中国修复重建外科杂志

中国修复重建外科杂志

仿生矿化胶原人工骨在兔脊柱后外侧融合中的应用研究

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目的探讨仿生矿化胶原人工骨以及复合自体骨髓对兔脊柱后外侧融合模型的骨修复和再生效果。方法20 周龄普通级雄性新西兰大白兔 27 只,采用电毛刺剥离横突并暴露松质骨的方法制备兔 L5、L6 节段脊柱后外侧融合模型。随机分为 3 组,每组 9 只。A、B、C 组分别于每处骨缺损处植入 1.5 mL 自体髂骨、1.5 mL(30 mm×10 mm×5 mm)单纯骼金人工骨修复材料和 1.5 mL(30 mm×10 mm×5 mm)骼金人工骨修复材料复合兔自体骨髓(按 1∶1 比例混合)。术后 4、8、12 周采用手触法观察植骨区表观硬度来判断植骨融合情况;各时间点每组各处死 3 只动物,切取椎体标本,采用 X 线片观察骨缺损修复和融合情况,三维 CT 检查评价新生骨是否在体内形成;并将各时间点标本切片行 HE 染色观察新生骨形成及骨缺损修复和融合情况。结果手触法检测示,术后 4 周各组均未发现明显植骨融合情况;术后 8 周 A、B、C 组分别有 3 只(50.0%)、2 只(33.3%)、4 只(66.7%)达植骨融合,12 周分别有 5 只(83.3%)、4 只(66.7%)、5 只(83.3%)达植骨融合,C 组融合率与 A 组相似,且均高于 B 组。X 线片观察示 C 组术后 8、12 周的融合率高于 B 组,与 A 组相似。三维 CT 观察示 C 组比 B 组的骨融合效果更佳,接近 A 组。HE 染色示,术后 12 周 A、B、C 组的植骨区域均出现大面积成熟板层骨覆盖,材料已完全降解,与宿主骨边缘界限消失且结合紧密。结论仿生矿化胶原人工骨复合自体骨髓具有良好的骨诱导性和成骨引导作用,与单纯仿生矿化胶原人工骨材料相比有更好、更快的成骨效果,接近自体骨移植。

ObjectiveTo investigate the bone repair and regeneration abilities of biomimetic mineralized collagen bone graft material and autologous bone marrow in rabbit posterolateral spinal fusion model.MethodsTwenty-seven 20-week-old male New Zealand white rabbits were used to establish the posterolateral spinal fusion model of L5 and L6 segments by stripping the transverse process and exposing cancellous bone with electric burr. The rabbits were randomly divided into 3 groups, 9 in each group. Groups A, B, and C were implanted 1.5 mL autologous iliac bone, 1.5 mL (30 mm×10 mm×5 mm) biomimetic mineralized collagen bone graft material, and 1.5 mL (30 mm×10 mm×5 mm) biomimetic mineralized collagen bone graft material and autologous bone marrow in each bone defect. At 4, 8, and 12 weeks after operation, the apparent hardness of the bone grafting area was observed by manipulation method, in order to evaluate bone graft fusion effects. Three animals were sacrificed in each group at each time point, the vertebral body specimens were excised and the bone defect repair and fusion were observed by X-ray films, and three-dimensional CT examination was performed to evaluate whether new bone was formed in the body. HE staining was performed at each time point to observe the formation of new bone and the repair and fusion of bone defects.ResultsThe manipulation test showed that bone graft fusion was not found in all groups at 4 weeks after operation; 3 (50.0%), 2 (33.3%), and 4 (66.7%) of groups A, B, and C reached bone graft fusion at 8 weeks after operation; 5 (83.3%), 4 (66.7%), and 5 (83.3%) of groups A, B, and C reached bone graft fusion at 12 weeks after operation; the fusion rate of group C was similar to that of group A, and all higher than that of group B. X-ray film observation showed that the fusion rate of group C at 8 and 12 weeks after operation was higher than that of group B, which was similar to group A. Three-dimensional CT observation showed that the degree of bone fusion in group C was better than that in group B, which was close to group A. HE staining observation showed that large area of mature lamellar bone coverage appeared in the bone graft area of groups A, B, and C at 12 weeks after operation, the material was completely degraded, and the marginal boundary of the host bone disappeared and tightly combined.ConclusionBiomimetic mineralized collagen bone graft material mixed with autologous bone marrow has good osteoinduction and osteogenesis guidance. Compared with biomimetic mineralized collagen bone graft material, it has better and faster osteogenesis effect, which is close to autologous bone transplantation.

关键词: 矿化胶原; 骨髓; 脊柱融合; 骨诱导;

Key words: Mineralized collagen; bone marrow; spinal fusion; osteoinductivity; rabbit

引用本文: 宋天喜, 胡艳丽, 崔云, 何志敏, 朱金亮, 王秀梅, 仇志烨. 仿生矿化胶原人工骨在兔脊柱后外侧融合中的应用研究. 中国修复重建外科杂志, 2018, 32(9): 1137-1143. doi: 10.7507/1002-1892.201804119 复制

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