摘要
目的研究带血管自体腓骨与同种异体骨复合移植术后,腓骨肌袖的自然转归及其规律。方法采用健康成年杂种犬36只,于双侧后肢胫骨结节下切除3.0 cm长胫骨骨干、骨膜,制作骨缺损实验动物模型,随机分成实验组和对照组。实验组植入深低温保存的同种异体骨与带血管自体腓骨,对照组植入深低温保存的同种异体骨。均用7孔93 mm长AO加压钢板内固定及石膏外固定。术后1、2、3、4个月分别行X线摄片、ECT检查、大体标本及组织学观察。结果X检查显示实验组较对照组异体骨吸收、新骨形成明显。第4个月实验组宿主骨-异体骨接合部愈合率83.3%,对照组未见愈合。ECT检查:实验组较对照组骨代谢活跃,但变化规律相似,均为术后1、2个月活跃,于第2个月达高峰,第3、4个月呈下降趋势。组织学观察:实验组较对照组异体骨髓腔内壁及哈弗管内的骨吸收、成骨活动显著增强。至第4个月,异体骨髓腔内壁与腓骨之间充满环形骨痂,并呈成熟至不成熟明显的阶梯状排列,靠近异体骨髓腔内壁骨痂较成熟,由大量成熟骨细胞组成。近腓骨侧骨痂较不成熟,主要由软骨细胞、骨细胞组成。异体骨髓腔内带血管蒂腓骨周围肌袖的肌纤维基本消失。结论带血管自体腓骨与同种异体骨复合移植术后,腓骨周围肌袖的自然转归是骨化。
Objective To investigate the natural progressing morphology and characteristic of the cuff of muscle tissue of vascularized fibular autografts, in the transplantation combined with massive allograft. Methods The bone massive defect animal models were made adult dogs at the shaft of tibia below the tibial tuberosity which remove 3.0 cm of diaphysis and periosteum. Thirty - six dogs were randomly divided into experimental and control groups. The bone defects were filled with either a frozen allograft combined with the ipsilateral vascularised fibular in experimental group, or a massive frozen allogeneic cortical bone alone in control group. Outcome assessment included X-ray, bone scintigraphy examinations, gross specimen as well as histological studies at the 1, 2, 3, 4 months postoperative. Results In the same period, radiographic evaluation of the allogeneic cortical bone and junctions between allografi bone revealed significantly allograft bone resorption, Greater new bone fromation and larger osteon radii in experimental group compared to control group. The healing rates of osteosynthesis was 83.3% by 4 month in experimental group, while no connection can be observed in control group. ECT showed that, in the same period, bone metabolism was more active in experimental group compared to cntrol gruup, bone metabolism were more active at 1, 2 months, and it reached its peak by 2 months, then it had a decreasing tendency at 3, 4 months postoperative. Histological observation showed, compared to control group, significantly higher resorption and osteogenesis were detected in the internal wall of the medullary cavity and Haversian canals in experimental group. At the 4 month, in transverse sections of allografts, the gaps between inner cortical areas of allograft and fibular autograft were filled with annular callus, which was put in order looking like ladder. The callus near inner cortical areas of allograft was mature, and most of which was lamellar bone being made up of mature osteocyte. While there was premature callus in the place near the fibular, which were primarily made up of osteoblasts and osteocytes. The fiber of periosteum and surrounding skeletal muscle tissue of vaseularized fibular autografts disappeared in the medullary cavity of massive allogeneie cortical bone. Conclusion Ultimately, the cuff of muscle tissue of vaseularized fibular autografts is ossification in the tranplantation combined with massive allograft.
出处
《中华显微外科杂志》
CSCD
北大核心
2005年第4期334-336,i0005,共4页
Chinese Journal of Microsurgery
基金
广东省科技厅资助项目(2002-254-20)
作者简介
通讯作者：徐中和
