应用自体微小颗粒骨复合红骨髓促进节段性骨缺损修复

摘要

BACKGROUND: Bone marrow stromal calls(BMSCs) that widely exist in bone marrow have powerful osteogenic potentialities and the study of them may provide a new therapeutic method for the clinical renovation of nonunion and bone defects of big bone segments.OBJECTIVE: To investigate the curative effects of autologous tiny granular bones combined with red bone marrow(RBM) in bone defects and provide an experimental basis for clinical application of them.DESIGN: A randomized controlled experimental study was conducted.SETTING and PARTICIPANTS: The experiment was finished in the D partment of Orthopaedics in the Fifth Hospital of Harbin. The subjects were 21 New Zealand male rabbits with body mass of 2.0 - 2.5 kg.INTERVENTIONS: The rabbits were divided into 4 groups randomly and bone defect models of bilateral ulnae at the middle segments were built up. Autologous tiny granular bones and the compound of autologous tiny granular bones and RBM were implanted, and blank control was also used simultaneously. The results were observed 4, 7, 9 weeks after operations respectively and the paired data were analyzed with t test.MAIN OUTCOME MEASURES: Results of X-ray, histological and biomechanical examination after treatments.RESULTS: It was found that the compound of autologous tiny granular bones and RBM could effectively renovate segmental bone defects 7 weeks after operations while there were not signs of bone union in blank group by X-ray and histological examination. The maximal stress and elastic modulus of the experimental group(group of autologous tiny granular bones combined with RBM) were all higher than those of the control group(group of autologous tiny granular bones), t = 3. 551, 2. 558, P ＜ 0. 05. It was confirmed that the mechanical property of experimental group was significantly superior to that of control group.%背景:广泛存在于骨髓中的骨髓基质干细胞(BMSCs)具有强大的成骨潜能,其为骨不连接、大段骨缺损的临床修复提供了一种新的治疗手段.目的:探讨自体微小颗粒骨复合红骨髓治疗骨缺损的效果,为其应用于临床提供实验依据.设计:随机对照实验研究.地点和对象:实验在哈尔滨市第五医院骨科完成,对象为体质量2.0～2.5kg新西兰雄性白兔21只.干预:将白兔随机分成4组,建立双侧尺骨中段骨缺损模型,分别植入自体微小颗粒骨和自体微小颗粒骨与红骨髓复合物,同时设立空白对照.分别于术后4,7,9周观察结果,配对资料用t检验.主要观察指标:骨缺损模型治疗后X射线、组织学和生物力学结果.结果:经组织学及X射线检查发现,术后7周自体微小颗粒骨复合红骨髓更有效地修复节段性骨缺损,空白组无骨愈合迹象,术后9周生物力学测试自体微小颗粒骨复合红骨髓组的最大应力和弹性模量均大于对照组,t值分别为3 551和2.588(P＜0.05).证明自体微小颗粒骨复合红骨髓组骨的力学性能明显优于对照组.结论:自体微小颗粒骨复合红骨髓组成骨速度快,成骨量多,骨的机械强度高,修复骨缺损的能力明显强于自体微小颗粒骨移植.