羟基磷灰石涂层钛板固定修复兔股骨缺损的随机对照实验

摘要

背景:普通金属接骨板对固定骨段具有强大的应力遮挡作用,且对骨组织生长无诱导及引导作用.而羟基磷灰石(HA)涂层钛板对固定骨段既有固定作用,HA涂层又可以引导骨组织再生,使早期内、外骨痂迅速增生.目的:观察普通金属接骨板、HA涂层钛板对骨缺损修复的影响.设计:完全随机对照的前瞻性实验研究.地点和对象:重庆医科大学动物实验中心完成,实验对象为成年新西兰大白兔15只,体质量2.52kg,雌雄不限,由该实验室提供.干预:动物在无菌操作下显露右股骨干,造成一长约10 mm的骨缺损模型,实验组用HA块状人工骨植骨+HA涂层钛板固定,对照组用或不用HA块状人工骨植骨+普通钛板或不锈钢骨板固定,分别于术后2,4,6,8,12,16周取出标本进行大体形态观察和组织学观察.主要观察指标:观察实验组和对照组新骨生成情况.结果:术后4周,取出的HA涂层钛板表面即有新生骨形成附着,至术后12周涂层钛板周围完全被片块状新生骨包裹,板与周围骨组织结合牢固,而对照组骨板表面未见新骨形成、附着.术后2,4,8,12,16周,组织学观察显示实验组各时期新骨生成的速度、质量与数量明显优于对照组.结论:HA涂层钛板具有引导成骨作用,与周围骨组织结合牢固,固定可靠,有利于骨缺损的修复.%BACKGROUND: Common metal bone fracture plate had powerful stress force shelter reaction in fixed bone segments and moreover, is has no induction and guiding reactions in bone growth. However, hydroxyapatite (HA) -coated titanium plate not only has fixing reaction in fixed bone segments, and the HA coat also could guide osseous regeneration, which would promote early rapid proliferation of interior and exterior callus.OBJECTIVE: To observe the effect of common metal bone fracture plate and HA-coated titanium plate on the restoration of osseous defect.DESIGN: A completely randomized controlled perspective study was conducted.SETTING and PARTICIPANTS: The study was conducted in the Center for Experimental Animals, Chongqing University of Medical Sciences, from which the 15 adult New Zealand rabbits of either gender with a body mass of 2.52 kg were obtained.INTERVENTIONS: Right femoral stem was exposed under aseptic operation for the establishment of osseous defect model with a 10 mm defect. HA mass artificial osseous graft + HA-coated titanium plate fixation were used in study group; HA mass artificial osseous graft(with or without) + common titanium plate or stainless steel plate were used in control group. Specimens were taken respectively at 2, 4, 8, 12 and 16 weeks after operation for the observation of general morphology and histology.MAIN OUTCOME MEASURES: The new osteogenesis was observed in both study and control groupRESULTS: At 4 weeks after surgery, there were osteogenesis and adhesion on the surface of the removed HA-coated titanium plate; at 12 weeks after surgery, the HA-coated titanium plate was completely wrapped by new bones and the connection between plate and surrounding tissue was substance. However, there were no osteogenesis and adhesion found on the surface of bone plate in control group. The observation of histology at 2, 4, 8, 12and 16 weeks after surgery indicated the speed, quality and quantity of osteogenesis at each time point in study group were significantly better than that of control group.CONCLUSION: HA-coated titanium plate has guiding reaction in osteogenesis, which can be substantially connected with surrounding osseous tissues fixation that is reliable and helpful to the restoration of osseous defect.