本文選題：同種異體骨　切入點(diǎn)：大段骨缺損　出處：《新鄉(xiāng)醫(yī)學(xué)院》2015年碩士論文　論文類型：學(xué)位論文

【摘要】：1 背景在機(jī)械、工業(yè)、交通日漸發(fā)達(dá)的今天,各種高能量損傷越來(lái)越多,程度越來(lái)越復(fù)雜。小腿開放性粉碎骨折發(fā)生率最高,術(shù)后骨感染率較高,且易轉(zhuǎn)化為慢性骨感梨[1]。徹底去除感染骨段及其周圍病灶是控制感染的重要手段,但可能造成骨缺損甚至大段骨缺損,且控制局部創(chuàng)面感染往往還需經(jīng)過(guò)漫長(zhǎng)的治療過(guò)程。創(chuàng)傷后感染性大段骨缺損是骨科難題,同種異體骨用于感染性大段骨缺損的修復(fù)尚未見報(bào)道,能否將其用于感染性大段骨缺損的治療?我們?cè)O(shè)想將同種異體骨段置于體內(nèi)血供豐富的部位,使其完成再血管化,待創(chuàng)面感染徹底控制后,再將其帶血管蒂的血管化同種異體骨段移植修復(fù)骨缺損。2 目的以中國(guó)白兔為實(shí)驗(yàn)對(duì)象,將制備好的同種異體骨段置于兔血運(yùn)豐富的隱動(dòng)脈處,探索其完成再血管化的時(shí)間。3 方法3.1同種異體骨的制備選取10只中國(guó)白兔,空氣栓塞耳緣靜脈殺死白兔,按照無(wú)菌手術(shù)的方法取出兔脛骨,把周圍的肌肉及骨膜剔除,截成1.5cm長(zhǎng)度的骨段,把骨髓組織用小刮匙徹底刮除,用無(wú)菌生理鹽水清洗干凈,浸泡于10%的慶大霉素中30分鐘,用滅菌好的雙層血漿袋密封包裝,經(jīng)過(guò)輻照滅菌后,放入冰箱4。冷藏12h,-30°冷凍12h,在-80。的深低溫冰箱3周后使用,可以去除更多的抗原。3.2同種異體骨再血管化以健康成年中國(guó)白兔為研究對(duì)象。把60只白兔按隨機(jī)數(shù)字表法隨機(jī)分為兩組,其中實(shí)驗(yàn)組和對(duì)照組各30只。實(shí)驗(yàn)組把已經(jīng)準(zhǔn)備好的長(zhǎng)1.5cm的異體骨段放置在兔大腿股直肌和股內(nèi)側(cè)間隙隱動(dòng)脈處,用1.Omm.克氏針把骨段固定在股骨內(nèi)側(cè),對(duì)照組為自體的脛骨段,長(zhǎng)度和實(shí)驗(yàn)方法與實(shí)驗(yàn)組相同,術(shù)后4周,8周,12周分別從肉眼大體標(biāo)本觀察、免疫組化切片檢測(cè)血管內(nèi)皮細(xì)胞生長(zhǎng)因子(vascular endothelial growth factor,VEGF)和血管內(nèi)皮細(xì)胞中CD34蛋白表達(dá),行統(tǒng)計(jì)學(xué)處理。4結(jié)果實(shí)驗(yàn)組和對(duì)照組部分兔手術(shù)部位感染,不包括在統(tǒng)計(jì)標(biāo)準(zhǔn)內(nèi),補(bǔ)充空缺。VEGF以新生的、未成熟的血管周圍,軟骨細(xì)胞、成骨細(xì)胞以及未分化的間葉細(xì)胞周圍最多,術(shù)后4、12周,VEGF的表達(dá)量實(shí)驗(yàn)組和對(duì)照組比較無(wú)差異,8周,與對(duì)照組相比,實(shí)驗(yàn)組VEGF的表達(dá)有顯著統(tǒng)計(jì)學(xué)差異,兩組縱向比較,8周多于4、12周。CD34蛋白以哈弗管周圍的血管內(nèi)皮細(xì)胞中最明顯。術(shù)后4周,CD34陽(yáng)性血管兩組比較有顯著差異,8、12周,實(shí)驗(yàn)組與對(duì)照組比較,無(wú)顯著差異。實(shí)驗(yàn)組和對(duì)照組CD34陽(yáng)性血管8周多于4、12周。術(shù)后4周,實(shí)驗(yàn)組和對(duì)照組都有較少的纖維組織膜包裹骨段、填充髓腔,與骨段結(jié)合松散,容易剝離,骨表面無(wú)明顯吸收陷窩,出現(xiàn)光澤。術(shù)后8周,兩組骨段上的纖維組織膜變厚,與骨段結(jié)合緊密,不易分開,骨段表面不平整,有吸收陷窩,出現(xiàn)光澤。術(shù)后12周兩組骨段上包裹的纖維組織膜更厚,與骨段結(jié)合更緊密,骨表面的吸收陷窩更多,光澤更明顯。5結(jié)論兔大段同種異體脛骨段在血運(yùn)豐富的隱動(dòng)脈處8周能夠?qū)崿F(xiàn)再血管化,時(shí)間與自體骨段無(wú)明顯差異。
[Abstract]:1 background in mechanical, industrial, traffic increasingly developed today, a variety of high energy injury more and more, more and more complex. The highest incidence of open comminuted fracture, bone infection rate after operation, and is easily transformed into chronic skinny pear [1]. to remove the infection of bone and peripheral lesions is an important means to control infection may, but bone defect even large bone defect caused by wound infection, and control of local needs through the long course of treatment. After trauma infection of large bone defects is a department of orthopedics problem, allograft bone for repair of infected large bone defect has not been reported, whether it can be used for the treatment of infected bone defect? We assume the allogeneic bone in vivo and abundant blood supply parts to complete revascularization, to completely control the wound infection, then the vascular pedicled vascularized allograft bone transplantation Objective to repair bone defect.2 China rabbits, saphenous artery will be for allogeneic bone in rabbit blood prepared supplyrich, explore its completion time.3 method of revascularization of 3.1 allograft preparation select 10 China rabbit ear vein air embolism rabbits were killed, according to the method aseptic operation out of rabbit tibia, the surrounding muscle and periosteum removed, cut into bone segment length 1.5cm, the bone marrow tissue with small curette curettage, with sterile saline washed, soaked in 10% gentamicin in 30 minutes, sealed with double plasma sterilization bag, after irradiation after sterilization the refrigerator 4. refrigerated 12h, -30 ~ 12h in deep frozen, low temperature refrigerator -80. after 3 weeks of use, can remove the.3.2 antigen of allogeneic bone more revascularization in healthy adult rabbits were China as the research object. The 60 rabbits at random Randomly divided into two groups, the experimental group and the control group with 30 rats in each experimental group. The allograft bone is ready for the long 1.5cm placed in the rabbit thigh of rectus femoris and vastus medial saphenous artery, 1.Omm. Kirschner wire to bone fixation in the medial femoral, tibial autogenous control group section, length and experimental methods and the same as the experimental group, 4 weeks, 8 weeks after surgery, 12 weeks respectively from specimen observation, immunohistochemistry detection of vascular endothelial growth factor (vascular endothelial, growth factor, VEGF) expression of CD34 protein and vascular endothelial cells, statistical treatment results of.4 experimental group and control group rabbit surgical site infection, not included in the statistical standard, add.VEGF to new vacancies, around the immature vascular into cartilage cells, bone cells and the most undifferentiated mesenchymal cells around 4,12 weeks after operation, the expression of VEGF in the experimental group 鍜屽鐓х粍姣旇緝鏃犲樊寮，

本文編號(hào)：1635200