rhBMP-2增强吻合血管腓骨-钛网复合结构重建长节段骨缺损的可行性研究

The reconstruction of critical size bone defect is still a challenging clinical problem.The author proposed that in the reconstruction of critical size bone defect, the advantages of the cylindrical titanium mesh cage and the vascularized fibular graft transplantation could be integrated to overcome drawbacks with each other and result in better effect. The specific method is: put the fibular graft in the hollow cage and insert into the bone defect as a whole. The author proposed to introduce the rhBMP-2 release system to speed up the cage-fibular graft-host bone integration, and therefore, to enhance the strength of the reconstruction.The author also introduced locking plate fixation to provide sufficient stability, and at the same time to avoid the stress shielding of the fibular graft. Thus the fibular graft will become hypertrophy by the stimulation of mechanical stress.The methods mentioned above are established and sophisticated. The combining of these methods will overcome drawbacks with each other and achieve better clinical results, therefore can provide a substantially practical alternative to handling the problem of critical size bone defect reconstruction.

长节段骨缺损的重建是有待解决的临床难题。作者提出将钛网的优点与吻合血管腓骨移植的优点进行整合，从而达到克服各自缺点的目的。方法是将吻合血管的腓骨置于中空的钛网内，再植入重建长节段骨缺损。为了实现整合并缩短整合的时间，作者提出在钛网内填充人重组骨成型蛋白-2缓释系统，以获得更佳的远期重建强度。腓骨及钛网植入后用锁定钢板固定，提高重建的初始稳定性以实现早期承重。锁定钢板提供生物学固定，最大限度降低了应力遮挡。因而应力刺激可传递至移植的腓骨，促进腓骨的增强效应。上述各方法均为目前临床上先进且实用的方法，整合后使各方法自身的优点得到体现而且弥补了单独应用时的缺陷，为临床上治疗长节段骨缺损提供了有实质可操作性的新方法。

长节段骨缺损（>6cm）的修复，是临床待解决的难题。本研究提出将带血管腓骨移植、钛网支撑、rhBMP-2的骨诱导性及锁定钢板生物学固定的优点充分整合，用于长节段骨缺损的重建，并取得阶段性成果。.体外生物力学研究发现，骨瓣-钛网-锁定钢板固定可以提供可靠的初始稳定性，可为骨整合提供有利的生物力学环境，并为术后早期负重提供了可靠条件。.动物体内实验表明，腓骨-钛网-rhBMP-2-锁定钢板复合结构可修复狗7cm缺损取得较为满意的结果。实验组动物术后可无保护负重活动，术后12周骨整合基本完成。实验组在骨整合时间及整合骨生物力学性能等方面优于对照组。.通过建立带血管腓骨-钛网-rhBMP-2-锁定钢板复合结构修复长节段骨缺损的实验模型并取得初步成果，为临床上重建长节段骨缺损的修复提供了有实质可操作性的新方法。