多孔羟基磷灰石、纤维蛋白和金葡液复合物修复骨缺损的实验研究

背景骨缺损的修复一直是骨科治疗的难点,寻找有效修复骨缺损的骨移植替代材料是目前骨缺损治疗的研究方向.目的探讨珊瑚多孔羟基磷灰石(coralline hydroxyapatite porous,CHAP)、纤维蛋白(fibrin sealant,FS)及金葡液(staphylococcus aureus injection,SAI)复合物修复骨缺损的作用及其作为人工骨移植替代材料的可行性.设计随机对照的试验研究.单位中山大学附属第三医院骨科.材料实验在中山大学动物实验室和解放军第一军医大学全军生物力学中心完成.羟基磷灰石,纤维蛋白,金葡液.方法采用新西兰大白兔54只在兔双侧桡骨制备骨缺损模型后分成实验组、对照组及空白组.将CHAP-FS-SAI复合物植入骨缺损处作为实验组,以自体骨植入作为对照组,空白组不植入任何物质.在2,4,8和12周分别进行大体标本观察,组织学,X射线片观察及生物力学测试,比较各组修复骨缺损的能力.主要观察指标动物一般情况,大体标本,X射线片,组织学,生物力学测定.结果实验组术后2周见植入物与骨端形成紧密的纤维性连接,镜下可见CHAP周围大量成纤维细胞、软骨细胞及细胞钙化.12周实验组和对照组均见大量成熟的骨细胞及板层骨;实验组见植入物完全骨化,塑形完全,CHAP未完全降解.空白组12周骨缺损区为纤维瘢痕组织填充.镜下主要为大量成纤维细胞.X射线片2周实验组与对照组有骨痂影.4周骨痂影增多.8周实验组骨缺损消失,CHAP分散在骨痂中;对照组骨折线消失,髓腔开始形成.12周实验组和对照组骨皮质连续,髓腔复通,塑形完全.空白对照组12周骨缺损区无骨性连接.生物力学测试最大扭矩及抗扭刚度在术后4,8,12周复合物组和自体骨组差异无显著性意义(P＞0.05).但术后2周,最大扭距实验组为(0.140±0.032)N·m,对照组为(0.105±0.035)N·m,抗扭刚度两组分别为(0.401±0.050),(0.311±0.050)N·m/rad,实验组高于对照组,差异有显著性意义(t=2.087 0,3.600 0,P＜0.05).结论CHAP-FS-SAI复合物具有较强的成骨能力和良好的生物相容性,能作为自体骨移植的一种替代物修复骨缺损.

Experimental study of coralline hydroxyapatite porous, fibrin sealant and staphylococcus aureus injection compound in bone defect restoration

BACKGROUND: The restoration of bone defect is always difficult in the treatment of orthopaedics. To find an effective replacement material of bone transplantation to repair bone defect is the direction of the researches in bone defect therapy at present.OBJECTIVE: To investigate the effects of coralline hydroxyapatite porous (CHAP), fibrin sealant(FS) and staphylococcus aureus injection(SAI)compound in bone defect restoration and the feasibility of the compound to be used as replacement material in artificial bone transplantation.DESIGN: A randomized controlled trial.SETTING: Third Hospital affiliated to Sun Yat-sen University.MATERIALS: The study was accomplished in the Animal Laboratory of Sun Yat-sen University and the Institute of Biomechanics of First Military Medical University of Chinese PLA. Materials were CHAP, FS and SAI.METHODS: Fifty-four New Zealand rabbits were randomly divided into study group, control group and bone defect model group after the establishment of bone defect model in the radius on both sides. CHAP-FS-SAI compound was transplanted in the bone defect in rabbits of the study group and autologous bone was transplanted in the rabbits of the control group, nothing was transplanted in rabbits of bone defect model group. Gross specimens observation, histology, X-ray film observation and biomechanics test were conducted at 2, 4, 8 and 12 weeks respectively to compare the ability in bone defect restoration among each group.MAIN OUTCOME MEASURES: General condition, gross specimens,X-ray, histology, and biomechanical testRESULTS: At two weeks after operation, compact fibrous union between graft and bone end was formed in the study group. It could be seen under microscope that CHAP was surrounded by a lot of fibroblast, chondrocyte,and cellular calcification. At 12 weeks, quantities of mature osteoblasts and lamellar bones could be seen in both study group and control group. Graft in the study group was completely ossified with complete moulding but CHAP did not completely degrade. The bone defect area was filled with fibrous scarring tissue at 12 weeks in bone defect model group, in which most of them were fibroblasts under microscope. X-ray films: callus could be seen in both study group and control group at 2 weeks, which increased at 4 weeks. Bone defect disappeared at 8 weeks in the study group and CHAP scattered in the callus. Bone fracture line disappeared and the medullary cavity started to form in control group. Cortical bone was continuous and the medullary cavity re-connected at 12 weeks in both study group and control group with complete moulding. No osseous union was found in bone defect area at 12 weeks in bone defect model group. Biomechanical test: there were no significant differences in maximum torque and anti-torque stiffness at 4, 8 and 12 weeks after operations between the study group and control group( P＞ 0. 05) . However, at 2 weeks after operation, the maximum torque was in control group ( t = 2. 087 0, 3. 600 0, P ＜ 0.05 ).CONCLUSION: CHAP-FS-SAI compound has relative powerful osteogenetic ability and favourable biocompatibility, which can be used as material to replace autologous bone transplantation in bone defect restoration.