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家兔骨延長術(shù)中固定剛度對骨愈合的影響

Effect of fixation stiffness on fracture healing inrabbit bone lengthening

作者: 王德龍  劉志成 
單位:首都醫(yī)科大學生物醫(yī)學工程學院(北京<p>100069)&nbsp;</p><p></p>
關鍵詞: 骨延長術(shù);固定剛度;愈合;骨痂;應力刺激 
分類號:R318.01
出版年·卷·期(頁碼):2017·36·5(488-494)
摘要:

目的 探討家兔骨延長術(shù)中固定剛度對骨痂生長和骨愈合的作用效果,為臨床骨延長術(shù)選擇最佳固定剛度提供參考依據(jù)。方法 在骨延長動物模型截骨愈合的過程中,對模型動物使用外固定架固定。通過改變克氏針的直徑(1.0mm和1.5mm),獲得不同的固定剛度。截骨愈合后獲取骨痂的HE染色片、X線平片、患肢與健肢負重力比值等,用自主開發(fā)的軟件計算患足的側(cè)位X線片上最弱截面與最強截面的慣性矩比值,計算正位X線片的骨痂總面積,分析這些參數(shù)與所采取的固定剛度的關系,描述不同的固定剛度對于骨痂形成及骨愈合所產(chǎn)生的作用效果。結(jié)果 截骨后,隨著治療時間的延續(xù),患肢的側(cè)位X片上最弱截面與最強截面的慣性矩比值先下降到0.15±0.10,隨后逐漸上升到0.44±0.12;患肢與健肢負重力比值由0.49±0.04逐漸上升到0.81±0.06;正位X線片骨痂總面積由80.03mm2±50.04mm2逐漸上升到134.81 mm2±39.73mm2。上述三項指標,在1.0mm和1.5mm直徑克氏針固定組之間的差異均沒有統(tǒng)計學意義。兩組動物X線片骨痂總面積測量結(jié)果顯示,1.0mm克氏針固定組骨痂面積稍大于1.5mm克氏針固定組;兩組動物的骨標本HE染色結(jié)果顯示,1.0mm克氏針固定組新生骨組織活躍程度比1.5mm克氏針固定組稍強。結(jié)論 使用1.0mm和1.5mm克氏針都能夠使截骨端愈合;兩種固定剛度對患肢的側(cè)位X線片上最弱截面與最強截面的慣性矩比值、患肢與健肢負重力比值的影響沒有統(tǒng)計學意義;使用1.0mm克氏針固定可以使截骨端產(chǎn)生更多的骨痂,增強新生骨組織的活躍程度。

Objective To discuss the ffect of fixation stiffness on fracture healing in rabbit bone lengthening,provide technical criterion and guidance for selecting the best fixation stiffness during the clinical bone lengthening. Methods During healing of bone lengthening,the model animals were fixed with external fixators. The different fixation stiffness were achieved by varying the diameters of the Kirschner pins (1.0mm and 1.5mm). The HE staining of the callus,X-ray images,and the load ratios of the treated leg to the control foot were obtained after healing. Ratios of the minimum to the maximum of equivalent bending moments of inertia on the lateral X-ray images were calculated with Self-developed software,and the total areas of the callus of the anteroposterior X-ray images were calculated. Finally,the relationship between these parameters and the fixation stiffness was analysis, and the effect of callus formation and fracture healing caused by different fixation stiffness was described. Results After the osteotomy,with the duration of treatment,the ratios of the moment of inertia of the equivalent weakest interface to the equivalent strongest interface on the lateral X-ray of the treated leg was reduced to 0.15±0.10,then gradually increased to 0.44±0.12. The load ratio of the treated leg to the control leg was increased from 0.49±0.04 to 0.81±0.06. The total area of the callus of the anteroposterior X-ray was gradually increased from 80.03mm2±50.04mm2 to 134.81mm2±39.73mm2. There were no statistically significant differences between the 1.0mm and 1.5mm diameter Kirschner fixation groups on the above three indicators.The total area of callus of the two groups showed callus area of 1.0mm Kirschner wire fixation group was slightly larger than 1.5mm Kirschner wire fixation group. The HE staining results of bone specimens of two groups showed that the activity of newborn bone tissue of 1.0mm Kirschner wire fixed group was slightly stronger than that in the 1.5mm Kirschner fixation group. Conclusions Both 1.0mm and 1.5mm Kirschner wires can heal the osteotomy end. The ratios of the moment of inertia of the equivalent weakest interface to the equivalent strongest interface on the lateral X-ray of the treated leg,and the load ratio of the treated leg to the control leg are no statistically significant differences between the two fixation groups. Using 1.0mm Kirschner wire fixation can make the osteotomy end produce more callus,and enhance the activity of new bone tissue. 

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