自体骨膜包裹肌腱-松质骨匀浆作为月骨替代物的对比研究

目的探讨自体骨膜包裹肌腱-松质骨匀浆植入关节腔后的骨化机制,以及作为月骨替代物治疗月骨无菌性坏死的可行性. 方法新西兰白兔45只,随机分为A(骨膜组)、B(复合体组)、C(对照组)3组,每组15只.分别于兔膝关节腔内植入骨膜包绕肌腱、骨膜包绕肌腱-松质骨匀浆及单纯肌腱球.术后3、6和9周取材,测量定量CT骨密度值,组织切片采用HE染色和免疫组织化学ABC法,在光镜下观察骨形成蛋白(bone morphogenetic protein,BMP)分布. 结果术后免疫组织化学染色显示,BMP A组3周为阴性, 9周呈阳性,主要分布于新生软骨细胞;B组3周为阳性, 9周呈强阳性, 主要分布于新生骨细胞和软骨细胞;C组始终为阴性.各组各时间点定量CT骨密度值经统计学分析,除3周时A、C组间差异无统计学意义(P＞0.05)外,其余各组间差异均有统计学意义(P＜0.01). 结论自体骨膜包裹肌腱-松质骨匀浆在骨膜及松质骨匀浆中BMP的诱导作用下可形成大量骨和软骨,有较强支撑作用,为其用作月骨替代物提供实验依据.

A COMPARISON STUDY ON AUTOLOGOUS PERIOSTEUM-WRAPPED TENDON AND SPONGIOSA HOMOGENATE AS A SUBSTITUTE FOR LUNATE

Objective To study and compare bone forming mechanism after compound of autologous periosteum wrapped tendon with spongiosa homogenate and other implants in articular cavity, and to explore the possibility of the compound as a substitute for the lunate in Kienbock's disease. Methods Forty five New Zealand white rabbits were randomly divided into three groups: periosteum group(group A, n =15), composite group(group B, n =15), and control group(group C, n =15). The three sorts of implants were placed into articular cavity of the knee respectively. The changes of bone formation and bone morphogenetic protein (BMP) distribution of the implants were examined under optical microscope with HE and immunohistochemical staining and measured by CT 3, 6 and 9 weeks after operation. Results The result of BMP staining was negative after 3 weeks and positive in new cartilage cells after 9 weeks in group A. The positive BMP staining was observed in group B after 3 weeks and 9 weeks, which mainly distributed in new bone cells and cartilage cells. And negative BMP staining was observed every stage in group C. The quantitative CT bone mineral density (BMD) values of 3 implants were analyzed, the difference was significant between the groups ( P <0.01), except that between groups A and C in the 3rd week ( P >0.05). Conclusion The above results demonstrated that the compound of autologous periosteum wrapped tendon and spongiosa homogenate can produce bone and cartilage massively under the induction of periosteum and bone forming factors such as BMP in spongiosa homogenate and the compound can be used as a substitute for the lunate.