered significantly in 8th week.Conclusion The results of histological examination and ECT demonstrated that the muscle pedicle grafted bone is a piece of bone with relatively poor blood supply.