李东亚;郑欣;邱旭升;王晓波;谢小肖;袁翰;王昌俊;陈一心;

• 1:南京大学医学院附属鼓楼医院骨科

摘要(Abstract)：

[目的]通过CT影像学研究分析6个月龄新西兰兔桡骨大段骨缺损模型的合理缺损长度与缺损位置。[方法]选用健康6个月龄雄性新西兰兔24只,其中18只兔按骨缺损长度,分为1.0 cm组,1.5 cm组,2.0 cm组,依次记为A、B、C组,每组6只,双侧手术共计12侧。在全麻下行双侧桡骨中段骨缺损手术,分别于术后当日,术后4、8、12周行CT三维重建检查,应用Hedberg评分评估骨缺损愈合情况,术后12周处死实验兔,留取尺桡骨标本,行HE染色组织学分析缺损处新生骨情况;根据实验结果选择最佳缺损长度,以距尺骨鹰嘴远端3.0 cm为桡骨近段骨缺损的中心,完成D组6只兔双侧桡骨近段骨缺损实验,应用上述方法比较近段与中段缺损的骨愈合情况及术后并发症。[结果]术后2只实验兔因严重感染,予处死并及时补充。术后4周时,D组中2只实验兔出现单侧尺骨骨折,骨折一侧未计入统计。术后12周时,大体观察见,A组中11侧(91.7%)桡骨已经完全桥接并且塑形较完全,新生桡骨表面光滑。B组、D组完全桥接仅3侧,C组未见桥接,缺损断端已封闭,见少量成骨,缺损区域为纤维组织填充。CT断层图像见A组完全桥接的桡骨已形成髓腔再通,未桥接的骨缺损断端及缺损尺侧均见少量新骨生成;组织学结果示,A组缺损多已修复完成,髓腔再通,塑形完成,而其余三组多表现为断端封闭,缺损区域纤维组织填充;CT三维重建的Hedberg评分结果示B组(1.75±1.06)与A组(3.83±0.39)有统计学差异(P<0.05),而与C组(1.33±0.65)、D组(1.60±0.70)均无统计学差异(P>0.05)。[结论]6个月龄新西兰兔桡骨大段骨缺损模型的缺损长度选择1.5 cm较为合适,其中,缺损位置选择在桡骨中段或者近段均可。

关键词(KeyWords)： 桡骨;大段骨缺损;缺损位置;缺损长度

Abstract:

Keywords:

基金项目(Foundation): 江苏省社会发展基金(编号:BE2011604);; 江苏省六大人才高峰项目(编号:2012-WS-092);; 江苏省博士后基金项目(编号:131024A);; 南京市青年卫生人才第一层次项目

作者(Author): 李东亚;郑欣;邱旭升;王晓波;谢小肖;袁翰;王昌俊;陈一心;

Email:

DOI:

参考文献(References)：

• [1]Lazard ZW,Heggeness MH,Hipp JA,et al.Cell-based gene therapy for repair of critical size defects in the rat fibula[J].J Cell Biochem,2011,6:1563-1571.
• [2]Zhou J,Lin H,Fang T,et al.The repair of large segmental bone defects in the rabbit with vascularized tissue engineered bone[J].Biomaterials,2010,6:1171-1179.
• [3]Nilsson OS,Urist MR,Dawson EG,et al.Bone repair induced by bone morphogenetic protein in ulnar defects in dogs[J].J Bone Joint Surg Br,1986,4:635-642.
• [4]Patel ZS,Young S,Tabata Y,et al.Dual delivery of an angiogenic and an osteogenic growth factor for bone regeneration in a critical size defect model[J].Bone,2008,5:931-940.
• [5]赵轶男,刘建,刘昌盛,等.不同孔径多孔CPC材料修复兔大段骨缺损的实验研究[J].中国矫形外科杂志,2012,10:924-927.
• [6]张建新,徐展望,常峰.组织工程化人工骨修复骨缺损的实验研究[J].中国矫形外科杂志,2009,16:1258-1261.
• [7]Bodde EW,Spauwen PH,Mikos AG,et al.Closing capacity of segmental radius defects in rabbits[J].J Biomed Mater Res A,2008,1:206-217.
• [8]冯振洲,陈峥嵘,夏庆,等.骨基质明胶与羟基磷灰石修复兔桡骨缺损模型的对照研究[J].复旦学报(医学版),2005,2:222-224.
• [9]Saito ASY,Kitamura M.Repair of 20 mm long rabbit radial bone defects using BMP-derived peptide combined with anα-tricalcium phosphate scaffold[J].J Biom Mater Res Part A,2006,4:700-706.
• [10]Kaweblum M,Aguilar MC,Blancas E,et al.Histological and radiographic determination of the age of physeal closure of the distal femur,proximal tibia,and proximal fibula of the New Zealand white rabbit[J].J Orthop Res,1994,5:747-749.
• [11]Bowman BM,Miller SC.Skeletal mass,chemistry,and growth during and after multiple reproductive cycles in the rat[J].Bone,1999,5:553-559.
• [12]Fernandez-Tresguerres-Hernandez-Gil I,Alobera-Gracia MA,delCanto-Pingarron M,et al.Physiological bases of bone regeneration II.The remodeling process[J].Med Oral Patol Oral Cir Bucal,2006,2:151-157.
• [13]Zhao L,Zhao JL,Wan L,et al.The study of the feasibility of segmental bone defect repair with tissue-engineered bone membrane:a qualitative observation[J].Strategies Trauma Limb Reconstr,2008,2:57-64.
• [14]den Boer FC,Wippermann BW,Blokhuis TJ,et al.Healing of segmental bone defects with granular porous hydroxyapatite augmented with recombinant human osteogenic protein-1 or autologous bone marrow[J].J Orthop Res,2003,3:521-528.