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題 名 | 預構帶血管骨移植之大鼠模式 |
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作 者 | 蔡耀輝; | 書刊名 | 臺北市獸醫師公會會刊 |
卷 期 | 16:1 1998.03[民87.03] |
頁 次 | 頁8-34 |
分類號 | 437.26 |
關鍵詞 | 帶血管骨移植; 大白鼠; |
語 文 | 中文(Chinese) |
中文摘要 | 目前修復硬骨缺損(cortical bone defect)的骨外科帶血管莖之自體骨移值( vascularized bone autograft)(7,29,36,42) 是公認最有效、癒合最快的方式之一(1, 2,25,31,35,41),但卻限於捐獻部位不多,數量與大小等的多層限制。其他方式如同種異體 骨(allogenic graft)(6,9,14,23,27),自體海棉骨(cancellous bone autograft)7 ,異種異體骨(xenograft)(4,23,27)等移值之應用,也有免疫排斥反應,感染危險,骨 骼癒合緩慢及移植骨之機械性骨折等不良副作用,發生率佔10-15%(1,6,13,22,26)。 利用「二次組織瓣」(secondary tissue flap)(8,11,12,32,43,44)理論的變更,應用 游離血管莖的移值至一移植骨內,使其留置體內一段時間後,由於血管新生作用 (neovascular ization)(30,33),生新血管長入移植骨,供應該移植營養,進而發展骨細 胞與骨基質,成為一帶血管莖的自體移植骨,可用以移植至缺骨部位。如此不但解決帶 血管莖骨的限制,亦可應需要選擇不同管徑血管配合不同大小的移植骨,進而得到理想的帶 血管莖骨,同時對血液供應不良的缺骨受床部位(receipient bed)例如曾經切除腫瘤、放 射線治療(24)等之後不佳的骨移植部位都有很好的癒合效果。 本實驗以大白鼠為對象,應用游離血管莖的移植至移植骨內,探討其成為一帶血管莖移植骨 的可行性,此外對血管新生作用是否能長入移植骨並供應其營養,及移植骨是否能因此等血 管而維持與生成骨細胞和骨基質的演發過程進一步了解,藉以評估其臨床上應用的可行性。 |
英文摘要 | Prefabrication provides a new method for creating donor sites which are not limited by natural vascular territories. We developed a model in rat to evaluate the phenomenon of prefabrication in bone grafts. Prefabrication of a lcm bone isorgrafts were performed by using the left sapheonus artery and vein in 60 male Brown-Norway rats. Two different types of pedicles were made; (1)Not folw-through pedicle, in which the distal ends of artery and vein were ligated and severed to facilitae passing them through the bone graft marrow cavity; (2)flow-through pedicle, which the pedicle was isolated from perivascular tissue without ligation in the distal end, so the vessels were passed through a longitudinal cut of the bone graft. The two major groups were further subdivided into four grop/ups to refill the bone graft marrow with the recepient's blood clot. A similar orocedure were done in the right side, except passing the vessel pedicle through the bone graft to serve as control. Experimental data from macroscopy、arteriography、intravascular microsphere injection、flurorochrome labelling and histology were obtained from different periods of observation in 1,2,4,8 and 12 weeks. As a result, the histological morphometric examinations showed the survival of bone cells in the experimental side were signifecantly higher than the control, the non-flow through pedicle gained a better result than the flow through pedicle(p<0.05), but there is no difference between groups with or without blood clot refilling. Fluorochrome labelling showed marked new bone regeneration in experiment side, fluorochrome label can be observed in periosteal, interstitial lamellae and endosteal. In contrast, only periosteal labelling were seen in the controls. Patency of the transplanted pedicle exceeded 90% and were independent of the vascular pedicle type, angiography also showed a very rich neovascularisation within the bone graft marrow. Histologically, the experiment side showed bone cells survival in all part of bone graft, bone resorption were limited, capillaries ingowth and marked angioneogenesis was noted in the marrow, osteogenic activity started early, osteiod formed early in the 4 week, eventually new bone trabeculae can be seen. In contrast, the bone graft in the control side showed gradually loss of bone cell, marked resorption occur in bone , low neovascularization occur in marrow, marrow filled with fibrous tissue and no osteogenic activity of new bone forming can be found. These results suggested prefabricated bone graft produces better results than conventional bone graft and it can be created by selectively using various vascular pedicles, it would be an useful prospective alternative for bone reconstruction surgery and encourage further investigation into it. |
本系統中英文摘要資訊取自各篇刊載內容。