预构复合组织瓣移植修复四肢骨及软组织缺损

Prefabricated composite tissue flaps for repairing bone and soft tissue defects of the extremities

背景:预构复合组织瓣自1973年被Bakamjjan应用于心脏修复,但是受限于技术原因一直没有得到广泛使用,国内关于预构复合组织瓣修复四肢骨的研究更是稀少。目的:分析预构复合组织瓣修复四肢骨及相应软组织缺损的效果。方法:构建四肢骨骨折合并软组织缺损新西兰兔模型(第1次手术),造模后随机分为3组,A组造模后10 d(第2次手术)应用预构复合组织瓣修复,B组造模后10d使用游离桡骨修复,C组造模后10d再次切开伤口缝合不做其他处理。对各组兔进行一般情况、体质量、影像学及组织学观察,并进行组间对比。结果与结论:(1)各组存活率均为100%,B组中2只出现移植骨块移位,畸形愈合,对兔活动能力影响不大;(2)A组体质量恢复速率及体质量增长量均高于B组(P<0.05);(3)影像学结果显示,A组在术后2周形成大量骨痂,4周骨痂桥节于间隙,8周缺损间隙填满,12周开始改造塑性;B组在术后2周形成少量骨痂,4周骨痂增多,股骨切断处明显,8周形成大量骨痂,12周缺损间隙填满;C组在术后8周开始形成骨痂,12周缺损间隙仍在,两端骨质硬化;(4)在第2次术后8,12周3组间Lane-Sandhu评分差异有显著性意义(P<0.05);(5)组织学观察发现,A组术后4周出现大量新生成骨细胞和骨细胞,8周管状结构增多,新生不规则骨岛,12周新骨生成,髓腔出现,包含脂肪细胞为主的黄骨髓;B组术后4周大多数植入骨被降解和吸收,8周成骨细胞骨化,剩余的植入骨仍然可见,12周大多数成骨细胞被骨化并成为板层骨;C组术后12周缺损区充斥大量纤维结缔组织,无骨质形成;(6)提示预构复合组织瓣对四肢骨及软组织缺损具有修复作用,并且在修复速度及效果方面均优于传统的游离骨块修复。

BACKGROUND:Prefabricated composite tissue flaps have been used by Bakamjjan for cardiac repair since 1973,but have not been widely used due to technique limitations.Domestic research on prefabricated composite tissue flaps to repair limb bones is rarely reported.OBJECTIVE:To analyze the effects of prefabricated composite tissue flaps in the repair of limb bone and corresponding soft tissue defects.METHODS:New Zealand big rabbit models of bone fracture and soft tissue defect of the extremities were constructed(first operation)and randomly divided into three groups.In group A,prefabricated composite tissue flap was used to treat bone and soft tissue defects of the extremities at 10 days after modeling(second operation).In group B,free femur was used to treat bone and soft tissue defects of the extremities at 10 days after modeling.In group C,the incision was open and sutured with no treatment.General condition,body weight,imaging finding and histological findings were compared between groups.RESULTS AND CONCLUSION:There was 100%survival in all the three groups.Graft displacement was observed in 2 rabbits in the group B,but the deformity healed,which had little effect on the rabbit’s mobility.The weight recovery and gain were higher in the group A than in the group B(P<0.05).The imaging findings showed that a large number of calluses were formed in the group A at 2 weeks after operation,which were bridged in gap at 4 weeks after operation,filled in the defect gap at 8 weeks,and remodeled at 12 weeks.In the group B,a small amount of calluses were formed at 2 weeks after operation,and began to increase at 4 weeks.The femoral cut was obvious.A large number of calluses were formed at 8 weeks after operation,and the defect gap was filled at 12 weeks after operation.In the group C,the callus began to form at 8 weeks after operation,and the defect gap was still present,with osteosclerosis at the two ends.The Lane-Sandhu score was statistically different between the three groups at 8 and 12 weeks after second operation(P<0.05).Histological observation indicated that a large number of newly formed osteoblasts and bone cells were formed in the group A at 4 weeks after operation,and the tubular structure increased and irregular bone island formed at 8 weeks;new bone formed at 12 weeks,with the presence of the medullary cavity containing yellow bone marrow dominated by adipocytes.In the group B,most of the grafted bones were degraded and absorbed at 4 weeks after operation,and osteoblasts were ossified at 8 weeks.The remaining implanted bones were still visible.Most of the osteoblasts were ossified and became lamellar bones at 12 weeks.In the group C,the defect area was filled with a large amount of fibrous connective tissues at 12 weeks after operation,and there was no bone formation.To conclude,the prefabricated composite tissue flap can be used to repair the bone and soft tissue defects of the extremities,and it has a faster and better therapeutic effect than the traditional free bone repair.