组合式可变应力接骨板对山羊股骨骨折愈合骨组织病理及功能的影响
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摘要
目的通过应用组合式可变应力接骨板(自行研究设计)固定对山羊股骨骨折骨愈合的骨组织进行定量观察,探讨组合式可变应力接骨板固定对骨折愈合的机制。方法健康成年山羊30只,随机分为实验组和对照组,每组15只。普通环境下饲养,制作山羊右下肢股骨骨折动物模型,实验组施以组合式可变应力接骨板固定内固定,对照组采用普通直型接骨板,分别于手术后4、8、12周处死山羊,取实验股骨断端组织进行组织病理学观察。测量两组钢板下面骨皮质厚度及髓腔直径的变化,评估钢板的应力遮挡效应;测量两组骨折断端骨痂中骨小梁密度,评估骨折愈合情况;通过两组的破骨细胞计数,评估骨折愈合过程中骨痂改建情况。结果与对照组相比,实验组4、8周的骨痂中骨小梁密度较高,差异有统计学意义(P<0.05);与对照组相比,实验组8周的骨小梁周边的破骨细胞较多,差异有统计学意义(P<0.05),12周时实验组破骨细胞计数明显低于对照组,差异有统计学意义(P<0.05);4周时,两组的骨皮质厚度与髓腔直径差异无统计学意义(P>0.05),实验组4、8、12周骨皮质及髓腔直径无明显变化,差异无统计学意义(P>0.05)。对照组在治疗8、12周骨髓腔直径显著高于实验组(P<0.05),而骨皮质厚度值显著低于实验组(P<0.05)。结论组合式可变应力接骨板通过骨折断端组合钢板间的微动,使骨折断端产生正向压应力,从而减少钢板对骨的应力遮档效应,促进骨痂的生成,加快骨痂的改建,促进骨折愈合。
Objective To investigate the mechanism of combined variable stress plate in fracture healing, through bone tissue quantitative observation of combined variable stress plate(self-designed) fixed on goat femur fractures. Methods The animal model of right lower limb femur fracture was successfully constructed on 30 healthy adult goats and randomly divided into the experimental group(given with combined variable stress plate) and the control group(given with common straight steel plate). The goats were sacrificed 4 weeks, 8 weeks and 12 weeks after operation. And the partial tissues of the femur distal end were taken for observation bone tissue function and pathological changes. The changes of thickness of cortical bone and medullary cavity diameter under the plate in two groups were measured, thus to evaluate stress shielding effect of the plate. The changes of fracture trabecular bone density in two groups were evaluated for fracture healing assessment. The osteoclast count was applied to evaluate bone callus remodeling process during fracture healing. Results The trabecular bone densities of the experimental group was significantly higher than those in the control group 4 and 8 weeks after treatment(P<0.05). The osteoclasts surrounding bone trabecular of the experimental group were significantly more than those in the control group 8 weeks after treatment(P<0.05), but were significantly lower than those in the control group 12 weeks after treatment(P<0.05), suggesting that the callus remodeling in the experimental group appeared earlier, and nearly ended 12 weeks after operation. There was no significant difference in the thickness of cortical bone or medullary cavity diameter between the two groups 4 weeks after operation(P>0.05); but the cavity diameter was significantly larger in control group than that in experimental group 8 and 12 weeks after operation, while the cortical thickness was significantly lower in control group(P<0.05). And there was no significant change in thickness of cortical bone or medullary cavity diameter in the experimental group 4, 8 and 12 weeks after operation(P>0.05). The results showed that there was stress shielding effect in the control group, but not in the experimental group. Conclusion Combined variable stress plate enables the micro-movement at fracture ends, thus produces the forward compressive stress at the fracture, thereby reduces the bone stress-shielding effect and promotes the formation of callus, accelerates callus reconstruction and fracture healing.
Objective To investigate the mechanism of combined variable stress plate in fracture healing, through bone tissue quantitative observation of combined variable stress plate(self-designed) fixed on goat femur fractures. Methods The animal model of right lower limb femur fracture was successfully constructed on 30 healthy adult goats and randomly divided into the experimental group(given with combined variable stress plate) and the control group(given with common straight steel plate). The goats were sacrificed 4 weeks, 8 weeks and 12 weeks after operation. And the partial tissues of the femur distal end were taken for observation bone tissue function and pathological changes. The changes of thickness of cortical bone and medullary cavity diameter under the plate in two groups were measured, thus to evaluate stress shielding effect of the plate. The changes of fracture trabecular bone density in two groups were evaluated for fracture healing assessment. The osteoclast count was applied to evaluate bone callus remodeling process during fracture healing. Results The trabecular bone densities of the experimental group was significantly higher than those in the control group 4 and 8 weeks after treatment(P<0.05). The osteoclasts surrounding bone trabecular of the experimental group were significantly more than those in the control group 8 weeks after treatment(P<0.05), but were significantly lower than those in the control group 12 weeks after treatment(P<0.05), suggesting that the callus remodeling in the experimental group appeared earlier, and nearly ended 12 weeks after operation. There was no significant difference in the thickness of cortical bone or medullary cavity diameter between the two groups 4 weeks after operation(P>0.05); but the cavity diameter was significantly larger in control group than that in experimental group 8 and 12 weeks after operation, while the cortical thickness was significantly lower in control group(P<0.05). And there was no significant change in thickness of cortical bone or medullary cavity diameter in the experimental group 4, 8 and 12 weeks after operation(P>0.05). The results showed that there was stress shielding effect in the control group, but not in the experimental group. Conclusion Combined variable stress plate enables the micro-movement at fracture ends, thus produces the forward compressive stress at the fracture, thereby reduces the bone stress-shielding effect and promotes the formation of callus, accelerates callus reconstruction and fracture healing.
引文
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[14] Frost HM.Does the anterior crueiate have a modeling threshold A case for the affirmative[J].J Musculoskelet Neuronal Interact,2001,2(2):131-136.
[15] 李智,李玉茂,谢晓勇,等.锁定钢板外置治疗胫腓骨骨折的力学分析和临床疗效[J].海军医学杂志,2017,38(2):149-152.
[2] 刘建恒,张里程,唐佩福.骨折延迟愈合和不愈合的诊治现状[J].中华外科杂志,2015,53(6):464-467.
[3] Einhorn TA,Gerstenfeld LC.Fracture healing:mechanisms and interventions[J].Nat Rev Rheumatol,2015,11(1):45-54.
[4] 马剑雄.生物可降解Zn-ZnMg-Mg梯度合金髓内钉研制及其固定股骨干骨折愈合机理的生物力学研究[D].天津:天津大学,2015.
[5] Wirtz C,Abbassi F,Evangelopoulos DS,et al.High failure rate of trochanteric fracture osteosynthesis with proximal femoral locking compression plate[J].Injury,2013,44(6):751-756.
[6] 何忠,李开静,王强,等.桥接组合式内固定系统治疗股骨干骨折术后骨不连的临床观[J].中国现代医生,2017,55(9):91-93.
[7] 熊鹰,李群辉,柳百炼,等.桥接组合式内固定系统与锁定接骨板钉系统在股骨骨折应用中的有限元分析[J].中国组织工程研究,2012,16(30):5516-5519.
[8] 刘振东,秦泗河.骨痂的形成与分类[J].中国矫形外科杂志,2016,24(4):332-337.
[9] 范志航,熊雁,杜全印,等.新型点式接触锁定加压接骨板在治疗四肢长骨骨折中的临床应用[J].创伤外科杂志,2014,16(3):240-243.
[10] 吴刚,罗晓中,谭伦,等.锁定加压接骨板皮外固定与传统外固定支架治疗胫骨开放性骨折的疗效对比研究[J].中国修复重建外科杂志,2013,27(11):1291-1295.
[11] 赵凯,努尔波力·哈里木,杨晶,等.可吸收材料在骨折治疗中的研究进展[J].中华生物医学工程杂志,2015,21(2):192-194.
[12] 徐蕾.DLS与LS生物力学试验和有限元比较研究[D].济南:山东大学,2016.
[13] 马显志,张伯松,王满宜,等.辅助钢板治疗股骨干骨折髓内钉固定术后骨折不愈合的生物力学研究[J].中华创伤骨科杂志,2016,18(2):158-162.
[14] Frost HM.Does the anterior crueiate have a modeling threshold A case for the affirmative[J].J Musculoskelet Neuronal Interact,2001,2(2):131-136.
[15] 李智,李玉茂,谢晓勇,等.锁定钢板外置治疗胫腓骨骨折的力学分析和临床疗效[J].海军医学杂志,2017,38(2):149-152.