带血管腓骨复合异体骨重建节段性骨缺损动物模型建立

Reconstruction of segmental bone defect with vascular fibula compound allograft in the animal model

目的本实验观察带血管腓骨复合异体骨重建节段性骨缺损动物模型建立。方法选52只新西兰大白兔,对18只成年新西兰大白兔在全麻下无菌取双侧兔胫骨,取下的兔胫骨无菌下反复冲洗、处理髓腔,再放入无菌容器内在-196℃液氮灭菌40 min,常温下复温,作为实验用兔异体骨。再对另外34只新西兰大白兔分批在全麻下行单侧兔胫骨人为制造骨缺损,骨缺损范围约为1.2~1.5 cm,再选取粗细、长度相同的兔异体胫骨复合兔自体带蒂腓骨瓣修复骨缺损,钢板固定,平均手术时间1.5 h。结果实验的34只兔术后单侧胫骨骨缺损用兔同种异体骨复合兔自体带蒂腓骨瓣修复骨缺损中,1只兔在术中麻醉意外死亡,1只在术后麻醉苏醒活动后出现肢体畸形,急查X线片显示:内固定断裂、骨头碎裂,对麻醉意外、内固定断裂、骨头碎裂的2只兔在实验中放弃。其余32只兔手术成功,术后复查X线片观察,兔胫骨骨缺损用兔同种异体骨复合兔自体带蒂腓骨瓣修复骨缺损后,有3只术后5个月复查X线片显示骨未愈合,其余29只骨完全愈合,愈合时间为平均4个月。结论兔胫骨、腓骨解剖结构和人类胫骨、腓骨解剖结构类似,兔适合行自体带蒂腓骨瓣移植,不用行腓骨瓣血管吻合,腓骨有丰富血供,能促进异体骨与宿主骨愈合,腓骨愈合后能提供中晚期力学支撑。临床用同种异体骨复合自体带血管腓骨移植修复大段骨缺损手术方案与此动物实验模型相对应,该模型的建立为临床手术提供了更有力的依据。

Objective To observe reconstruction of segmental bone defect with vascular fibula compound allograft in the animal model. Methods A total of 52 New Zealand white rabbits were selected, and bilateral tibia was taken from 18 adult New Zealand white rabbits under general anesthesia and sterile conditions. The removed tibia was repeatedly washed, and the tibial medullary cavity was processed under sterile conditions. It was put in a sterile container and underwent liquid nitrogen sterilization at minus 196 degrees Celsius within 40 minutes. And then it was rewarmed at room temperature, which was taken as the experimental rabbit allograft. Artificial bone defects were made from the unilateral tibia of the other 34 New Zealand white rabbits under general anesthesia in batches, which were in the range of about 1.2 - 1.5 cm. The bone defects were repaired with the combination of allogeneic tibia and autologous tibia with pedicled fibular flap of the same thickness and length, and the plate was fixed. The average operation time was 1.5 h. Results Among the 34 experimental rabbits whose unilateral tibia bone defects were repaired with the combination of allogeneic tibia and autologous tibia with pedicled fibular flap, 1 rabbit died in an intraoperative anesthesia accident, and 1 rabbit had limb deformities when it walked after waking from anesthesia after surgery. The X-ray was checked hurriedly, and breakage of internal fixation and bone fracture were found. The 2 rabbits with anesthesia accident, breakage of internal fixation and bone fracture were given up. Successful operations were realized in the other 32 rabbits. The postoperative X-ray showed that among the rabbits whose bone defects were repaired with the combination of allogeneic tibia and autologous tibia with pedicled fibular flap, bone nonunion was noticed in 3 rabbits at 5 months after the operation, and bone union in the other 29 rabbits, with 4 months of healing time. Conclusions Through this experiment, the anatomy of the rabbit tibia and fibula is similar to that of human tibia and fibula, and rabbits are suitable for autologous pedicled fibular flap transplantation. Vascular anastomosis of the fibular flap isn’t needed. The fibula with rich blood supply can promote the healing of allograft bone and host bone, and middle and late mechanical support can be provided after the healing of the fibula. Clinical surgery of massive bone defects with the combination of allogeneic bone and autologous bone with pedicled fibular flap corresponds to the animal experimental model, which provides more powerful basis for clinical surgery.