胶原膜/国产多孔钽金属双相支架修复山羊大面积骨软骨缺损的实验研究

Collagen membrane integrated with self-made porous tantalum scaffold to repair large osteocho n ndral defects in goats

背景:骨软骨联合病变是骨科常见疾病,一直缺乏有效的治疗手段。目的:通过使用胶原膜联合自主研发的三维多孔钽金属支架,设计构建了一种新型的仿生骨组织工程复合体,并探讨其修复山羊大面积骨软骨缺损的效果。方法:将多孔碳化硅支架通过化学气相沉积技术制备成多孔钽金属,然后采用纤维蛋白黏合剂将胶原膜及自主研发的多孔钽金属进行界面结合,得到双相支架材料;在体外通过扫描电镜观察胶原膜及多孔钽的微观形貌,并通过能谱分析测定其组成成分;万能力学测试机进行双相支架材料的力学检测。32只雄性山羊采用随机数字表法分为4组,每组各8只,于左后肢建立骨软骨缺损模型(缺损面积直径为10 mm,深度为12 mm)。单纯骨软骨缺损组不做任何治疗,其余3组分别采用单纯胶原膜、单纯国产多孔钽金属、胶原膜/国产多孔钽金属双相支架修复。植入16周后进行大体观察及硬组织切片、染色,并进行定量分析。结果:扫描电镜观察结果表明,双相支架结合面均匀、光滑、牢固。能谱分析表明,胶原膜由碳、氧、钙3种元素组成,国内多孔钽金属主要由碳、硅和钽组成。该支架具有良好的抗压强度、抗拉强度、粘结强度和抗剪强度。植入山羊负重区大面积骨软骨缺损区16周后,国际软骨修复学会评分(ICRS)及改良O'Driscoll组织学评分结果显示,与单纯多孔钽金属组、单纯胶原膜组及单纯骨软骨缺损组相比,胶原膜/国产多孔钽金属双相支架组具有明显的骨软骨修复效果(P<0.05)。结论:本研究对于在负重区的大面积骨软骨缺损的成功修复显示了临床转化的潜能。为大面积骨软骨联合病变的临床治疗提供新的组织工程思路。

Background:Osteochondral defects are common diseases in orthopedics,and there are still no efficient treatment methods.Objective:To construct a novel bionic complex by using collagen membrane combined with three-dimensional po rous tantalum scaffold,and to explore its efficacy in repairing large osteochondral defects in goats.Methods:Porous tantalum was prepared by chemical vapor deposition(CVD)on a porous silicon carbide scaffold.Then the collagen membrane and selfmade porous tantalum were integrated with the fibrin binder to obtain the biphasic scaffold material.The microscopic morphol ogy and the components of the collagen membrane and porous tantalum were observed in vitro by scanning electron microsco py and energy spectroscopy.To simulate the stress in vivo,we tested the tension and compression separately.Thirty-two goats with large osteochondral defects(10 mm in diameter and 12 mm in depth)in femoral heads of left hind legs were randomly di vided into 4 groups(n=8):collagen membrane(CM)group,porous tantalum(pTa)group,CM-pTa group,and osteochondral de fect group.After 16 weeks of implantation in goats,general observation and hard tissue sections and staining were performed.Results:The scanning electron microscopy showed that the bonding surface was uniform,smooth and firmly bonded.The ener gy spectrum showed that the collagen membrane was composed of three elements:carbon,oxygen and calcium,and porous tan talum metals were composed of carbon,silicon and tantalum.The scaffold had good compressive strength,tensile strength,bonding strength and shear strength.International Cartilage Repair Society(ICRS)score and modified O'driscoll histological score showed that the bone and cartilage repair efficacy in CM-pTa group was significantly better than that in the other three groups after 16 weeks of implantation in goats(P<0.05).Conclusions:This work demonstrated the potential for clinical transfor mation of the repair of large osteochondral defects in load-bearing areas of large animals in the near future.