不同比例自体骨与骨替代物植入对兔骨缺损愈合的影响

Effect of different proportions of autologous bone and bone substitute implantation on bone defect healing of rabbits

目的将不同比例自体骨与骨替代物植入具有诱导膜的骨缺损兔模型,探索其治疗骨缺损的理想比例。方法选取新西兰大白兔60只,制成骨缺损模型后采用随机数字表法将兔分为A、B、C、D、E组,每组12只。将不同比例的自体骨与骨替代物(3∶1、2∶1、1∶1、1∶2、1∶3)分别植入A、B、C、D、E组兔骨缺损处。自体骨选用兔另一后肢胫骨骨质修剪为颗粒状;骨替代物选用硫酸钙,制成直径5 mm大小的颗粒。分别于术后1、2、3、4个月采用Samantha X线评分评估各组兔骨愈合情况;分别于术后1、2、3个月采用X线片观察各组兔胫骨愈合情况;分别于术后1、2、3、4个月计算各组兔新生骨面积占缺损骨百分比;苏木精-伊红染色观察缺损部位新骨生长情况。结果术后1、2、3、4个月,A、B、C组兔Samantha X线评分及新生骨面积占缺损骨百分比比较差异均无统计学意义(P> 0. 05);D组和E组兔Samantha X线评分及新生骨面积占缺损骨百分比比较差异无统计学意义(P> 0. 05);D、E组兔Samantha X线评分及新生骨面积占缺损骨百分比显著低于A、B、C组(P <0. 01)。各组兔术后1、2、3、4个月Samantha X线评分及新生骨面积占缺损骨百分比随时间的延长逐渐增大,两两比较差异均有统计学意义(P <0. 01)。A、B、C 3组兔骨愈合速度无明显差异;D组、E组兔胫骨愈合速度也无明显差异,但A、B、C 3组兔骨愈合速度快于D组、E组。术后3个月,A组兔胫骨骨组织中可见较多的骨小梁及少量骨基质,骨组织愈合情况较好;B组兔胫骨骨组织中出现少量的骨小梁,骨组织大部分已愈合;C组兔胫骨骨组织中出现较多的骨母细胞,骨组织正在愈合中;D组兔胫骨骨组织中出现较多的纤维组织和成骨细胞,骨组织正在加速愈合;E组兔胫骨骨组织中存在大量的结痂,骨组织开始愈合。结论自体骨与骨替代物植入均可以有效促进骨缺损的愈合,且在一定范围内自体骨含量越高愈合速度越快。

Objective To implant different proportions of autologous bone and bone substitutes into bone defect rabbit models with induced membrane,and explore the ideal proportion for bone defect treatment.Methods Sixty New Zealand white rabbits were made into bone defect models.Then,the rabbits were divided into group A,B,C,D and E by random number table method,12 rabbits in each group.Different proportions of autogenous bone and bone substitutes(3 GA6FA 1,2 GA6FA 1,1 GA6FA 1,1 GA6FA 2,1 GA6FA 3)were implanted into bone defect sites of rabbits in group A,B,C,D and E,respectively.The other posterior limb tibia was selected as autologous bone,which was trimmed as graininess shape.The calcium sulphate was applied as bone substitute,which was made into granules with 5 mm diameter.The bone healing situation of tibia of rabbits in each group was evaluated by Samantha X-ray films scores and X-ray films at 1,2,3 and 4 months after operation;the ration of new bone area to defected bone of rabbits in each group was calculated at 1,2,3 and 4 months after operation;the growth of new bone was observed by hematoxylin eosin staining.Results There was no significant difference in Samantha X-ray score and the ratio of new bone area to defect bone among group A,B and C(P>0.05).There was no significant difference in Samantha X-ray score and ratio of new bone area to defect bone between group D and E(P>0.05).Samantha X-ray score and ratio of new bone area to defect bone of rabbit in group D and E were significantly lower than those in group A,B and C(P<0.01).The Samantha X-ray score and ratio of new bone area to defect bone of rabbits at 1,2,3 and 4 months after surgery were increased gradually with the prolongation of time in each group(P<0.01).There was no significant difference in bone healing rate among group A,B and C(P>0.05).There was no significant difference in bone healing rate of rabbits between group D and group E(P>0.05).The bone healing rate of rabbits in group A,B and C was faster than that in group D and E.At 3 months after surgery,in group A,there were much trabeculae and a small amount of bone matrix in the tibia bone tissue of rabbits,and the healing condition of bone tissue was good;in group B,there were a small amount of trabeculae in the tibia bone tissue,and most of bone tissues were healed;in group C,there were much osteoblasts in tibia bone tissue,and the bone tissue was healing;in group D,there were many fibrous tissue and osteoblasts in tibia bone tissue,and the bone tissue was accelerating healing;in group E,there were a lot of scabs in tibia bone tissue,and the bone tissues began to heal.Conclusion Both autologous bone and bone substitute implantation can effectively promote healing of bone defects.The higher the content of autologous bone,the faster the healing rate in certain range.