量化比较带蒂筋膜瓣促血管化成骨与膜诱导成骨作用及成骨效果的实验研究

目的通过量化指标测定,明确带蒂筋膜瓣包裹自体骨髓基质干细胞（BMSC）接种的非细胞型组织工程骨在修复骨缺损各时间段中的主要作用及成骨效果,为临床干预骨缺损的治疗提供依据。方法制作动物骨缺损模型及带蒂筋膜瓣,随机分为A、B、C三组,A组为单纯植入对照组,B组为无蒂筋膜瓣对照组,C组为带蒂筋膜瓣实验组,在第4、8、12、16周进行骨修复区吸光度比测量、骨形态计量分析、交界区和中心区血管图像计量分析,第8、12、16周同时进行放射性核素骨显像检查、腋动脉注入墨汁检查及生物力学测定分析。结果第4、8周时,C组与A组、B组相比较其骨修复区吸光度比值、新生骨小梁面积、再生血管面积和放射性核素骨显像摄取比值明显增多,生物力学强度增加,各项量化指标差异均有统计学意义（P〈0.05）,表现为早期骨修复过程中血管体积增多对成骨作用是有利的;第12、16周时,三组骨修复区吸光度比测量、新生骨小梁面积和生物力学强度逐渐明显增加,C组仍大于A组、B组,但各组再生血管面积和放射性核素骨显像摄取比值较第8周下降明显,差异有统计学意义（P〈0.05）,表现为随着时间的推移,成熟骨组织量的增多,血管化作用逐渐减弱,后期膜诱导成骨作用显著。结论带蒂筋膜瓣包裹自体BMSC接种的非细胞型组织工程骨具有构建血管化和膜诱导组织再生双重作用,早期促血管化成骨作用占主导地位,并有助于膜诱导成骨作用,后期膜诱导成骨作用为主,促血管化成骨作用消失,临床适时干预治疗对骨缺损修复有极好作用。

Comparision between vascularization osteogenesis and the membrane guided osteogenesis of the pedicle fascial flap and the osteogenetic effect between them by quantification

Objective To ascertain the dominant function and osteogenetic effect of the uncellular tissue engineering bone with pedicle fascial flap packing autologous BMSC at each time of the bone repair by quantification measurement,and to provide reference for the bone defect repair in the clinical practice.Methods Constructed the bone defect model and the pedicle fascial flap.Divided the animals into three groups randomly, in which Group A was a simple control,Group B was a control with the fascial flap without pedicle and Group C was the experimental group with the pedicle fascial flap.The absorbance ratio measuerment,bone morphology quantitive analysis,vessel image quantitive analysis in the junctional and central area were performed at the 4 th,8 th,12 th and 16 th weeks after the operation and ECT, ink perfusion experiment by axillary artery,biomechanics test were performed at the 8 th,12 th and 16 th weeks after the operation. Results The absorbance ratio,the new bone trabeculae area,the regenerated vascular area and the ECT ratio in the bone repair area increased obviously and the biomechanics intensity also increased at the 4 th and 8 th weeks after the operation comparing Group C to Group A and Group B.All the differences among the indexes had statistical significance（P0.05）,which manifested that the increase of the vascular volume in the early stage of the bone repair was beneficial to the osteogenesis and had obvious positive correlation. The absorbance ratio,the new bone trabeculae area and the biomechanics intensity increased obviously at the 12 th and 16 th weeks after the operation among the three groups, but these indexes in Group C were still more than that in Group A and Group B while the the regenerated vascular area and the ECT ratio decreased obviously in each group comparing to that at the 8 th week,all of which had significant difference（P0.05） and manifested that the vacularization weakened with the increase of the mature bone quantitiy and the membrane guided osteogenesis became obvious in the later period. Conclusions The uncellular tissue engineering bone with pedicle fascial flap packing autologous BMSC had a dualfunction of constructing vascularization and membrane guided tissue regenesis and the vascularization osteogenesis was dominant in the early stage and was helpful to membrane guided osteogenesis which was dominant in the later period when the vascularization osteogenesis disappeared.Thus it is useful to the clinical treatment if the progress was intervened at the proper time.