[1]贾　鹏,卢锋成,赵志辉,等.可吸收锁钉鞘预防带锁髓内钉应力遮挡的动物实验研究[J].新乡医学院学报,2020,37(2):120-124.[doi:10.7683/xxyxyxb.2020.02.005]
　JIA Peng,LU Fengcheng,ZHAO Zhihui,et al.Experimental study of absorbable nail sheath preventing stress shielding with interlocking intramedullary nail[J].Journal of Xinxiang Medical University,2020,37(2):120-124.[doi:10.7683/xxyxyxb.2020.02.005]
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可吸收锁钉鞘预防带锁髓内钉应力遮挡的动物实验研究
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《新乡医学院学报》[ISSN:1004-7239/CN:41-1186/R]

卷:
37
期数:
2020年2
页码:
120-124
栏目:
基础研究
出版日期:
2020-02-05

文章信息/Info

Title:
Experimental study of absorbable nail sheath preventing stress shielding with interlocking intramedullary nail
作者:
贾　鹏1 ; 卢锋成2 ; 赵志辉3; 王永清3
（1.中国人民武装警察部队特色医学中心特战创伤急救技术研究所，天津　300162；2.阳泉市第一人民医院骨科，山西　阳泉　045000；3.南开大学附属第四中心医院骨科，天津　300140）
Author(s):
JIA Peng1; LU Fengcheng2; ZHAO Zhihui3; WANG Yongqing3
(1.Institute of First Aid Techniques for Special Warfare Trauma,Chinese People′s Armed Police Force Characteristic Medical Center,Tianjin 300162,China;2.Department of Orthopedics,the First People′s Hospital of Yangquan City,Yangquan 045000,Shanxi Province,China;3.Department of Orthopedics,the Fourth Central Hospital Affiliated to Nankai University,Tianjin 300140,China)
关键词:
髓内钉; 动力化; 应力遮挡; 骨折固定; 骨折愈合; 生物力学
Keywords:
intramedullary nails; dynamization; stress shielding; fracture fixation; bone healing; biomechanics
分类号:
R683.42
DOI:
10.7683/xxyxyxb.2020.02.005
文献标志码:
A
摘要:
目的　探讨可吸收锁钉鞘在骨折愈合后期对带锁髓内钉应力遮挡的预防作用。方法　将22只健康1 a龄雌性波尔山羊随机分为对照组与观察组，每组11只。2组山羊均制作右股骨干骨折模型，应用钛质髓内钉固定。对照组锁孔采用钛质螺钉锁定，观察组锁孔采用带可吸收鞘的螺钉锁定。术后定期复查X线片，观测骨折愈合情况；于术后1、3、6、9个月处死山羊，观察骨折固定处的大体情况，测量髓钉近端锁钉与股骨近端标记钉的移动距离。术后1、3个月，采用苏木精-伊红染色观察2组山羊骨痂组织中骨小梁的生长情况，免疫组织化学染色检测骨痂组织中骨形成蛋白（BMP）、转移生长因子β（TGF-β）、血管内皮细胞生长因子（VEGF）的表达情况。结果　2组山羊术后3个月时骨折均愈合。术后3个月，观察组山羊开始有锁钉微动表现，可吸收锁钉鞘开始有降解表现，术后9个月时大部分吸收；对照组山羊骨折固定处无明显变化。术后3、6、9个月，观察组山羊可吸收锁钉鞘周围组织有炎症刺激表现。术后1、3、6、9个月观察组山羊标记钉与近端锁定钉的微动距离为(1.55±0.21)、(1.85±0.25)、(1.86±0.36)、(2.05±0.02) mm，对照组山羊标记钉与近端锁钉的微动距离为(0.43±0.12)、(0.40±0.10)、(0.25±0.05)、(0.35±0.05) mm。术后1、3个月，2组山羊骨痂组织中可见增生的骨性及软骨性骨痂，期间散在增生的成纤维细胞及新生毛细血管和少量破骨细胞，并可见BMP、TGF-β及VEGF的表达。结论　可吸收鞘锁钉鞘可有效减少带锁髓内钉在骨折愈合后期的应力遮挡效应。
Abstract:
Objective　To investigate the effect of absorbable nail sheath preventing stress shielding with interlocking intramedullary nail.Methods　Twenty-two healthy 1-year-old female Bohr goats were randomly divided into control group and observation group,with 11 goats in each group.Fracture models of right femoral shaft were made and fixed with titanium intramedullary nail.In the control group,the locking hole was locked by titanium screw;while the locking hole was locked by screw with absorbable nail sheath in the observation group.After the operation,X-ray films were reexamined regularly to observe the fracture healing.The goats were sacrificed at 1,3,6 and 9 months after the operation to observe the general situation of the fixation site of the fracture and the movement distance between the proximal locking nail of the medullary nail and the proximal femoral marker nail of the proximal femur was measured to detect the micro motion of the screw.At 1 and 3 months after the operation,the growth of trabeculae in the callus tissues of the two groups of goats was observed by hematoxylin-eosin staining.The expressions of bone morphogenetic protein（BMP）,transfer growth factor β（TGF-β），vascular endothelial cell growth factor（VEGF） were detected by immunohistochemical staining.Results　The fractures of goats in both groups were healed 3 months after operation.At 3 months after the operation,the fixation site of the fracture in the observation group began to show screw fretting,and the absorbable nail sheath began to show degradation.At 9 months after the operation,most of them were absorbed.There was no obvious change at the fixation site of the fractare in the control group.At 3,6 and 9 months after the operation,the goats in the observation group showed inflammatory stimulation in the tissues around the nail sheath.At 1,3,6,9 months after operation,the fretting distance between the marker nail and the proximal locking nail was (1.55±0.21)，(1.85±0.25)，(1.86±0.36)，(2.05±0.02) mm in the observation group,and it was (0.43±0.12)，(0.40±0.10)，(0.25±0.05)，(0.35±0.05) mm in the control group.At 1 and 3 months after the operation,hyperplastic bone and chondrogenic callus were observed in the callus tissues of goats in the two groups,and proliferated fibroblasts,new capillaries and a small number of osteoclasts were scattered.Expressions of BMP,TGF-β and VEGF were also observed.Conclusions　Absorbable locking nail sheath can effectively reduce the stress shielding effect of interlocking intramedullary nail in the later period of fracture healing.

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更新日期/Last Update: 2020-02-05