骨膜包绕肌腱松质骨粒与BMP复合体替代月骨的实验研究

An experimental study of the use of autologous periostcum wrapping tendon, grains of cancellous bone and BMP to substitute lunate bone

目的 探讨自体骨膜包绕肌腱松质骨粒与BMP形成复合体替代月骨治疗Kienbock病的可行性。方法 4 2只日本大耳白兔随机分为 2组 ,A组取兔胫骨上段骨膜包绕部分髌腱、松质骨粒与BMP组成复合体 ,B组以骨膜包绕髌腱复合体作为对照 ,将两组复合体分别置于兔膝关节髌上囊(此环境类似于人体替代月骨后的生理环境 ) ,术后 1、2、4、8、1 2、1 6、2 4周取标本进行放射学、光镜及电镜检查 ,并对复合体CT值进行统计学分析。结果 A组复合体在骨膜及BMP/松质骨粒缓释系统双重诱导下 ,2周即有新生骨出现 ,8周形成表面光滑、外周为完整骨包壳中心为骨髓细胞的类圆形骨性团块 ,2 4周复合体无退变吸收。B组复合体 2 4周内无骨团块形成 ,A、B组复合体CT值在不同时间段差异均有统计学意义 (P <0 0 1 )。结论 自体骨膜包绕肌腱松质骨粒与BMP复合体成骨时间早、成骨完全 ,并具有适宜的可塑性 。

Objective To explore the feasibility of implantation of a composite of tendon, grains of cancellous bone and bone morphogenic protein (BMP) wrapped in antologous periosteum to substitute lunate bone lunatum in the treatment of Kienbock disease. Methods 42 Japanese big ear rabbits were randomly divided into two groups. In group A periostum wrapping a composite of tendon, grains of cancellous bone and bone morphogenic protein (BMP) was implanted. In group B only tendon wrapped by periostum was used. Both of them were respectively implanted into rabbits' suprapatellar bursa, the physiological environment of which seemed to be similar to that of the carpal joint after extirpating the lunate bone in human being. The composites were removed in 1,2,4,8,12,16 and 24 weeks after the operation. X ray imaging, gross, histological and EM changes at varies intervals were observed. And CT value of the composite was statistically analyzed (Stata 4 0). Results Periosteum wrapped BMP/grains of cancellous bone could induce bone and cartilage formation. In group A, newly formed bone could be found at 2 weeks. Rounded bony body with cortex and bone marrow was found to be formed by the implanted composite at 8 weeks. No degenerative changes were observed up to 24 weeks. In group B, the composite didn't form bony body in 24 weeks. In different periods, statistically significant difference in CT value between group A and B was found ( P <0 01). Conclusion Composites including autologous periosteum wrapped tendon, cancellous bone and BMP could form bony tissue with good plasticity, and it could be considered as a potential strategy for the treatment of Kienbock disease.