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家兔骨延长术中固定刚度对骨愈合的影响

Effect of fixation stiffness on fracture healing inrabbit bone lengthening

作者: 王德龙  刘志成 
单位:首都医科大学生物医学工程学院(北京<p>100069)&nbsp;</p><p></p>
关键词: 骨延长术;固定刚度;愈合;骨痂;应力刺激 
分类号:R318.01
出版年·卷·期(页码):2017·36·5(488-494)
摘要:

目的 探讨家兔骨延长术中固定刚度对骨痂生长和骨愈合的作用效果,为临床骨延长术选择最佳固定刚度提供参考依据。方法 在骨延长动物模型截骨愈合的过程中,对模型动物使用外固定架固定。通过改变克氏针的直径(1.0mm和1.5mm),获得不同的固定刚度。截骨愈合后获取骨痂的HE染色片、X线平片、患肢与健肢负重力比值等,用自主开发的软件计算患足的侧位X线片上最弱截面与最强截面的惯性矩比值,计算正位X线片的骨痂总面积,分析这些参数与所采取的固定刚度的关系,描述不同的固定刚度对于骨痂形成及骨愈合所产生的作用效果。结果 截骨后,随着治疗时间的延续,患肢的侧位X片上最弱截面与最强截面的惯性矩比值先下降到0.15±0.10,随后逐渐上升到0.44±0.12;患肢与健肢负重力比值由0.49±0.04逐渐上升到0.81±0.06;正位X线片骨痂总面积由80.03mm2±50.04mm2逐渐上升到134.81 mm2±39.73mm2。上述三项指标,在1.0mm和1.5mm直径克氏针固定组之间的差异均没有统计学意义。两组动物X线片骨痂总面积测量结果显示,1.0mm克氏针固定组骨痂面积稍大于1.5mm克氏针固定组;两组动物的骨标本HE染色结果显示,1.0mm克氏针固定组新生骨组织活跃程度比1.5mm克氏针固定组稍强。结论 使用1.0mm和1.5mm克氏针都能够使截骨端愈合;两种固定刚度对患肢的侧位X线片上最弱截面与最强截面的惯性矩比值、患肢与健肢负重力比值的影响没有统计学意义;使用1.0mm克氏针固定可以使截骨端产生更多的骨痂,增强新生骨组织的活跃程度。

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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