Objective To evaluate the effect of internal fixation on the stability of pedicled fascial flap and the osteogenesis of exceed critical size defect (ECSD) of bone so as to provide theory for the clinical application by the radiography and histology observation. Methods The ECSD model of the right ulnar midshaft bone and periosteum defect of 1 cm in length was established in 32 New Zealand white rabbits (aged 4-5 months), which were divided into group A and group B randomly (16 rabbits in each group). The composite tissue engineered bone was prepared by seeding autologous red bone marrow (ARBM) on osteoinductive absorbing material (OAM) containing bone morphogenetic protein and was used repair bone defect. A pedicled fascial flap being close to the bone defect area was prepared to wrap the bone defect in group A (control group). Titanium miniplate internal fixation was used after defect was repair with composite tissue engineered bone and pedicled fascial flap in group B (experimental group). At 2, 4, 6, and 8 weeks, the X-ray films examination, morphology observation, and histology examination were performed; and the imaging 4-score scoring method and the bone morphometry analysis was carried out. Results All rabbits survived at the end of experiment. By X-ray film observation, group B was superior to group A in the bone texture, the space between the bone ends, the radiographic changes of material absorption and degradation, osteogenesis, diaphysis structure formation, medullary cavity recanalization. The radiographic scores of group B were significantly higher than those of group A at different time points after operation (P lt; 0.05). By morphology and histology observation, group B was superior to group A in fascial flap stability, tissue engineered bone absorption and substitution rate, external callus formation, the quantity and distribution area of new cartilage cells and mature bone cells, and bone formation such as bone trabecula construction, mature lamellar bone formation, and marrow cavity recanalization. The quantitative ratio of bone morphometry analysis in the repair area of group B were significantly larger than those of group A at different time points after operation (P lt; 0.05). Conclusion The stability of the membrane structure and the bone defect area can be improved after the internal fixation, which can accelerate bone regeneration rate of the tissue engineered bone, shorten period of bone defect repair, and improve the bone quality.
【摘 要】 目的 探讨布鲁杆菌病性脊椎炎有效的外科治疗方法及临床效果。 方法 2002年1月－2010年10月，对78例具有手术指征的胸腰椎布鲁杆菌病性脊椎炎患者采用一期病灶清除联合后路椎弓根内固定治疗。男42例，女36例；年龄24～65岁，平均45岁。病程8～29个月，平均12个月。2个椎体受累70例，3个椎体受累8例。均合并不同程度神经功能损伤。术后随访行疼痛视觉模拟评分（VAS）、神经功能Frankel分级、临床疗效评价以及X线片、MRI影像学观察。 结果 术后78例均获随访，随访时间12～30个月，平均26个月。无窦道形成及复发。术前及术后1、3、6、12个月VAS评分分别为（9.2 ± 0.6）、（2.4 ± 0.3）、（1.0 ± 0.2）、（0.5 ± 0.4）及0分，术后各时间点均较术前显著改善（P lt; 0.05）。术后各时间点神经功能Frankel分级均较术前显著改善，差异均有统计学意义（P lt; 0.05），其中C、D级改善最为显著。临床疗效评价：术后12个月内均无加重患者；随时间推移，改善及无变化患者逐渐转向痊愈，术后12个月改善率和痊愈率分别为100%和91.03%。影像学评价：术前及术后1、3、6、12个月影像学盲测评价指标评分分别为（0.17 ± 0.03）、（4.11 ± 0.09）、（4.68 ± 0.04）、（4.92 ± 0.08）及5分，术后各时间点均较术前显著改善（P lt; 0.05）。 结论 一期病灶清除联合后路椎弓根内固定治疗胸腰椎布鲁杆菌病性脊椎炎，在解除疼痛、稳定脊柱、恢复神经功能及早期康复方面均有明显优势。