可降解聚乳酸腰椎间融合器植骨融合成骨方式的研究

Osteoinducibility of degradable poly-D and L-lactic acid cage

中文关键词:  组织学  成骨细胞  聚-DL-乳酸  腰椎  融合

英文关键词:Histology  Osteoblast  Poly-D and L-lactic acid  Ｌumbar vertebra  Ｆusion

中文摘要:

  【摘要】 目的：探讨可降解聚乳酸腰椎间融合器实现椎体间植骨融合的成骨方式。方法：健康9月龄内江猪48只，随机分成两组：实验组24只，采用聚-DL-乳酸可降解腰椎融合器置入L4/5椎间隙并植骨；对照组24只，采用与融合器相同大小自体骨行L4/5椎间植骨。分别于1、3、6、9、12、18个月时取标本进行组织学检查。结果：术后1个月，实验组填充骨与融合器之间没有见纤维组织的长入，在融合器与骨之间可见少量软骨细胞存在；对照组植骨部位见软骨组织与纤维组织交错。术后3个月，实验组中融合器边缘与中央与填充骨和椎体骨接触部分可见明显的胶原纤维、纤维组织、软骨组织交互长入，软骨内化骨形成成熟的骨小梁，但排列很紊乱；对照组中软骨组织逐渐进化为骨组织，骨小梁排列较术后紊乱，部分已钙化成骨。术后6个月，实验组中残存融合器边缘及中空部分仍可见大量纤维细胞、软骨细胞，部分软骨组织已经成骨并钙化；对照组已达到良好的骨性融合。术后9个月，实验组已大部分融合，填充骨与椎体间的界限已消失，手术部位仍可见明显胶原、纤维组织，软骨细胞进化为骨细胞；对照组骨性融合，可见大量软骨组织和成熟板层骨形成。术后12个月，实验组基本达到骨性融合，仍可见明显软骨组织和纤维组织，对照组完全融合，且塑形良好。术后第18个月，两组均达到骨性融合，并且塑形良好接近周围正常骨组织。结论：生物降解可降解聚-DL-乳酸腰椎间融合器在猪的椎间成骨方式主要是软骨内成骨和纤维性成骨，膜内成骨不起重要作用。

英文摘要:

  【Abstract】 Objective：To investigate in vivo osteoinducibility of degradable poly-D and L-lactic acid cage.Method：48 healthy 9-month Neijiang Pig were divided into experimental group and control group randomly with 24 animals　ｉｎ　each group .Experimental group received PDLLA cage and filling autograft implantation，while control group received autograft alone with the same size at L4/5.At 1，3，6，9，12 and 18 monthｓ respectively，the animals were sacrificed，and the surgical sites were harvested and tested histologically.Result：At 1 month after operation：fibrous tissue was not found at the edge of cage and filling bone，while a few cartilage cells were evidenced between cage and vertebra；3 month after operation：a lots of collagen fiber，fibrous tissue and cartilage tissue grew interactively on cage-vertebra and cage-bone interfaces，ａｎｄ　ｍatured bone trabeculae formed by cartilaginous ossification was seen and ｄｉｓａｒｒａｎｇｅｄ；6 month after operation：collagen fiber，small amount of fibrous tissue，cartilage cells and osteocytes still ｃｏｕｌｄ be seen，ａｎｄ　ｐart of cartilage tissue fell into ossification and calcification；9 month after operation：fusion could be seen in experimental group，and the edge between filling autograft and vertebra disappeared，collagen fiber and fibrous tissue still could be seen and chondrocyte evolved into osteocyte；12 month after operation，bony fusion had been accomplished basically in experimental group，collagen fiber and fibrous tissue still could be seen，while bony fusion was finished completely　ｉｎｃｏｎｔｒｏｌ　ｇｒｏｕｐ；18 month after operation：bony fusion had been accomplished in two groups which approached normal bone tissue.Conclusion：Degradable poly-D and L-lactic acid cage act as intracartilaginous ossification and fibrous ossification rather than ｉntramembranous ossification.