自体骨膜包裹肌腱复合松质骨匀浆及重组人骨形态发生蛋白2体内成骨重建月骨*

背景：月骨摘除术后选择合适的月骨替代物填充遗留的空隙,是维护腕关节生物力学特性和良好功能的关键。目的：探讨自体骨膜包裹肌腱复合重组人骨形态发生蛋白2(recombinant human bone morphogenetic protein-2,rhBMP-2)与松质骨匀浆植入自体关节腔后的成骨和骨化机制,以及作为月骨替代物重建月骨的可行性。方法：按随机数字法将45只新西兰白兔分成3组：骨膜包裹肌腱组、rhBMP-2组、单纯肌腱球对照组。分别以骨膜包绕肌腱团,1 mg rhBMP-2与游离肌腱、肌腱团块置入兔髌上囊。置入后3,6和9周取材,测量定量CT骨密度值,组织切片采用苏木精-伊红染色和免疫组织化学ABC法,在光镜下观察rhBMP-2分布。结果与结论：移植物植入后,早期骨膜包裹肌腱组rhBMP-2染色阴性,9周时阳性,之后呈阴性,表明其骨化形成主要是在骨膜成软骨作用基础上的成骨过程,而无rhBMP-2的作用;rhBMP组显示rhBMP-2分布及骨化明显强于骨膜包裹肌腱组,且随时间延长逐渐加强,9周时呈强阳性,主要分布于新生骨细胞簇和新生软骨细胞簇及周围,之后随骨细胞成熟量增多而逐渐减弱。单纯肌腱球对照组玻璃样变,最终呈胶原状rhBMP-2染色始终阴性。各组各时间点定量CT骨密度值经统计学分析,除3周时骨膜包裹肌腱组、单纯肌腱对照组间无显著性差异(P > 0.05),其余各组间差异均有显著性意义(P < 0.01)。自体骨膜包裹肌腱复合rhBMP-2及松质骨匀浆植入物在骨rhBMP-2及松质骨匀浆中rhBMP-2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。关键词：月骨;骨膜;重组人骨形态发生蛋白2;松质骨匀浆;修复重建

Reconstruction of lunar bone using autologous periosteum-wrapped tendon, spongiosa homogenate and recombinant human bone morphogenetic protein-2

BACKGROUND: Selection of optimal substitute to fill the gaps following lunar bone enucleation plays a key role in maintaining biomechanical properties and good wrist joint function. OBJECTIVE: To study bone-forming mechanism of transplantation autologous periosteum-wrapped tendon, spongiosa homogenate and recombinant human bone morphogenetic protein-2 (rhBMP-2) in joint cavity, and to explore the possibility of the compound as a substitute for the lunar bone. METHODS: Forty-five New Zealand white rabbits were randomly divided into three groups: periosteum group, rhBMP-2 group and control group. The three sorts of implants were placed into articular cavity of the knee respectively. The changes of bone formation and rhBMP-2 distribution of the implants were examined under optical microscope with hematoxylin-eosin staining and immunohistochemical staining and measured by CT at 3, 6 and 9 weeks after operation. RESULTS AND CONCLUSION: The result of rhBMP-2 staining was negative after 3 weeks and positive in new cartilage cells after 9 weeks in periosteum group. The strong positive rhBMP-2 staining was observed in the composite group at 9 weeks, which mainly distributed in new bone cells and cartilage cells. And negative rhBMP-2 staining was observed every stage in control group. The quantitative CT bone mineral density values of 3 implants were analyzed, the difference was significant between the groups (P < 0.01), except that between periosteum group and control group at 3 weeks (P > 0.05). 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 rhBMP-2 in spongiosa homogenate and the compound can be considered as a preferred substitute to reconstruct lunate bone.