摘要
目的观察对火器伤造成的骨缺损行一期原位骨延长术治疗的病理学和影像学变化,分析在骨膜损伤条件下行骨延长术治疗骨缺损的可行性及其生物学基础。方法成年犬38只,随机分成两组,制造犬股骨火器伤骨缺损模型,对两组动物分别采用外固定器行一期原位骨延长术和单纯骨折固定术治疗,治疗全程行X线检查、病理学检查和放射性核素骨显像分析。结果骨延长组动物8周内骨延长长度为(2.82±0.94)cm,平均为伤前股骨全长的19.3%(15.8%～21.4%)。骨延长组动物骨缺损区的延迟相放射性计数逐渐增加。两组动物骨折端的延迟相和血池相变化趋势一致,其放射性计数无统计学差异。骨延长主要的成骨方式是软骨化骨。残存骨碎片可能具有成骨能力。结论残存骨膜和骨碎片在骨延长的成骨过程中有明显作用。但在骨膜损伤的条件下,骨延长技术仍可用于其骨缺损的治疗,骨折端周围组织新生血管不仅为骨愈合提供了血供,而且为其提供了骨细胞的来源。操作正确的骨延长术对骨折端血供和骨代谢无明显的不良影响。
Objective To investigate the pathological changes of bone in situ lengthening for the gunshot bone defect, and to discuss the practical feasibility and biological basis of bone lengthening in the conditions of periosteum damage. Methods The 38 canines were randomly distributed into two groups and sustained the same gunshot bone defect in the mid femoral diaphysis. In one group, the femur were stabilized with Bastiani external fixator and 2 weeks later the fractured limb with fixation were lengthened 2-4 times per day at a speed of 0.5-1 mm/d until the normal length was reached. The control group only had external fixation without lengthening. 3, 6 and 12 weeks after injury, the canines were given 99mTc MDP and got radionuclide examination under SPECT (ADAC company, USA.). Pathological and X ray observation were carried out at 1, 2 ,3 ,6 and 12 weeks respectively after injury for comparison between two groups. Results The X ray measurement showed that the length of callus distraction in the bone lengthening group increased by (2.82±0.94)cm and the relative lengthening of bone is 19.3% (15.8%-21.4% ), compared with normal femur on the same X ray film. The count of radionuclide increased gradually at the region of bone defect in the lengthening group. While in the fracture ends, no significant difference was found in the development pattern through each radionuclide observation phase between two groups. The main mode of osteogenesis was endochondral ossification and the bone defect area was enriched by chondrocyte in the bone lengthening group. Conclusion There are no obvious negative influence on bone turnover and local blood flow in the bone lengthening for gunshot bone defect. The remained periosteum and bone fragment under gunshot injury may have important role in the progression of osteogenesis. The neogenetic capillary provided not only blood supply for healing of bone but also source of osteocyte for bone lengthening in the case of the periosteum and blood circulation damaged with gunshot wound.
出处
《中华骨科杂志》
CAS
CSCD
北大核心
2002年第2期108-112,共5页
Chinese Journal of Orthopaedics
