两种骨延长术式对股骨缺损修复的实验研究

发布时间：2018-07-15 13:24

【摘要】：目的通过建立兔股骨骨缺损模型，观察并对比研究两种骨延长手术方式修复骨缺损后的疗效，以选择最佳手术方案，达到缩短骨延长治疗时间的目的，进一步为临床合理选择治疗股骨骨缺损的手术方法提供理论依据。方法本实验选择41只新西兰大白兔，兔龄均在3～5个月，体重均在2.25～3.25kg，均由济南军区总医院动物实验中心提供，雌雄不限。随机抽取5只新西兰大白兔制作长度为15mm股骨骨缺损模型。术后12周后经大体观察及影像学检查，证实兔的股骨骨缺损15mm未能自行修复。证实模型制作成功后，取1只新西兰大白兔进行骨延长预实验，，摸索实验经验。再选择30只3～5个月龄的新西兰大白兔入组，随机分成两组，记为A组、B组，（A组为股骨原位延长修复术，B组为股骨近端截骨骨延长修复术），每组15只，组内编号。术后7天，骨缺损断端开始延长，A、B两组各每天牵引1mm，其延长时间为15天。术后观察并记录所有实验动物的一般情况及患肢缺损愈合情况。将所有实验动物在相同条件下饲养，预防感染并定期换药。观察伤口生长情况并及时作出处理。A、B两组于术后0天、15天、8周、12周行X线检查，观察X线下股骨骨缺损愈合情况，术后2周、8周、12周分别取标本进行组织学观察及骨密度检测，术后12周并进行生物力学有关检查，分析并比较各组骨缺损修复情况。并对各组所得数据用SPSS16.0进行分析，得出实验结论。结果 B组术后15天、8周、12周的影像学结果显示骨痂生长情况优于A组（P0.05）。随着观察时间的延长，两组骨密度值均呈现逐渐上升趋势，B组均高于A组（P0.05）。生物力学结果显示B组骨缺损区的三点弯曲静刚度、最大载荷以及扭转静刚度均高于A组（P0.05）。组织学观察结果示术后2周、6周、12周B组骨组织较A组成熟。结论 1、成功建立兔股骨骨缺损模型，12周内15mm的兔股骨骨缺损无法自行修复。 2、原位骨延长修复术与近端截骨骨延长修复术均是治疗股骨缺损的手术方法，近端骨延长术在治疗大段骨缺损方面优于原位骨延长术。
[Abstract]:Objective to establish a rabbit model of femoral bone defect, observe and compare the curative effect of two kinds of bone lengthening operation methods to repair bone defect, so as to select the best operation plan and shorten the time of bone lengthening treatment. To provide theoretical basis for the rational selection of surgical methods for the treatment of femoral bone defect. Methods 41 New Zealand white rabbits were selected in this experiment. The age of the rabbits was 3 ~ 5 months and their body weight was 2.25 ~ 3.25 kg. All of them were provided by the Animal Experimental Center of Jinan military region General Hospital. Five New Zealand white rabbits were randomly selected to make 15mm femoral bone defect model. After 12 weeks of operation, gross observation and imaging examination confirmed that 15mm of femur defect could not be repaired by itself. After the successful establishment of the model, a New Zealand white rabbit was selected for bone lengthening experiment and the experimental experience was explored. Thirty New Zealand white rabbits aged from 3 to 5 months were randomly divided into two groups: group A, group B, group, (A, group B, lengthening and repairing proximal femur osteotomy, group B (n = 15, group A, n = 15, n = 15). 7 days after operation, the bone defect was lengthened by 1 mm in each group, and the lengthening time was 15 days. All experimental animals were observed and recorded after operation. Keep all laboratory animals under the same conditions to prevent infection and change medicine regularly. The wound growth was observed and treated in time. The X-ray examination was performed at 15 days and 8 weeks to 12 weeks after operation, and the healing of femoral bone defect was observed. The specimens were taken from 2 weeks to 12 weeks after operation for histological observation and bone mineral density detection. At 12 weeks after operation, biomechanical examination was performed to analyze and compare the repair of bone defects in each group. The data of each group were analyzed by SPSS 16.0, and the experimental results were obtained. Results the imaging results showed that the callus growth in group B was better than that in group A (P 0.05). With the prolongation of observation time, the bone mineral density of both groups showed a trend of increasing gradually. Group B was higher than group A (P0.05). Biomechanical results showed that the three-point bending static stiffness, maximum load and torsional static stiffness of bone defect in group B were higher than those in group A (P0.05). Histological observation showed that the bone tissue of group B was more mature than that of group A at 2 weeks and 12 weeks after operation. Conclusion 1. The rabbit femur bone defect caused by 15mm could not be repaired by itself within 12 weeks after successful establishment of rabbit femoral bone defect model. (2) both in situ bone lengthening and proximal osteotomy were the operative methods for the treatment of femoral defect. Proximal bone lengthening is superior to in situ bone lengthening in the treatment of large bone defects.
【学位授予单位】：泰山医学院
【学位级别】：硕士
【学位授予年份】：2012
【分类号】：R-332;R687.3

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