摘要
目的研究大段同种异体皮质骨移植过程中哈佛系统的成骨作用,探讨大段同种异体皮质骨愈合活化表面的临床意义。方法48只新西兰大白兔为实验动物,手术移植2cm经深低温处理的大段同种异体皮质骨段,于术后2、4、8、12周取材,观察各组X线片、组织学、BMP免疫组织化学染色、四环素荧光标记变化,记录骨吸收重建情况。结果骨端愈合率:近端宿主骨-异体骨接合部4周90%,8周100%;远端4周60%,8周90%,12周100%。组织学观察:4周时皮质骨内哈佛管扩大,多位于近骨髓腔处的皮质内;8周时可观察到扩大的哈佛管壁周围新骨形成;12周时可见到新形成的类哈佛系统。BMP免疫组织化学染色显示移植后4周皮质内扩大的哈佛管壁有弱阳性表达,8周时有强阳性表达,管腔内细胞成分增多,哈佛管周围的骨陷窝内亦有阳性表达。四环素荧光标记显示术后2周可观察到异体骨周边的四环素荧光标记,移植后4周可见较强的荧光标记于哈佛管内,哈佛管内与福克曼管交叉处为强阳性表达。术后8周邻近骨髓腔处的皮质骨陷窝内亦有强的四环素荧光标记。结论大段同种异体皮质骨通过四个愈合表面进行活化重建:(1)哈佛系统的骨吸收、骨诱导成骨;(2)宿主骨-异体骨接合端的爬行替代;(3)异体皮质骨周围的吸收与重建;(4)骨髓腔内壁的成骨活动。研究提示在临床实践中应尽?
Objective To study inductive osteogenesis of H aversian system and evaluate the cli nical significance of the vitalization su rface in the healing process of the ma ssive cortical allografts.Methods Forty-eight New Zealand rabbits underwent 2cm massive frozen allogeneic cortial bone transplantation.Groups of rabbits were sacrificed an d specimens were procured at 2-,4-,8-,and 12-week after surgery for X-ray,histology,immunohistochem istry,tetracycline immunofluorescence observation in order to record the resorption and remodeling rconstru ction of the allografts.Results The healing rates of osteosynthesis site were:the proximal:90%by 4weeks,100%by 8weeks;the distal:60%by 4week s,90%by 8weeks,100%by 12weeks.Histological observation showed that the Haversian can als in the cortex were expanded by4weeks,most of them were located in t he cortex near the medullary cavity.The new bone formation was observed around the expanded Haverisan canal wall by 8weeks.The new form ative Haversian -like system was observed by 12weeks.The expanded Haversian canal walls were detecte d and weak positive expressions of BMP by immunohistochemistry staining by 4weeks.By 8weeks,the BMP exp ressions were strong posi-tive.The number of cells in the canals was increasing,and the BMP expressions were also detected in the bone lacunae around the Haversian canals.The tetracycline fluorescences were detected in the periphery of the allografts by 2weeks and were detected in the Haversian canals by 4weeks.In the transverse section of Haversian canal and Volkmanns canal,the fluorescences were strongly p ositive.There were also strongly positive fluorescences in the bone l acunae near the medullary cavity by 8weeks.Conclusion The massive bone allograft is vitalized and reco nstructed by four healing surfaces:1)resorption and inductive osteogenesis of the Haversian system.2)creeping substitution at the osteosynthesis site.3)resorption and reconstruction at the periphery of the allografts.4)osteogenesis of the internal wall of the medullary cavity.The study suggests that it is advantageous to r econstruct the blood circulation of the allografts by retaining more valid osteogenetic vitalization surfaces in clinical practice,for example,reducing all kinds of mechanical shelters,applying the intramedullary needle,and preserving a certain space of the medullary cavity.
出处
《中华骨科杂志》
CAS
CSCD
北大核心
2002年第5期313-317,共5页
Chinese Journal of Orthopaedics
