多孔羟基磷灰石与富血小板血浆和纤维蛋白胶复合修复骨缺损

背景：自体骨移植是治疗骨缺损的最理想方法，但来源有限，供区有一定的并发症，所以寻找自体骨的替代材料一直是骨科学领域的研究方向。目的：观察珊瑚多孔羟基磷灰石、富血小板血浆和纤维蛋白胶复合物修复骨缺损的效果。方法：在新西兰大白兔双侧前臂桡骨中段截骨1．5cm制成骨缺损模型，随机分为3组，实验组植入珊瑚多孔羟基磷灰石、富血小板血浆和纤维蛋白胶复合物，对照组植入自体骨，空白对照组未植入任何物质。结果与结论：①X射线：实验组术后12周时骨缺损基本修复，塑性完全，愈合过程与对照组同步：空白对照组骨缺损无明显变化。②组织病理学：实验组与对照组术后12周时骨缺损基本修复，出现成熟板层骨及哈佛氏管；空白对照组仅见大量成纤维细胞增生，未见骨质形成。③生物力学：术后2周时实验组最大扭矩和抗扭刚度优于对照组（P〈0．05），术后12周时两组最大扭矩和抗扭刚度差异无显著性意义。表明珊瑚多孔羟基磷灰石、富血小板血浆和纤维蛋白胶复合物具有促骨质愈合的作用，甚至在术后早期修复骨缺损的效果优于自体骨。

Compound of porous hydroxyapatite, platelet-rich plasma and fibrin glue in the treatment of bone defects

BACKGROUND： Autogenous bone graft is the best way to treat bone defects, but its limited sources and donor site complications restrain its clinical application. Therefore, to develop a substitute material has been a hotspot in the orthopedics. OBJECTIVE： To investigate the feasibility and effectiveness of the compound of coralline hydroxyapatite porous platelet-rich plasma and fibrin glue acting as a bone substitute material for repair of bone defects. METHODS： 1.5 cm radial segments from the bilateral forearms of New Zealand white rabbits were removed to prepare bone defect models. Then, bone defect models were randomly divided into a compound group （coralline hydroxyapatite porous, platelet-rich plasma and fibrin glue）, control group treated with autogenous bone graft, and blank group without implantation. RESULTS AND CONCLUSION： （1） X-ray observation： Bone defects were repaired completely in the compound group till the end of postoperative week 12, appearing with complete plasticity. The healing process in the compound group was synchronized with that in the control group. However, there were no changes in bone defects of the blank group. （2） Histopathological examination： Bone repair basically completed in the compound and control groups at week 12 after operation, presenting with mature lamellar bone and Haversian canals. In the blank group, only a great amount of fibroblasts proliferated, but no bone formed. （3） Biomechanical analysis： The maximum torque and torsional stiffness of the compound group were better than those of the control group at 2 weeks postoperation （P 〈 0.05）. However, there was no significant difference between the maximum torque and torsional stiffness of the compound and control groups. These results demonstrate that the compound of coralline hydroxyapatite porous, platelet-rich plasma and fibrin glue acting as a bone substitute is superior to autologous bone in the early repair of bone defects, which is beneficial to bone healing.