长骨近关节端骨缺损的力学和生物力学结构重建

背景长骨近关节端的复杂粉碎骨折或骨肿瘤切除后造成的骨缺损是临床治疗的难点,寻找一种可行的重建方法是当前研究的热点问题.目的对比观察3种骨重建方法,探讨一种修复长骨近关节端骨缺损的治疗方法.设计完全随机设计,自身及组间对照.材料实验2000-10/2002-04在吉林大学第一医院动物室完成.采用12只健康成年杂种狗,雄5只,雌7只,体质量12～18 kg.方法12只狗制作股骨髁上方骨缺损模型,随机分为3组(n=4),采用3种方式进行重建①Ⅰ组单纯骨水泥填充.②Ⅱ组自体髂骨移植+骨水泥填充.③Ⅲ组自体髂骨移植+骨水泥填充+L梯形加压钢板固定.术后3,6,12,24周麻醉状态下处死动物取标本,右股骨为实验侧,左股骨为对照侧.处死前1周开始进行荧光标记.处死前行双硫兰血管灌注.主要观察指标取标本后进行X摄线片、生物力学测定、血管灌注及免疫荧光观察.观察3组骨愈合、骨血运恢复情况及生物力学测定情况.结果12只狗均进入结果分析.①X射线片结果Ⅰ组于6及12周,Ⅱ组于6周发生实验侧骨折,Ⅲ组无骨折发生.②生物力学所测定的骨刚度实验侧较对照侧Ⅰ组降低67%,70%;Ⅱ组降低66%,76%,46%;Ⅲ组降低8%.③术后标本观察,在成骨和骨痂生成方面,以及血管双硫兰灌注显示的血运重建方面等结果显示,Ⅲ组在各时期均明显优于其余两组.结论自体髂骨+骨水泥填充+L-梯形加压钢板固定的方式是较为理想的骨重建方式.可恢复病损骨的功能,防止再骨折、骨不连等并发症.

Experimental study on mechanical and biomechanical reconstruction of bone defect of long bone near joint

BACKGROUND:The repairing of bone defect near joint in long bone resulting from complicated comminuted fracture or excision of bone tumor is very difficult. It is a much studied issue to find a feasible solution to this problem.OBJECTIVE: To explore a feasible treatment to bone defect near joint in long bone through comparative observation of 3 reconstruction methods.DESIGN: A completely randomized experiment with self-control and mutual control.SETTING: Laboratory for Experimental Animals, First Hospital of Jilin University.MATERIALS: Twelve healthy adult hybrid dogs, 5 males and 7 females weighing 12 to 18 kg, were recruited.METHODS: The bone defects near joints were established in upper femoral condyle in the 12 dogs, which were reconstructed by 3 operation styles: only filling with bone cement, filling with bone cement + autogenous ilium bone graft, and filling with bone cement + autogenous ilium bone graft + fixation with L-trapezoid compression plate. There was one dog in each method. The specimens were harvested at the end of weeks 3, 6, 12and 24, respectively, after operation. One week before specimens were harvested the fluorescent labeling was prepared; we conducted vascular perfusion of disulphine blue before the animals were executed.MAIN OUTCOME MEASURES: A series of examinations were carried out, including X-ray film, biomechanical test, intravascular perfusion and tetracycline fluorescent labeling. The bone healing, blood supply recovery and biomechanics were observed in the three groups.RESULTS: The 12 dogs all entered the result analysis. ① Results of Xray examination: Two cases of fracture occurred in experimental side at 6and 12 weeks in group Ⅰ; one case of fracture occurred in experimental side at 6 weeks in group Ⅱ. No fracture happened in group Ⅲ. ② Bone stiffness assayed with biomechanics: It decreased in experimental side as compared to control side by 67% and 70% in group Ⅰ; 66%, 76% and 46% in group Ⅱ; and 8% in group Ⅲ. ③ Specimen observation after operation: Bone formation, callus, and blood supply recovery were significantly better in group Ⅲ than in groups Ⅰ and Ⅱ at all stages.CONCLUSION: The third operation, filling with bone cement + autogenous ilium bone graft + fixation with L-trapezoid compression plate, is an ideal method of bone reconstruction. It can recover bone function, and prevent complications such as refracture and bone nonunion.