带血管骨膜瓣移植修复烧伤坏死管状骨的实验研究

目的探讨带血管骨膜瓣移植修复烧伤坏死管状骨的可行性，试图为临床修复烧伤坏死骨提供一种有效的方法。方法8月龄成年新西兰家兔20只，设一侧肢体的桡骨为实验组，另一侧为对照组，采用同体对照法。实验组保留带血管的骨膜瓣，从桡骨中下段离断1．2cm桡骨，置沸水中煮沸30min冷却后原位回植，再行骨膜瓣移植包绕、固定。对照组按上述方法处理后不移植骨膜瓣。分别于术后2、4、6、8～10、12周摄X线平片，同时分别处死4～5只兔并取两侧桡骨行组织学切片检查。结果实验组：术后2～4周在骨坏死区见到明显的骨膜增生影像；术后6～8周见骨折断端连接征象，新生骨小梁形成并逐渐改建；术后8—10周可见网织骨普遍融合重建，形成板层，新的哈佛系统形成；术后12周新生骨结构更加成熟，骨折愈合。对照组：术后2周仍为死骨，骨坏死区无骨膜增生现象；术后4、6周未见骨折愈合征象；8周可见骨缺损；12周坏死骨完全溶解、吸收，骨缺损区清晰可见，骨缺损区被少许纤维组织充填。结论带血供的骨膜瓣能不断形成新生骨并爬行替代原坏死骨，使坏死骨获得再生，能很好地修复烧伤坏死的管状骨。

An experimental study on the repair of the necrotic tubular bone with pedicled vascular periosteum grafting in rabbits

OBJECTIVE: To investigate the mechanism of the repair of the necrotic tubular bone with pedicled vascular periosteum grafting in rabbits. METHODS: Twenty mature New Zealand rabbits aged 8 months were randomly divided into test and control groups by placebo-controlled protocol. A segment of radius measuring 1.2 cm in length with pedicled vascular periosteum of the rabbits in the test group was obtained from the middle distal part of the bone, and boiled for 30 minutes. The cooled bone was then re-grafted and wrapped with vascularized periosteum and immobilized, while those in the control group, no periosteal grafting was done. X-ray examinations of the bones were carried out at 2, 4, 6, 8 approximately 10 post operation weeks (POWs). Meanwhile 4-5 rabbits were sacrificed for the harvesting of the radius on both sides for histological examination. RESULTS: It was revealed by X-ray and histological study that the periosteal hyperplasia could be observed 2-4 weeks after operation in the test group. The sign of union of the fracture and the formation and reconstitution of the trabeculae could be observed 6-8 weeks after operation. The reconstitution of reticulated bone, the formation of the lamellar bone and new haversian system could be observed during 8-10 POW. The structure of the new formed bones became more mature and the fracture healed at 12 POW. In contrast, there was no changes in the necrotic bones in the control group at 2 POW and no signs of fracture healing at 4-6 POW, and the defect of the bones could be observed at 8 POW. The necrotic bones were totally dissolved and absorbed, and the bone defects could be observed clearly filled with fibrotic tissues at 12 POW. CONCLUSION: The necrotic bones could be replaced by regeneration of new bone originated from the pedicled vascular periosteum, so that the necrotic tubular bones could be repaired. But the necrotic bones in the control group were eventually absorbed, resulting in bone defects.