自体骨膜、肌腱包裹nHA/PA66复合材料替代腕舟骨的早期实验研究
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摘要
目的:初步探讨自体骨膜、肌腱包裹致密型纳米羟基磷灰石/聚酰胺66(nHA/PA66)复合材料形成复合体替代重建腕舟骨的可行性。
方法:36只新西兰白兔,随机分为A、B、C三组,每组12只。A组:自体骨膜、肌腱包裹致密型nHA/PA66复合材料植入组;B组:自体肌腱包裹致密型nHA/PA66复合材料植入组;C组:单纯自体肌腱球植入组。完整摘除动物双侧桡侧腕舟骨后,分别将上述三种植入物放置于腕关节桡侧腕舟骨缺损处。于术后3、6、12周,取全腕关节标本行大体观察、放射学及组织学观察,并测量腕髙率,进行统计学分析。
结果:A组植入物在3和6周时,nHA/PA66复合材料的表面即可见少量软骨母细胞;12周时,软骨母细胞数量增多,材料周缘形成类软骨组织。12周时,nHA/PA66复合材料与周缘软组织间的纤维愈着较3、6周时更为紧密。在不同时间段,均未见nHA/PA66复合材料碎裂、吸收或降解。B、C组植入物在不同时间段均未见类软骨组织在材料周缘形成,但C组腕关节标本较A、B组经大体观察和X线摄片显示腕关节高度明显丢失,塌陷明显。标本X线腕高率经统计学分析,A、B组无明显减低(P>0.05), C组有非常明显的减低(P<0.01)。
结论:自体骨膜、肌腱包裹致密型nHA/PA66复合材料形成的复合体在腕关节腔中,其表面能够化生出类软骨组织,且具有良好的抗压强度,可以用作腕舟骨替代物。
Objective: To investigate whether the composite materials of dense nano- hydroxyapatite / polyamide 66 (nHA/PA66) wrapped by autologous periosteum and tendon can reconstructe carpal scaphoid.
Methods: 36 New Zealand white rabbits were randomly divided into three groups, A, B and C, 12 rabbits per group. Group A: composite material of dense nHA/PA66 wrapped by autologous periosteum and tendon; Group B: composite material of dense nHA/PA66 wrapped by autologous tendon; Group C: autologous tendon ball alone. After bilateral carpal bones were completely removed, the above three materials were respectively implanted to replace radial carpal bone. 3,6,12 weeks after surgery, the whole wrist was collected for gross observation, radiological and histological examination,and carpometacarpal index whose data were statistically analyzed .
Results: In Group A, 3 and 6 weeks after surgery, a small amount of chondroblasts were found on the surface of the composite material of nHA/PA66; 12 weeks after surgery, chondroblasts increased and transparent cartilage formed around the material. The composite materials of nHA/PA66 were combined more closely with soft tissue around by the firbers in the twelfth week than that in the third or the sixth week. During different time periods, no composite materials of nHA/PA66 were fragmentated, absorbed or degraded. In Group B and C, no transparent cartilage was found around the implants during different periods, but the gross observation and radiological examination showed that the cartilage in wrists lost obviously and the wrists collapsed significantly in Group C more that those in Group A and B.The statistical analysis of sample with carpometacarpal index,A,B group had no significantly lower(P>0.05), C group had significantly lower(P<0.01).
Conclusion: That autologous periosteum and tendon wrapping dense nHA/PA66 cound form composite materials in the wrist joint cavity; hyaline-like cartilage could form on their surface, and the materials were so strong that they could be used to replace scaphoid bones .
方法:36只新西兰白兔,随机分为A、B、C三组,每组12只。A组:自体骨膜、肌腱包裹致密型nHA/PA66复合材料植入组;B组:自体肌腱包裹致密型nHA/PA66复合材料植入组;C组:单纯自体肌腱球植入组。完整摘除动物双侧桡侧腕舟骨后,分别将上述三种植入物放置于腕关节桡侧腕舟骨缺损处。于术后3、6、12周,取全腕关节标本行大体观察、放射学及组织学观察,并测量腕髙率,进行统计学分析。
结果:A组植入物在3和6周时,nHA/PA66复合材料的表面即可见少量软骨母细胞;12周时,软骨母细胞数量增多,材料周缘形成类软骨组织。12周时,nHA/PA66复合材料与周缘软组织间的纤维愈着较3、6周时更为紧密。在不同时间段,均未见nHA/PA66复合材料碎裂、吸收或降解。B、C组植入物在不同时间段均未见类软骨组织在材料周缘形成,但C组腕关节标本较A、B组经大体观察和X线摄片显示腕关节高度明显丢失,塌陷明显。标本X线腕高率经统计学分析,A、B组无明显减低(P>0.05), C组有非常明显的减低(P<0.01)。
结论:自体骨膜、肌腱包裹致密型nHA/PA66复合材料形成的复合体在腕关节腔中,其表面能够化生出类软骨组织,且具有良好的抗压强度,可以用作腕舟骨替代物。
Objective: To investigate whether the composite materials of dense nano- hydroxyapatite / polyamide 66 (nHA/PA66) wrapped by autologous periosteum and tendon can reconstructe carpal scaphoid.
Methods: 36 New Zealand white rabbits were randomly divided into three groups, A, B and C, 12 rabbits per group. Group A: composite material of dense nHA/PA66 wrapped by autologous periosteum and tendon; Group B: composite material of dense nHA/PA66 wrapped by autologous tendon; Group C: autologous tendon ball alone. After bilateral carpal bones were completely removed, the above three materials were respectively implanted to replace radial carpal bone. 3,6,12 weeks after surgery, the whole wrist was collected for gross observation, radiological and histological examination,and carpometacarpal index whose data were statistically analyzed .
Results: In Group A, 3 and 6 weeks after surgery, a small amount of chondroblasts were found on the surface of the composite material of nHA/PA66; 12 weeks after surgery, chondroblasts increased and transparent cartilage formed around the material. The composite materials of nHA/PA66 were combined more closely with soft tissue around by the firbers in the twelfth week than that in the third or the sixth week. During different time periods, no composite materials of nHA/PA66 were fragmentated, absorbed or degraded. In Group B and C, no transparent cartilage was found around the implants during different periods, but the gross observation and radiological examination showed that the cartilage in wrists lost obviously and the wrists collapsed significantly in Group C more that those in Group A and B.The statistical analysis of sample with carpometacarpal index,A,B group had no significantly lower(P>0.05), C group had significantly lower(P<0.01).
Conclusion: That autologous periosteum and tendon wrapping dense nHA/PA66 cound form composite materials in the wrist joint cavity; hyaline-like cartilage could form on their surface, and the materials were so strong that they could be used to replace scaphoid bones .
引文
[1]Gutierrez G. Office management of scaphoid fractures. Phys Sports Med.1996;24:60~70.
[2]Scott P.Steinmann Adams.Scaphoid fractures and nonunions:diagnosis and treatment. J Orthop Sci 2006,11:424~431.
[3]Schubert HE. Scaphoid fracture. Review of diagnostic tests and treatment. Can Fam Physician. 2000,46:1825~32.
[4]W Roolker. M.Maas. A.H. Broekhuizen. Diagnosis and treatment of scaphoid fractures, can non-union be prevented? Arch Orthop Trauma Surg.1999,119:428~431.
[5]卢世璧,杨贵勇,王继芳等.在连续被动活动作用下自体骨膜游离移植修复髋、膝关节软骨大面积缺损的临临床应用中华骨科杂志,1996;16(8):475
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[7]Goldfarb CA, Stern PJ, Kiefhaber TR. Palmar midcarpal instability: the results of treatment with four-corner arthrodesis. J Hand Surg 2004;29(2):258~63.
[8]Kobza PE, Budoff JE, Yeh ML. Management of the scaphoid during four-corner fusion-a cadaveric study. J Hand Surg 2003;28(6):904~9.
[9]Krakauer JD, Bishop AT, Cooney WP. Surgical treatment of scapholunate advanced collapse. J Hand Surg 1994;19(5):751~9.
[10]Tomaino MM, Miller RJ, Cole I, Burton RI. Scapholunate advanced collapse wrist: proximal row carpectomy or limited wrist arthrodesis with scaphoid excision? J Hand Surg 1994;19A:134~42.
[11]Swanson AB.Flexible implant arthroplasty for arthritic disabilities of the radiocarpal joint.A silicone rubbe rintmmedullary stemmed flexible implant for the wrist joint.Orthop Clin North Am .1973,4:383-394.
[12]Schil S,Thabe H,Mohr W.Handchir Plast Chir,2001;33(3):198～206
[13]Hollier LH,Boulas J Semin Arthoplasty,1997,8(4):180～184
[14] Adans BD.Orthopedics,2004;27(3):278～284
[15] Kleinert JM, Stern PJ, Lister GD, et al. Complications of scaphoid silicone
[16]Swanson AB, de Groot Swanson G, DeHeer DH, et al. Carpal bone titanium implant arthroplasty. 10 years' experience. Clin Orthop Relat Res. 1997 Sep;(342):46-58.
[17]Huang JI, Durbhakula MM, Angele P, et al. Lunate arthroplasty with autologous mesenchymal stem cells in a rabbit model. J Bone Joint Surg Am. 2006 Apr;88(4):744-52.
[18]Carroll RE. Long term review of fascial replacement after excision of the carpal lunate bone.Clin Orthop Relat Res.1997,(342):59-63
[19]黄伟,桥诘博行,永山则之.腕舟骨的腱球置换术.中华手外科杂志, 2006, 22(4): 226-228
[20]Livesey JP,Norris SH,Page RE.First carpometacarpal joint arthritis:a comparison of two arthroplasty technique.J Hand Surg.1996,2l:l82~l88
[21]Kadiyala RK,Gelberm an RH.Radiographic assessment of the trapezial space before and after ligament reconstruction and tendon interposition arthroplasty.J Hand Surg(Br).1996,21:177~181
[22]Horita k., Ikuta Y, Murakami K, et al. An experimental study on the bone-core tendon ball replacement for the treatment of Kienbock's disease. J Jpn Sco Surg Hand. 1990;7(4):767-71
[23]Oda M, Hashizume H, Miyake T, Inoue H, Nagayama N. A stress distribution analysis of a ceramic lunate replacement for Kienbock's disease. J Hand Surg [Br]. 2000 Oct;25 (5):492-8
[24]李春梅,王桂芝,王禹增,王春祯.自体骨肌腱腱膜团填塞治疗月骨缺血性坏死,中国骨与关节损伤杂志。2 0 0 8年2月第2 3卷第2期
[25]Sakai A, Toba N, Oshige T, et al. Kienb?ck disease treated by excisional arthroplasty with a palmaris longus tendon ball: a comparative study of cases with or without bone core. Hand Surg. 2004 Dec;9(2):145-9
[26]Wang XJ,Li YB. Development of composites nano-hydroaptite and polyamide as a bone substite.Chin J Biomed Eng,2001,10:199-203
[27]盂纯阳,安洪,蒋电明.新型骨关节修复重建复合材料(n-HA/PA66)的生物活性及近期对机体钙磷代谢的影响.中国骨与关节损伤杂志.2005,20:34-36
[28]蒋电明,权正学,黄伟,欧云生,倪卫东,梁熙,孟纯阳.纳米羟基磷灰石/聚酰胺66复合生物活性人工椎板的初步临床应用[J].中国修复重建外科杂志, 2007, 21(5): 441-4
[29]王仁崇,黄伟,甘强,蒋电明,钦斌,聂茂.腕舟骨芯假体的受力分析研究.重庆医学, 2008, 37(19): 2138-2141
[30]朱建民,金宗达.细胞因子在骨形成和骨吸收中的作用.中华外科杂志, 1993, 31(8): 504-507
[31]胡成栋,张伯勋,邵新中等.四种复合体体内成骨及成软骨后重建月骨缺血性坏死的实验.中国临床康复, 2005, 9(14): 32-33
[32]孟钊,田利军,邵新中.自体骨膜包裹肌腱-松质骨匀浆作为月骨替代物的对比研究.中华手外科杂志, 2001, 17(3): 169-171
[1] Meder JF,Chiros J,Roland J,et a1.Venous territories of the brain[J].J Neuroadiol,1994,21(2):118—133.
[2]胥少汀,葛宝丰,徐印坎.实用骨科学[M].第三版,北京:人民军医出版社,2006:460-466
[3] Sauerbier M ,Bickert B,Trankle M .et a1.Surgical treatment possibilities of advanced carpal collapse(SNAC/SLAC wrist).U~allchlrurg,2000.103:564-571.
[4] Neviaser RJ.Proximal row carpectomy for posttraumatic disorders of the carpus[J].Journal of Hand Surgery,1992,3:301—305
[5] Allende BJ . Osteoarthritis of wrist secondary to nonunion of the scaphoid[J].International Orthopaedics,1996,12:201—211
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[17]Kauer JM.Functional anatomy of the wrist.Clin Orthop,1980;149(6):9
[18]Krakauer JD,Bishop AT,Cooney WP.Surgical treatment of scapholunate advanced collapse J Hand Surg(Am),1994;19(5):751
[19]Calandruccio JH,Goldforb MD,Capitolunate arthrodesis with scaphoid and triquturm excision[ J], J Hand Surg(Am)J,2002;25(5):824-832
[20]Swanson AB.Flexible implant arthroplasty for arthritic disabilities of the radiocarpal joint.A silicone rubbe rintmmedullary stemmed flexible implant for the wrist joint.Orthop Clin North Am .1973,4:383-394.
[21]Schil S,Thabe H,Mohr W.Handchir Plast Chir,2001;33(3):198～206
[22]Hollier LH,Boulas J Semin Arthoplasty,1997,8(4):180～184
[23] Adans BD.Orthopedics,2004;27(3):278～284
[24] Kleinert JM, Stern PJ, Lister GD, et al. Complications of scaphoid siliconearthroplasty. J Bone Joint Surg Am. 1985 Mar;67(3):422-7
[25]Swanson AB, de Groot Swanson G, DeHeer DH, et al. Carpal bone titanium implant arthroplasty. 10 years' experience. Clin Orthop Relat Res. 1997 Sep;(342):46-58.
[26]Swanson AB, de Groot Swanson G, DeHeer DH, Pierce TD, Randall K, Smith JM, Van Gorp CC. Carpal bone titanium implant arthroplasty. 10 years' experience[J]. Clin Orthop,1997,Sep,(342):46~58
[27]Hom S,Ruby LK, Attempted scapholunate arthrodesis for chronic scapholunate disscociation.J Hand Surg(Am),1991;16(2):334
[28]Siegel JM,Ruby LK,Midcarpal arthrodesis J Hand Surg(Am),1996;12(2):179
[29]Krakauer JD,Bishop AT,Cooney WP.Surgical treatment of scapholunate advanced collapse J Hand Surg(Am),1994;19(5):751
[30]weiss,A.C.,Wiedeman,G.Jr.et al:Upper extremity function following wrist arthrodesis.J hand Surg,20:813,1995
[31]黄伟,桥诘博行,永山则之.腕舟骨的腱球置换术[J].中华手外科杂志2006年,8月第22卷,第4期
[2]Scott P.Steinmann Adams.Scaphoid fractures and nonunions:diagnosis and treatment. J Orthop Sci 2006,11:424~431.
[3]Schubert HE. Scaphoid fracture. Review of diagnostic tests and treatment. Can Fam Physician. 2000,46:1825~32.
[4]W Roolker. M.Maas. A.H. Broekhuizen. Diagnosis and treatment of scaphoid fractures, can non-union be prevented? Arch Orthop Trauma Surg.1999,119:428~431.
[5]卢世璧,杨贵勇,王继芳等.在连续被动活动作用下自体骨膜游离移植修复髋、膝关节软骨大面积缺损的临临床应用中华骨科杂志,1996;16(8):475
[6]张伯勋,陶笙,卢世壁.自体骨膜碎片血肿内植入修复骨缺损.军医进修学院学报,1996,17 (3):157
[7]Goldfarb CA, Stern PJ, Kiefhaber TR. Palmar midcarpal instability: the results of treatment with four-corner arthrodesis. J Hand Surg 2004;29(2):258~63.
[8]Kobza PE, Budoff JE, Yeh ML. Management of the scaphoid during four-corner fusion-a cadaveric study. J Hand Surg 2003;28(6):904~9.
[9]Krakauer JD, Bishop AT, Cooney WP. Surgical treatment of scapholunate advanced collapse. J Hand Surg 1994;19(5):751~9.
[10]Tomaino MM, Miller RJ, Cole I, Burton RI. Scapholunate advanced collapse wrist: proximal row carpectomy or limited wrist arthrodesis with scaphoid excision? J Hand Surg 1994;19A:134~42.
[11]Swanson AB.Flexible implant arthroplasty for arthritic disabilities of the radiocarpal joint.A silicone rubbe rintmmedullary stemmed flexible implant for the wrist joint.Orthop Clin North Am .1973,4:383-394.
[12]Schil S,Thabe H,Mohr W.Handchir Plast Chir,2001;33(3):198～206
[13]Hollier LH,Boulas J Semin Arthoplasty,1997,8(4):180～184
[14] Adans BD.Orthopedics,2004;27(3):278～284
[15] Kleinert JM, Stern PJ, Lister GD, et al. Complications of scaphoid silicone
[16]Swanson AB, de Groot Swanson G, DeHeer DH, et al. Carpal bone titanium implant arthroplasty. 10 years' experience. Clin Orthop Relat Res. 1997 Sep;(342):46-58.
[17]Huang JI, Durbhakula MM, Angele P, et al. Lunate arthroplasty with autologous mesenchymal stem cells in a rabbit model. J Bone Joint Surg Am. 2006 Apr;88(4):744-52.
[18]Carroll RE. Long term review of fascial replacement after excision of the carpal lunate bone.Clin Orthop Relat Res.1997,(342):59-63
[19]黄伟,桥诘博行,永山则之.腕舟骨的腱球置换术.中华手外科杂志, 2006, 22(4): 226-228
[20]Livesey JP,Norris SH,Page RE.First carpometacarpal joint arthritis:a comparison of two arthroplasty technique.J Hand Surg.1996,2l:l82~l88
[21]Kadiyala RK,Gelberm an RH.Radiographic assessment of the trapezial space before and after ligament reconstruction and tendon interposition arthroplasty.J Hand Surg(Br).1996,21:177~181
[22]Horita k., Ikuta Y, Murakami K, et al. An experimental study on the bone-core tendon ball replacement for the treatment of Kienbock's disease. J Jpn Sco Surg Hand. 1990;7(4):767-71
[23]Oda M, Hashizume H, Miyake T, Inoue H, Nagayama N. A stress distribution analysis of a ceramic lunate replacement for Kienbock's disease. J Hand Surg [Br]. 2000 Oct;25 (5):492-8
[24]李春梅,王桂芝,王禹增,王春祯.自体骨肌腱腱膜团填塞治疗月骨缺血性坏死,中国骨与关节损伤杂志。2 0 0 8年2月第2 3卷第2期
[25]Sakai A, Toba N, Oshige T, et al. Kienb?ck disease treated by excisional arthroplasty with a palmaris longus tendon ball: a comparative study of cases with or without bone core. Hand Surg. 2004 Dec;9(2):145-9
[26]Wang XJ,Li YB. Development of composites nano-hydroaptite and polyamide as a bone substite.Chin J Biomed Eng,2001,10:199-203
[27]盂纯阳,安洪,蒋电明.新型骨关节修复重建复合材料(n-HA/PA66)的生物活性及近期对机体钙磷代谢的影响.中国骨与关节损伤杂志.2005,20:34-36
[28]蒋电明,权正学,黄伟,欧云生,倪卫东,梁熙,孟纯阳.纳米羟基磷灰石/聚酰胺66复合生物活性人工椎板的初步临床应用[J].中国修复重建外科杂志, 2007, 21(5): 441-4
[29]王仁崇,黄伟,甘强,蒋电明,钦斌,聂茂.腕舟骨芯假体的受力分析研究.重庆医学, 2008, 37(19): 2138-2141
[30]朱建民,金宗达.细胞因子在骨形成和骨吸收中的作用.中华外科杂志, 1993, 31(8): 504-507
[31]胡成栋,张伯勋,邵新中等.四种复合体体内成骨及成软骨后重建月骨缺血性坏死的实验.中国临床康复, 2005, 9(14): 32-33
[32]孟钊,田利军,邵新中.自体骨膜包裹肌腱-松质骨匀浆作为月骨替代物的对比研究.中华手外科杂志, 2001, 17(3): 169-171
[1] Meder JF,Chiros J,Roland J,et a1.Venous territories of the brain[J].J Neuroadiol,1994,21(2):118—133.
[2]胥少汀,葛宝丰,徐印坎.实用骨科学[M].第三版,北京:人民军医出版社,2006:460-466
[3] Sauerbier M ,Bickert B,Trankle M .et a1.Surgical treatment possibilities of advanced carpal collapse(SNAC/SLAC wrist).U~allchlrurg,2000.103:564-571.
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