富血小板血浆和脱钙骨基质促进牵拉成骨矿化过程的实验研究

目的观察局部植入富血小板血浆(platelet-rich plasma,PRP)复合脱钙骨基质(decalcified bone matrix,DBM)是否具有协同作用加速牵拉成骨矿化过程,促进骨愈合。方法健康雄性新西兰大白兔40只,体重2.2～2.8 kg,随机分为4组,每组10只。于兔耳中央动脉取血采用Landesberg法制备PRP。于兔左胫骨胫腓关节下制备1 cm骨缺损模型。A组为对照组,行牵拉成骨1 cm;B组:植入0.5 cm长DBM并牵拉成骨0.5 cm;C组:牵拉成骨1 cm加局部注射PRP 1 mL;D组:植入0.5 cm长复合1 mL PRP的DBM并牵拉成骨0.5 cm。术后7 d开始延长,每天2次,每次0.5 mm;A、C组延长10 d,B、D组延长5 d。延长结束后进入矿化期。术后0、12、17、27、37 d摄X线片观察新生骨矿化过程;术后37 d处死实验动物,完整切取胫骨行Micro-CT扫描及三维重建,并进行生物力学测试。结果 X线片观察示术后37 d内B、C组新生骨生成情况明显优于A、D组。B、C组新生骨的骨矿物质密度(bone mineral density,BMD)、骨矿物质含量(bone mineral content,BMC)和骨体积分数(bone volume fraction,BVF)均显著高于A、D组(P<0.05);C组BMC、BMD显著高于B组(P<0.05),B、C组间BVF差异无统计学意义(P>0.05);A、D组间BMD、BMC及BVF比较差异无统计学意义(P>0.05)。C组骨小梁数量(trabecula number,Tb.N)明显多于其余各组,骨小梁间隔(trabecula spacing,Tb.Sp)小于其余各组(P<0.05);其余各组间Tb.N和Tb.Sp比较差异均无统计学意义(P>0.05)。各组骨小梁厚度比较,差异均无统计学意义(P>0.05)。生物力学测试显示,各组极限角位移比较差异均无统计学意义(P>0.05)。B、C组最大扭矩明显大于A、D组,C组大于B组,差异均有统计学意义(P<0.05);A、D组间差异无统计学意义(P>0.05)。结论 局部注射PRP可促进牵拉成骨矿化过程,加速骨缺损愈合;在正常牵拉速度下,DBM可促进牵拉成骨矿化过程;但在牵拉成骨早期植入复合PRP的DBM并未进一步加速矿化促进骨愈合。

Experimental study on promoting bone consolidation by using platelet-rich plasma and decalcified bone matrix during distraction osteogenesis

Objective To investigate whether combining use of platelet-rich plasma(PRP) and decalcified bone matrix(DBM) has synergistic action on promoting bone consolidation and healing.Methods Forty male New Zealand rabbits(weighing 2.2-2.8 kg) were randomly divided into 4 groups(n=10).The whole blood was extracted from the central aural artery and PRP was prepared with the Landesberg's method.An 1 cm-defect was made below the tibiofibular joint of the left tibia through osteotomy.In group A,defect was repaired by d...