摘要
目的探讨Masquelet技术诱导膜自发成骨的原因。方法取42只7~9周龄雄性SD大鼠,制备右后肢股骨中段临界骨缺损(长度10 mm)模型后,随机分为4组,其中A~C组各12只、D组6只。A~C组骨缺损部位填塞负载万古霉素的聚甲基丙烯酸甲酯骨水泥间隔;其中A、B组以克氏针贯穿骨水泥间隔固定于髓腔内,且B组骨水泥间隔与截骨端连接处以骨水泥包裹;C组以捆绑于骨水泥间隔的钢板固定;D组骨缺损旷置,仅钢板固定两截骨端。术后观察各组大鼠一般情况;术后5周A~C组各取6只大鼠诱导膜行STRO-1免疫组织化学染色,观测诱导膜中MSCs含量;术后12周,取各组剩余大鼠行X线片观察、大体观察、组织学观察(HE、番红O-固绿染色),评价诱导膜自发成骨效果。结果4组大鼠均存活至实验完成。术后5周免疫组织化学染色示B组呈阴性,A、C组MSCs含量分别为14.20%±1.92%和5.00%±0.71%,差异有统计学意义(P<0.05)。术后12周,A组见截骨端有新骨形成并向骨缺损中央方向生长,一侧新骨平均长度达3.1 mm,组织学观察示诱导膜中含有骨、软骨、纤维组织和少量新生血管;C组仅截骨端有少许新骨形成,诱导膜中仅含纤维和少量新生血管;B、D组均未见新骨形成且截骨端骨吸收或骨萎缩。结论尽管Masquelet技术的诱导膜具有成骨活性,但截骨端髓腔内骨髓提供的MSCs才是诱导膜自发成骨的关键,诱导膜自发成骨方式为软骨内成骨。
Objective To investigate the causes of spontaneous osteogenesis of Masquelet technique induced membrane.Methods Forty-two male Sprague-Dawley rats aged 7-9 weeks were selected to establish a critical-sized bone defect of the right middle femur model.Then the rats were randomly divided into 4 groups,with 12 rats in groups A-C and 6 rats in group D.The bone defects in groups A-C were filled with vancomycin-loaded polymethyl methacrylate bone cement spacers.Then the Kirschner wires were used for intramedullary fixation in groups A and B,and the bone cement was used to connect the bone cement spacers and the bone ends in group B.The steel plate was used to fixation in group C.The bone defect in group D was only fixed with steel plate as a blank control group.The general condition was observed after operation.At 5 weeks after operation,6 rats in groups A-C were selected for STRO-1 immuno-histochemical staining to observe the content of mesenchyme stem cells(MSCs)in the induced membrane(STRO-1+cells).At 12 weeks after operation,the remaining rats in groups A-D were taken for X-ray observation,gross observation,and histological observation(HE,safranin O-green staining)to observe the spontaneous osteogenesis of the membrane.Results All rats in the 4 groups survived until the completion of the experiment.At 5 weeks after operation,the immunohistochemical staining showed that group B was negative,while the contents of MSCs in the induced membrane in groups A and C were 14.20%±1.92%and 5.00%±0.71%,respectively,with a significant difference(P<0.05).At 12 weeks after operation,group A showed that the new bone formed at the osteotomy site and growth towards the center of the bone defect,with an average length of 3.1 mm on one side;and the presence of bone,cartilage lesions,fibers,and a small amount of neovascularization were observed in the induced membrane.Group C only had a small amount of new bone at the osteotomy site,and a small amount of neovascularization in the induced membrane.Groups B and D did not have any new bon
作者
殷渠东
毛栋
芮永军
YIN Qudong;MAO Dong;RUI Yongjun(Department of Orthopaedics,Wuxi No.9 People’s Hospital Affiliated to Soochow University,Wuxi Jiangsu,214062,P.R.China;Orthopedic Research Institute,Wuxi No.9 People’s Hospital Affiliated to Soochow University,Wuxi Jiangsu,214062,P.R.China)
出处
《中国修复重建外科杂志》
CAS
CSCD
北大核心
2024年第10期1254-1260,共7页
Chinese Journal of Reparative and Reconstructive Surgery
基金
2021年江苏省卫生健康委课题(Z2020010)
2020年无锡市太湖人才计划顶尖医学专家团队项目(WXTTP-202010)
2020年无锡市科技局课题(Y20212014)
无锡九院“优博”项目(YB02)。
