以带蒂筋膜瓣为膜诱导促非细胞型组织工程骨血管化及骨再生修复骨缺损的实验研究

目的 研究以带蒂筋膜辨为膜诱导促非细胞型组织工程骨血管化及骨再生修复骨缺损的效果,为临床应用提供依据.方法 将24只成年新西兰大白兔右侧桡骨造骨缺损模型,取自体红骨髓与含骨形成蛋白的骨诱导活性材料混合成非细胞型组织工程复合体.分为2组,对照组12只,仅植入复合物;实验组12只,利用显微外科技术在骨缺损邻近制备一个带有无名血管蒂所属毛细血管网的筋膜瓣,使其包裹组织工程复合体并充填骨缺损.在一定时间内进行X线检查和吸光度比测量、大体观察和组织学检查、修复区内骨形态计量分析和交界区血管图像分析.定量变量组间所得数据比较,采用SPSS 11.5软件行方差分析以及t检验.结果 筋膜瓣机械性地阻碍了纤维结缔组织和周围软组织进入骨缺损部位,保持骨缺损部位有相对稳定的环境;膜下间隙空间本身及充填物的形状和量对骨再生的形状和量起决定作用;在构建组织工程化骨的同时建立其血液供应,2组术后4周的吸光度值[对照组(0.732±0.021)与实验组(0.651±0.018)]相比差异有统计学意义(P<0.05),2组各时间点(术后4、8、12、16周)的骨小梁面积占修复区面积的比值[对照组为(2.32±2.57)%、(8.37±3.52)%、(28.57±2.98)%、(47.24±3.42)%,实验组分别为(19.37±3.52)%、(30.24±3.42)%、(58.76±4.62)%、(88.72±5.84)%]和骨修复交界区单位面积内血管再生面积[对照组为(5.04±1.62)%、(10.37±2.96)%、(18.20±2.12)%、(17.82±2.74)%,实验组为(17.53±2.86)%、(35.24±1.13)%、(48.76±4.62)%、(57.72±5.84))%]比较,差异均有统计学意义(P均<0.05),说明无论植入物内部血管的长入、骨小梁及软骨组织形成的数量和速度,还是成熟骨结构的形成、骨干结构的重塑、骨髓腔的再通、植入物的吸收降解,明显优于无筋膜瓣对照组.结论 以带蒂筋膜瓣为膜诱导,具有促非细胞型组织工程骨血管化和膜引导性骨再生双重作用,对骨缺损有极好的修复作用.

The experiment research on the repairment of bone defect by using fascial flap with vessels inducing the vas-cularization of uncellular tissue engingeering complex and the regenration of bone

Objective To study the effect of fascial flap with vessels inducing the vascularization of uncel-lular tissue engingeering complex and the regenration of bone on the repair of bone defect, so as to provide the basis for the clinical application. Methods An animal model of bone defect on adult Newzland rabbits'right radial bone was established .and autologous red bone marrow were taken out and mixed into uncellulax tissue engineering comple-xes with OAM which contained BMP. The experiment animals were divided into two groups : experiment group and control group( n = 12 for each ). The control group was only implanted with complexes, meanwhile, the experiment group had fascial flap with vessels. By microsurgery technology,a non-named fascial flap with vessels was prepared, which belonged to capillary net,around the bone defect,and let it wrap tissue engineering complex,fill up bone de-fect. In a certian time, radiograph(X-ray) and light density measure was conducted, gross morphology and histological inspection was exmained. Bone shape measurement analysis and image of vessel analysis were conducted. All the sta-tistics were analyzed by the SPSS 11.5 software. Results Because of mechanically preventing fiber connective tis-sues and surrounding soft tissues from entering the areas of bone defect by fascial flap, it can keep bone defect having a relative stable environment ;The subfascial space itself, and also the shape and mass of filled-in subject had the de-cisive effect on the results of the regeneration of the bone; Owing to the establishment of blood supply during the con-structing tissue engineering complex. The experiment group was obviously superior to the control group. Compared with control group,the absor bance obviously increased in experiment group [(0. 732 ± 0. 021 ) vs (0. 651± 0.018)] (P < 0. 001 ) four weeks after the operation; also the bone trabecular body was significantly increased [(2.32±2.57)% vs(19.37±3.52)% ,(8.37±3.52)% vs(30.24±3.42)% ,(28.57±2.98)% vs(58.76± 4.62)% ,(47.24±3.42)% vs(88.72±5.84)%] ,and capillary area [(5.04±1.62)% vs(17.53±2.86)%, (10.37 ±2.96)% vs(35.24±1. 13)%,(18.20±2. 12)% vs(48.76±4. 62)%,(17.82 ±2. 74)% vs (57.72 ±5.84)%] (P <0.05) at each time period(4 weeks,8 weeks,12 weeks,and 16 weeks after operation). Despite of growth of implant's internal vessel, the number and speed of forming bone trabecula and cartilaginous tis-sue, even developing of mature bone structure, recreating of diaphysis structure, reconstructing of marrow cavity, ab-sorbing and decomposing of implant, the experiment group was obviously superior to the control group. Conclusions The induction of fascial flap with vessels shows double effects, one of which is the vascularization of uncellular tis-sue engineering complex and the other is membrane guided bone regeneration, So the method has a wonderful effect on the repair of bone defect.