骨皮质纵血管系统在骨折愈合中的作用

本实验用兔２４只，４只采用墨汁灌注方法观察正常兔胫骨皮质微血管构筑，其它制备骨折模型，并于术后３，８，１８，２８，４２ｄ分别处死，注入中国墨汁，观察纵血管系统的重建。结果表明，在骨折愈合９～１８ｄ，纵血管系统与骨痂之间的循环才得到建立，提示纵血管系统在骨折愈合早期没有横系统重要，但在中期非常重要纵系统建标志着骨折断端皮质骨的连接，可考虑施加横向有任意方向的截荷，以促进纵血管系统生长，防止骨不连，加     

实验性骨折愈合的血运重建

本实验对骨折愈合局部血液循环的重建进行了研究.8只山羊分为两组:正常组.用于观察骨微血管;实验组,观察骨折血运重建,线锯造成胫骨中段横骨折,6周后处死.两组动物均在股动脉插管,注射中国墨汁,连续切片观察.结果表明;(1)滋养动脉供应骨干骨髓,骺——干骺动脉供应骺、干骺端骨髓;皮质深层2/3由滋养动脉分支供应,而皮质浅层1/3由骨膜动脉供应;(2)当骨折损伤滋养动脉,干骺部血管、骨膜血管扩张,增多.提示这些动脉在骨折愈合血运重建中起重要作用.     

矩形髓内钉对实验性骨折局部微循环的影响

目的：探讨矩形髓内钉（RIN）对骨折愈合过程中骨折局部微循环的影响。方法：运用兔胫骨骨折内固定模型，通过微血管墨汁造影，组织切片观察等方法对RIN等不同内固定后骨折局部微循环的变化进行了动态对比研究。结果：骨折早期，各组皮质血容量均锐减，RIN，END组以内1／2，SPL组以外1／2的减少明显，术后7d，血容量明显恢复，各组均超过正常值。术后14d,血容量扩增至最高峰，约为正常值的6倍，之后血容量渐渐降低，术后84d接近正常。同组相比术后28d骨痂血管最丰富；同期相比RIN组骨痂血管最丰富，END组次之，SPL组最小，组间差异显著，结论：RIN对骨折局部微循环影响小，有利于骨折愈合。     

骨皮质纵血管系统在骨折愈合中的作用

本实验用兔24只,4只采用墨汁灌注方法观察正常兔胫骨皮质微血管构筑。其它制备骨折模型,并于术后3,8,18,28,42d分别处死。注入中国墨汁,观察纵血管系统的重健。结果表明:在骨折愈合9～18d,纵血管系统与骨痂之间的循环才得到建立,提示纵血管系统在骨折愈合早期没有横系统重要,但在中期非常重要。纵系统重建标志着骨折断端皮质骨的连接,可考虑施加横向及任意方向的载荷,以促进纵血管系统生长,防止骨不连,加速骨折愈合。     

连续碳纤维聚烯烃髓内钉治疗兔胫骨骨折

目的 观察连续碳纤维增强聚烯烃复合材料髓内钉对兔胫骨骨折愈合的影响.方法 雄性新西兰兔39只,制作兔双侧胫骨中断骨折髓内钉固定模型,左侧实验侧以碳纤维复合材料髓内钉固定,右侧以不锈钢髓内钉做对照.24只动物术后2、4、8、12周取材行大体观察、影像学观察和组织学检查.另15只术后4、8、12周取材做愈合骨强度的生物力学分析.结果 术后4周及8周,试验组矿化沉积率及平均类骨质宽度均优于对照组.愈合8周与12周,实验组骨愈合负载优于对照组25～30%(P＜0.05),弯曲强度实验组高于对照组15%(P＜0.05).结论 与不锈钢髓内钉比较,连续碳纤维增强聚烯烃复合材料髓内钉更有利于兔胫骨骨折愈合.     

不同延长速度对延长肢局部血流量及骨愈合的影响

延长速度是肢体延长术的基本问题之一，其对延长肢局部血流量及延长区骨愈合质量有很大的影响，５０只兔行左胫骨上下骺端截骨延长术，通过对延长肢局部血流量的测定，延长区Ｘ线，组织学检查及力学扭转测试，观察１ｍｍ／ｄ，２ｍｍ／ｄ和３ｍｍ／ｄ（Ａ、Ｂ、Ｃ三组）三种不同延长速度对延长肢局部血流量及骨再生修复过程的影响。结果提示，延长后Ａ组血流量平均减少约５％，２小时后恢复正常，Ｂ组减少３０％，恢复正常时间超过１     

实验性长骨缺损的一期骨外固定治疗

为观察加压外固定的骨断端和骨延长区微循环的重建过程及血流动力学的变化，作者以羊胫骨干骨缺损为模型，进行了微血管造影和铸型、墨汁灌注透明切片、放射微球法局部血流量测定等观察。结果证实延长区血管极丰富，与延长速度（１．０ｍｍ／天）同步生长，并随延长区新生骨皮质出现逐渐向正常皮质骨血管系统衍变。延长结束２周时血流量达高峰（５４．５６±８．５３ｍｌ／ｍｉｎ／１００ｇ）。骨缺损断端皮质血管于术后７周长入间隙并相互吻合，此时血流量达（３１．８２±２．８５ｍｌ／ｍｉｎ／１００ｇ）。术后１２周仍比正常皮质骨血流量（３．０２±０．１３ｍｌ／ｍｉｎ／１００ｇ）高２倍，断端对位良好，呈一期愈合。作者认为胫骨干骺端血循环丰富，延长区骨修复迅速，加压外固定同样可出现骨折一期愈合。     

骺——干骺端皮质微血管在骨愈合中的形态变化

目的：关于骺--干骺动脉在骨折愈合中的作用,资料较少,有必要研究。方法：本研究用家兔24只,4只用于观察正常骺端皮质血管。其余制作骨折模型并于骨折后38、18、28、42d分别处死,观察骺--干骺端皮质微血管的变化。结果：早期（3～8d）骺端皮质微血管扩张明显,中期（8～28d）血管扩张及血管相对密度达到最高峰。后期,血管变细,密度降低,但仍然比正常组高。结论：骺--干骺血管在骨折愈合中具有重要的作用。     

坚硬接骨板对板下皮质骨结构的影响——扫描电镜观察

为了对坚硬接骨板固定及取出后板下皮质骨结构变化进行观察，作者选用新西兰兔２８只，其中４只作对照；２４只在左胫骨作不锈钢接骨板固定，其中２０只于术后２个月取出接骨板，并分别在取钢板当时及取钢板后１、２、３和４个月各处死４只取材，另４只在内固定后６个月处死取材。用扫描电镜对各组板下皮质骨的结构变化进行观察。结果显示：坚硬接骨板内固定后，板下皮质骨不仅有大量骨丧失，而且骨的结构包括骨表面矿柱和骨内胶原纤维的结构排列也发生明显紊乱；接骨板取出后，骨量和骨结构可逐步恢复正常，但骨结构恢复有一延迟过程。作者认为，骨结构恢复延迟可能是接骨板取出后固定骨段再骨折的原因之一。     

上肢骨干骨折内固定实验动物模型的建立

目的：建屯内固定术治疗上肢骨干骨折的实验动物模型，为研究不同内固定下骨折愈合的机制提供实验对象。方法：新西兰大白兔25只，随机选择一侧前肢上臂，取外侧切口显露肱骨，以线锯在其中段截骨，复位后植入天鹅记忆接骨器(SMC组)；同法在对侧植入4孔动力加压接骨板(DCP组)。分别在术后l、2、48、12周摄片观察骨折愈合情况，并处死5只动物取材，HE染色，行病理学观察。结果：术后动物全部成活，前肢负重明显低于后肢。X线片显示：SMC组在术后8周骨折愈合，愈合过程中未见明显外骨痂及板下皮质骨疏松；DCP组骨折愈合速度较慢，术后12周时骨折端仍有骨痂，伴局部皮质骨疏松。，病理学观察：术后8周，SMC组骨折端直接由板层骨替代；术后12周，DCP组形成骨性连接，处于改建塑形期。结论：SMC固定下实验性兔肱骨干骨折愈合过程与临床相似，愈合速度和质量优于DCP固定。兔肱骨干骨折内固定模型是一种较为理想的上肢骨干骨折内固定实验模型。     

外敷中药对骨折愈合微血管重建的影响

目的 探讨中药对骨折愈合微血管重建的影响。方法 家兔１５只,双侧胫骨制作骨折模型,左侧外敷中药,右侧未用中药为对照组。术后１０,２０,３０天分别处死动物,将中国墨汁注射入腹主动脉,采用组织切片法,观察微血管变化,以评价中药对骨折愈合的影响。     

The role of the tibial nutrient artery. Microsphere estimation of blood flow in the osteotomised canine tibia

There has been a long-standing debate as to whether medullary or periosteal flow is the dominant vascular supply during the healing of diaphyseal fractures. We used radioactive microspheres to quantify blood flow to the canine tibia two weeks after an osteotomy. There was a significant contribution from the periosteum to the blood supply of healing cortical bone after nutrient artery ligation, with a reversal of flow from a centrifugal to a centripetal direction. Our study has confirmed the qualitative observations of Trueta (1974) regarding the significant recruitment of vessels from surrounding soft tissue during fracture healing. We have not studied the later stages of healing.     

中药对小鼠骨折后血管重建与骨折愈合方式关系的影响

目的 探讨中药对小鼠骨折后血管重建与骨折愈合方式关系的影响。方法 昆明种小鼠50只，制作闭合性胫腓骨骨折模型，随机分为两组，实验组口服中药，对照组口服生理盐水。分别于术后第3、7、15、21、28天处死动物。腹主动脉墨汁灌注，制成石蜡切片。HE染色，光镜观察。结果 实验组骨折部位血管的增生、扩张程度高于对照组。软骨内成骨占整个骨痂的比例少于对照组。实验组较对照组约提前1周愈合。结论 中药通过促进骨折部位血管增生、扩张，加速软骨骨痂改建，减少软骨内成骨，增加膜内成骨的比例，促进骨折的愈合。     

A quantitative study of the routes of blood flow to the tibial diaphysis after an osteotomy

Techniques of tissue exclusion have been used previously in qualitative investigations of the vascularity of long bones, after experimental fracture; we quantified their effects on bone blood flow in rabbits. Thirty-six adult rabbits were divided into three groups in which flow was measured, with the microsphere technique, 1 and 2 weeks after osteotomy. In Group 1, osteotomy of the tibial shaft only was done; in Group 2, osteotomy was done with exclusion of the periosteum and muscle by a silicone rubber sheath; and in Group 3, osteotomy was done with exclusion of the marrow by reaming and insertion of an intramedullary nail. All involved limbs were immobilized in a cast. In Group 1, cortical flow increased but marrow flow did not change, which suggests that the changes in cortical flow were mediated by a supply paralleling that of the marrow. In Group 2, the changes in cortical flow were abolished, which implies that this parallel supply is from the periosteum and extraosseous tissues. In Group 3, cortical flow was not significantly reduced, which demonstrates reeruitment of this periosteal and extraosseous supply. These results lend support to the hypothesis that the blood supply to the healing diaphysis is principally from the periosteum and extraosseous tissues during the early peak period of blood flow.     

天鹅记忆接骨器对长骨干骨折愈合的影响

目的 探讨天鹅记忆接骨器（swan-like memory compressive connector，SMC）对实验性长骨干骨折愈合过程中骨力学性能、形态结构和微循环的影响。方法 56只新西兰大白兔行双侧肱骨干截骨后，随机选取一侧用SMC固定，取侧用四孔加压接骨板（dynamic compressive plate,DCP）固定。分别于术后2、4、8、12、16、20周取材，行应力遮挡试验、CT扫描和水平扭转力学测定，观察两组内固定对骨结构和力学性能的影响。另外于骨膜愈合情况。结果 各时相SMC时间延长而加重；SMC组皮质骨厚度和密度保持正常。术后4周开始，SMC组的扭转刚度大于DCP组。SMC组对骨血供的损伤较DCP组轻，从术后3d至术后4周，两组同骨外板血流量的差异均有显著性。SMC组骨外板血供术后4周即恢复正常，而DCP组8周才恢复正常。从内固定后即刻开始，SMC组髓内血流量始终大于DCP组。SMC组骨愈合速度比DCP组快，且骨折愈合局部无骨痂，也无骨质疏松。结论 SMC与DCP相比，具有材料和几何构型上的优势，对固定段骨干几乎不产生应力遮挡；且对骨折局部血供的损伤轻，有利于骨血供恢复。何构型上的优势，对固定段骨干几乎不产生应力遮挡；且对骨折局部血供的损伤轻，有利于骨血供恢复。     

Cortical revascularization after reamed and unreamed intramedullary nailing in the rabbit femur: a microangiographic histometric analysis.

BACKGROUND: Intramedullary nailing leads to a reduction in cortical bone blood flow. The relative effect of reamed versus unreamed nailing on the degree of avascularity and on revascularization of the cortex remains controversial. We compared the effects of reamed versus unreamed intramedullary nailing on cortical revascularization and the time course for its recovery in the unfractured rabbit femur. METHODS: A total of 56 New Zealand white rabbits were used as experimental animals. Reamed nailings with Kirschner wire (diameter, 3 mm) were performed in the right femora (group R, n = 49), and unreamed nailings with Kirschner wire (diameter, 2 mm) were performed in the left femora (group UR, n = 49) of the same animals after a standard surgical procedure. Microangiography that used Indian ink was performed for each killed animal at one of seven postoperative time periods: 2 hours, 3 days, and 1, 2, 3, 4, and 5 weeks after surgery. The right femora and the left femora of seven rabbits were used as the postoperative day 0 controls of group R and those of group UR, respectively. We evaluated the vascularization ratio (VR) in cross-sections according to the following formula: VR = the number of enhanced vessels with Indian ink/total cortical vessels. Each cross-section was divided into an inner and outer half, which were in turn divided into quarters, so that the entire cross-sectional are is represented by eight regions. The VR was calculated for each regions and then comparison was made between group R and group UR at various time periods and areas. RESULTS: No statistically significant differences were observed in VR at any time period between group R and group UR in total cortical area and total periosteal side. However, on the total medullary side, the VR of group UR was significantly higher than that of group R at postoperative day 3 (p = 0.04). Statistically significant differences were observed between the VR on the periosteal side and that on the medullary side in both groups at all time periods aside from the 5-week period (p < 0.05). Revascularization of the cortex occurred 4 weeks after intramedullary nailing in both group R and group UR. CONCLUSION: The periosteal circulation was maintained better than the medullary circulation, irrespective of whether the canal was reamed or not. The present study failed to detect any statistically significant differences in cortical revascularization between reamed nailing and unreamed nailing. Thus, we concluded that reamed and unreamed nailing are not differentially advantageous in the unfractured rabbit femur, in terms of impairment of cortical blood supply.