基于Masquelet诱导膜技术比较不同固定方式构建的胫骨大段骨缺损模型

Comparison of massive tibial bone defect models established by three different methods based on Masquelet induced membrane

目的基于Masquelet诱导膜技术,比较内固定钢板、髓内针和外固定架三种固定方式建立的大鼠胫骨大段骨缺损(MTBD)模型及诱导膜形成特点,从而选择较优的模型构建方法。方法 60只10周龄SPF级雄性SD大鼠随机分为3组:内固定钢板组(IFP)、髓内针组(IMP)和环形外固定架组(CEF)。在右侧胫骨中段构建4 mm骨缺损模型,分别应用自制六孔不锈钢钢板、直径1 mm克氏针、自制环形外固定架固定。记录造模用时、出血量及肢体肿胀持续时间;行X线检查,观察骨水泥、固定装置稳定情况;诱导膜行HE染色,观察组织形态结构特点。结果在造模用时、出血量及模型成功率方面,IMP和CEF两组明显优于IFP组(P<0.05)。②CEF组肿胀时间最短,但三组之间肿胀持续时间差异无显著性(P> 0.05)。③IFP组出现1例螺钉松动和3例骨水泥松动,CEF组出现1例骨水泥松动,而IMP组固定良好。④在感染方面,IFP组出现3例钢板外露,IMP组出现2例脓性包块,而CEF组无感染发生。⑤诱导膜组织厚度在460～520μm,三组差异无显著性(P> 0.05)。结论三种方式均可成功构建MTBD模型,但综合考虑CEF为模拟Masquelet技术构建大鼠MTBD模型较优的方式。

Objective To compare the characteristics of massive tibial bone defect(MTBD)models and induced membrane established by the internal fixation plate(IFP),intramedullary pin(IMP),and circular external fixator(CEF)based on Masquelet technology and selecting the optimal model method.MethodsA total of6010-week-old SD male rats of SPF grade were randomly divided into three groups,namely,the IFP group,IMP group,and CEF group.A4-mm bone defect model was generated at the middle of the right tibia,which was fixed with a custom-made six-hole stainless steel plate,a1-mm-diameter Kirschner wire,and a custom-made circular external fixator,respectively.The time of modeling,the amount of bleeding,and the duration of limb swelling were recorded.X-ray examination was performed to observe the stability of bone cement and fixation devices.HE staining was conducted to observe the histomorphological characteristics.ResultsIn terms of modeling time,bleeding volume,and model success rate,the IMP and CEF groups were significantly better than the IFP group,and significant differences were observed(P<0.05).The duration of limb swelling was the shortest in the CEF group,but no significant difference was found(P>0.05).In addition,one case of screw loosening and three cases of bone cement loosening occurred in the IFP group,and1case of cement loosening occurred in the CEF group,whereas bone cement was well fixed in the IMP group.With regard to infection,there were three cases of plate exposure in the IFP group,two cases of purulent mass in the IMP group,and no infection in the CEF group.The thickness of induced membrane in the three groups was460-520μm,showing no significant difference(P>0.05).Conclusions Taking the findings together,the three fixation models can successfully construct the MTBD model,but CEF is optimal for constructing the MTBD model by simulating the Masquelet technology.