深低温冷存的吻合血管同种异体长骨移植的实验研究

Experimental Study of Transplantation of Cryopreserved Vascularized Long Bone Allograft

目的 :探讨深低温冷存的吻合血管异体长骨治疗大块骨缺损的效果。方法 :32只兔随机分成 3组 :A组 12只 ,用深低温冷存的吻合血管作异体骨移植 ;B组 12只 ,深低温冷存的吻合血管异体移植术后 4周用免疫抑制剂环孢素A(CyclosporineACsA) ;C组 8只作新鲜的吻合血管异体骨移植。术后 2、4、8、12周摄X线片 ,第 3周取外周血检测自发性淋巴母细胞生成率 ,第 8周取外周血检测白细胞介素 2 (IL - 2 ) ,并于 12周通过灌注墨汁等检测吻合血管的通畅情况 ,并对移植骨进行组织学检测。结果 :A、B 2组术后 12周两端可达骨性连接 (愈合 ) ,而C组仅 1例近端达骨连接且明显延迟。术后 3周A、B 2组自发性淋巴母细胞生成率与未移植兔比值均 <2。术后 8周外周血IL - 2活性 ,C组最高 ,A组次之 ,B组最低 ,且任意 2组之间均有显著性差异 (P <0 .0 1)。术后 12周 ,A、B 2组血管通畅率无显著性差异 (P >0 .0 5 )。组织切片中可见移植骨与受区两端有骨小梁连接。结论 :深低温冷存吻合血管异体长骨可修复大块骨缺损 ;深低温冷存和CsA可协同抑制吻合血管异体长骨移植的排斥反应。

Objective: To investigate the effect of reconstructing massive bone defect with cryopreserved vascularized long bone allograft.Methods:32 rabbits divided into three groups were evaluated.Allotransplantation of cryopreserved radius diaphysis with a vascular pedicle was performed in 12 rabbits(group A).As controls,similar cryopreserved grafts with the vascular pedicles were implanted to other 12 rabbits and Immunosuppressive agent was administrated postoperatively for 4 weeks (group B).8 rabbits received allotransplantation of fresh vascularized long bone were also compared (group C)postoperatively.Radiograph was taken for each graft at 2?4?8?12 weeks.Immunological analysis was performed using spontaneous lymphoblast transformation rate(SLTR) and IL-2 assay.At sacrifice,12 weeks after operation,the patency of the pedicle was observed through Chinese-ink infusing and histological studies were done.Results In group A and B,bony union can be obtained at both osteosynthesis sites by 12 weeks post transplantation.While in group C,bony union only occurred at proximal osteosynthesis site in one case,but with apparent delay.The ratio of SLTR between group A and untransplantation group,ratio of SLTR between group B and untransplantation group is below 2 respectively.The changes of IL-2 in group C were maximal and the difference between group A and group B reached significante difference statistically( P<0.01) ,the statistical difference of the patency rate between group A and group B was not significant ( P>0.05) .Histologic examination revealed new trabeculate crossing the graft recipient junction.Conclusions: Cryopreserved vascularized long bone allografts can reconstruct massive bone defects;cryopreservation combined with cyclosporine A has synergistic effect on reducing rejection response of revascularized long bone allograft.