Chinese Journal of Tissue Engineering Research ›› 2017, Vol. 21 ›› Issue (10): 1495-1500.doi: 10.3969/j.issn.2095-4344.2017.10.004
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Yang Hong-sheng, Cao Zong-rui, Yan Xiao-hu, Li Yu-gang, Xu Ze-chuan, Chang Shan
Received:
2017-01-10
Online:
2017-04-08
Published:
2017-05-08
Contact:
Chang Shan, Master, Chief physician, Professor, Department of Spinal Surgery, the First Affiliated Hospital of Chengdu Medical College, Chengdu 610500, Sichuan Province, China
About author:
Yang Hong-sheng, Master, Attending physician, Department of Spinal Surgery, the First Affiliated Hospital of Chengdu Medical University, Chengdu 610500, Sichuan Province, China
Supported by:
a grant from Sichuan Provincial Department of Education, No. CYZ12-008, 13ZB0232; a grant from Sichuan Provincial Health and Family Planning Commission, No. 130395
CLC Number:
Yang Hong-sheng, Cao Zong-rui, Yan Xiao-hu, Li Yu-gang, Xu Ze-chuan, Chang Shan . Guided bone regeneration membrane tube made of nano-hydroxyapatite/multi(amino acid) copolymer in the repair of large segmental bone defects[J]. Chinese Journal of Tissue Engineering Research, 2017, 21(10): 1495-1500.
2.1 参与者数量分析 32只山羊随机分为2组,所有实验动物术后均成活良好,无意外死亡,伤口愈合良好,无红肿、积液、感染,术后10-12 d全部拆线。无手术后再骨折,内固定系统无移位、断裂等情况。 2.2 X射线观察结果 术后4周,实验组膜管与股骨接触两端可见较为均匀的云雾状密度影,膜管无塌陷移位;对照组同种异体骨管两端也可见云雾密度影,但实验组更为明显。 术后8周,实验组膜管外有明显骨痂生长、膜管内出现较多均匀密度影,膜管无异常;对照组同种异体骨管密度稍降低、骨管两端骨折线模糊、管内出现不均匀密度影。 术后12周,实验组膜管表面骨痂继续生长、增厚,骨缺损区内密度增加,两端可见呈帽状生长的骨皮质密度影,膜管位置良好,无移位;对照组骨痂生长较8周时稍增多,异体骨管两端与宿主骨开始融合,异体骨管密度有所增加。 术后16周,实验组股骨中段大量骨痂生长,骨痂包裹于膜管及钢板周围膜管与股骨连成整体,骨痂呈皮质骨样密度影像;对照组移植骨与宿主骨已完全连接,骨髓腔再通,整体塑形良好,对照组整体外骨痂量明显较实验组少(图1)。 "
2.3 大体标本观察结果 实验组和对照侧动物各时间段被处死后观察,植入物周围无化脓、积液或坏死等迹象。 术后4周,实验组及对照组骨缺损两端有少量骨痂形成,膜管及同种异体骨管未被包裹,均与山羊股骨边界清楚,无明显连接。膜管及骨管均无塌陷、移位,管腔内外可见机化的血肿。 术后8周,实验组膜管内外均有见大量骨痂生长,以两端最明显,有部分骨痂开始向膜管表面爬行,膜管位置良好,管腔内有软骨样组织形成。对照组同种异体骨管外表面有较多骨痂生长,但异体骨段仍然未于股骨连接,管腔内成骨不明显。 术后12周,实验组膜管表面骨痂大量生长,膜管及接骨板完全被包裹,且骨痂在局部形成突起,膜管、骨痂与股骨连成整体,骨痂呈皮质骨硬度。对照组骨管表面少量骨痂形成,整体外骨痂量明显较实验组少,异体骨段与股骨靠骨痂连接。 术后16周,实验组膜管表面骨痂较12周更多,膜管内外均有再生皮质骨将缺损两端相互连接;对照组移植骨与宿主骨已完全连接,骨髓腔再通,骨痂塑形良好,但整体外骨痂形成较实验组少(图2)。"
2.4 骨痂组织学观察 术后4周,实验组膜管桥接端开始出现肉芽组织及新生细小骨小梁。骨小梁成骨细胞增生活跃,间质中肉芽组织血管丰富,管腔内见陈旧性机化血凝块组织及新生毛细血管形成。对照组同种异体骨管内外均有肌纤维结缔组织长入。骨管开始出现骨吸收陷窝,陷窝内见肉芽组织形成及新生骨小梁长入,骨管内见新生肉芽组织形成。 术后8周,实验组膜管外见大量骨痂形成,骨小梁增粗,间质开始纤维化,并出现新生软骨细胞岛及软骨内成骨现象,膜管内部见纤维骨痂形成;对照组,同种异体骨管管壁骨吸收增多,新生骨小梁长入,异体骨管腔内外见新生骨小梁。 术后12周,实验组膜管外见大量骨性骨痂,骨小梁粗大成网格状,骨痂开始塑形成板层骨,板层骨排列紊乱、无序,膜管内骨小梁形成,间质出现新生骨髓成分及髓腔形成,膜管与内外骨痂紧靠但无明显连接(图3A);对照组骨小梁增厚,与异体骨管融合,管腔内骨小梁增多,骨髓腔再通(图3B)。 术后16周,实验组膜管外骨板形成、塑形,板层骨排列整齐、有序,膜管内骨断端有不规则骨形成,髓腔再通(图3C);对照组移植骨与宿主骨已完全连接,骨髓腔再通,整体塑形良好(图3D)。"
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