高能量骨折延期手术促进骨愈合的实验研究

目的研究延期手术刺激旺盛的外骨痂生长在高能量骨折中的作用,探索提升骨折愈合能力的新途径。方法取成年狗20只,随机分为ABCD四组,各组均行股骨中段线锯截骨,电凝破坏周围骨膜,制造1 cm缺损,8孔钢板固定。A组截骨14 d后行内固定,B组即时内固定,C组即时内固定,但不用电凝破坏骨膜,D组14 d后行内固定,但固定时切除骨端周围已形成的肉芽。结果狗股骨破坏骨膜制造骨缺损后,早期手术固定组无外骨痂生长,几乎无内骨痂生长,引发了萎缩性骨不连;在同样破坏骨膜制造骨缺损的情况下延期手术固定组产生了旺盛的骨痂生长,产生了稳定固定下的骨痂愈合。结论高能量骨折早期手术固定抑制外骨痂生长,容易造成骨痂生长不良的低质量愈合现象。延期手术固定可以刺激良好的外骨痂生长,改善骨折愈合能力,预防骨不连的发生。

Experimental study of high-energy fractures delayed operation in promote bone healing

Objective To study the function of the strongly stimulated external callus growth in the high-risk cases of nonunion in the delayed operation,and explore the new way to enhance bone fragment healing.Methods Twenty adult dogs were randomly divided into four groups,group A,B,C and D.Each group underwent middle femoral osteotomy using line saws,electric coagulation was used to damage the surrounding periosteum,and 1cm bone defect was made and fixed by 8-hole plate.In group A,internal plate fixation was performed after 14 days.Group B,internal plate fixation was executed immediately.Group C,immediate fixation was made,but no electric condensate was used to damage the periosteum.Group D,14 days later,internal plate fixation was performed,meanwhile,the bone callus formed surround bone-side was removed.Results After damaging the surrounding periosteum and making the bone defect of dog femur,there was almost neither external nor internal callus growth in the early surgical fixation group,which led to atrophy nonunion.However,in equal degree of the damage to bone,delayed operation fixation group had an abundant bone callus growth,engendering a stable bone callus healing.Conclusion The animal research on femoral osteotomy of the severe local damaged adult dogs showed that the early surgical fixation restrained growth of external callus and was more likely to cause poor growth and low quality of bone callus healing.However,delayed operation fixation can stimulate growth of bone callus rapidly,enhance bone fragment healing and prevent the occurrence of nonunion.