聚乳酸-乙醇酸共聚物/羟基磷灰石可吸收空心螺钉治疗犬股骨外髁骨折的实验研究_《中国修复重建外科杂志》

作者：

郑果 ¹ , 刘东 ² , 唐新 ¹ , 李棋 ¹ , 李箭 ¹ , 李庆 ³ , 肖建平 ³

1四川大学华西医院骨科（成都，610041）;;
2 遂宁市中心医院骨科;;
3中国科学院成都有机化学有限公司;

关键词：

聚乳酸-乙醇酸共聚物/羟基磷灰石可吸收空心螺钉股骨外髁骨折内固定生物降解犬

DOI：

10.7507/1002-1892.20130151

视频：

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目的探讨聚乳酸-乙醇酸共聚物/羟基磷灰石（polylactic-co-glycolic acid/ hydroxyapatite，PLGA/HA）可吸收空心螺钉治疗犬股骨外髁骨折的内固定效果、体内降解过程及生物相容性，为其进一步改进和临床应用提供参考。方法成年雄性比格犬16只，体重9～12 kg，制备双侧股骨外髁骨折（AO分型为B1型）模型。左侧采用PLGA/HA可吸收空心螺钉固定，作为实验组；右侧采用金属螺钉固定，作为对照组。术后观察实验动物一般情况，于2、4、8、12周分别处死4只动物，大体观察并摄X线片观察骨折愈合情况，测量骨密度；取骨折端及螺钉周围组织行组织学观察；检测可吸收空心螺钉降解性能。结果所有实验动物均存活至实验完成。大体观察两组骨折无移位，均于12周时愈合；12周内实验组可吸收空心螺钉形状完整，无松动、移位及断裂。X线片示，实验组可吸收空心螺钉不显影，对照组可见金属螺钉X线显影；随时间延长，两组骨折均逐渐愈合。两组骨折部位骨密度均于8周时达峰值，但各时间点两组比较以及组内比较，差异均无统计学意义（P gt; 0.05）。组织学观察示术后各时间点两组骨折愈合进程相似，实验组可吸收空心螺钉周围未见明显炎性反应。可吸收空心螺钉降解性能检测示，特性黏度及分子量分布术后2周内明显下降；数均分子量和重均分子量术后4周内显著下降；最大剪切力于术后8周内下降不明显，之后显著下降。各指标不同时间点间比较，差异均有统计学意义（P lt; 0.05）。结论PLGA/HA可吸收空心螺钉固定犬股骨外髁骨折后，骨折愈合进程与金属螺钉相似，且具有良好的生物相容性。植入8周内最大剪切力无明显下降，保证了骨折的充分愈合。

引用本文： 郑果,刘东,唐新,李棋,李箭,李庆,肖建平. 聚乳酸-乙醇酸共聚物/羟基磷灰石可吸收空心螺钉治疗犬股骨外髁骨折的实验研究. 中国修复重建外科杂志, 2013, 27(6): 680-685. doi: 10.7507/1002-1892.20130151 复制

1.	Jayabalan M, Shalumon KT, Mitha MK, et al. Effect of hydroxyapatite on the biodegradation and biomechanical stability of polyester nanocomposites for orthopaedic applications. Acta Biomaterialia J, 2010, 6(3): 763-775.
2.	白雁斌, 黄晓琴, 雷自强. 聚乳酸类医用生物降解材料的研究进展. 高分子通报, 2006, (3): 46-51.
3.	Cordewener FW, Bos RR, Rozema FR, et al. Poly (L-lactide) implants for repair of human orbital floor defects: clinical and magnetic resonance Imaging evaluation of long-term results. J Oral Maxillofac Surg, 1996, 54(1): 9-13.
4.	李庆, 庞秀炳, 蒋柳云, 等. 可吸收骨内植入材料及其制备方法: 中国, CN102085397A. 2011-06-08.
5.	Friend G, Grace K, Stone HA. L-osteotomy with absorbable fixation for correction of tailor’s bunion. J Foot Ankle Surg, 1993, 32(1): 14-19.
6.	徐又佳, 郑祖根, 王晓东, 等. 可吸收内固定材科对实验性骨折愈合影响的超微结构观察. 中华骨科杂志, 1996, 16(10): 653-655.
7.	黄福龙, 戴红莲, 方园, 等. HA/PDLLA复合材料的制备及其降解性能研究. 无机材料学报, 2007, 22(2): 333-337.
8.	Fan Y, Xiu K, Duan H, et al. Biomechanical and histological evalution of the application of biodegradable poly-L-lactic cushion to the plate internal fixation for bone fracture healing. Clin Biomech (Bristol, Avon), 2008, 23 Suppl 1: S7-S16.
9.	Hasegawa S, Neo M, Tamura J, et al. In vivo evaluation of a porous hydroxyaptite poly-DL-lactide composite for bone tissue engineering. J Biomed Mater Res A, 2007, 81(4): 930-938.
10.	Hasegawa S, Tamura J, Neo M, et al. In vivo evaluation of a porous hydroxyapatite poly-DL-laetide composite for use as a bone substitute. J Biomed Mate Res A, 2005, 75(3): 567-579.
11.	赵建华, 廖维宏, 王远亮, 等. 消旋聚乳酸/轻基磷灰石/脱钙骨基质的制备及其体外降解特性研究. 中国修复重建外科杂志, 2003, 17(1): 61-64.
12.	Dong J, Kojima H, Uemura T, et al. In vivo evaluation of a novel porou hydroxyapatite to sustain osteogenesis of transplanted bone marrow-derived osteoblastic cells. J Biomed Mater Res, 2001, 57(2): 208-216.
13.	Hoffman GO. Biodegradable implants in traumatology: a review on the state-of-the-art. Arch Orthop Trauma Surg, 1995, 114(3): 123-132.
14.	Hoffmann JF. Update on biodegradable plating systems: theory and results. Otolaryngol Head Neck Surg, 2000, 8(4): 288-293.
15.	Ashammakhi N, Suuronen R, Tiainen J, et al. Spotlight on naturally absorbable osteofixation devices. J Craniofacial Surg, 2003, 14(2): 247-259.
16.	Palmer RH. Biological osteosynthesis. Vet Clin North Am Small Anim Pract, 1999, 29(5): 1171-1185.
17.	Cotton NJ, Egan MJ, Brunelle JE. Composites of poly (DL-lactide-co-glycolide) and calcium carbonate: in vitro evaluation for use in orthopedic applications. J Biomed Mater Res A, 2008, 85(1): 195-205.
18.	Matsusue Y, Yamamuro T, Oka M, et al. In vitro and in vivo studies on bioabsorbable ultra-high-strength poly (L-lactide) rods. J Biomed Mater Res, 1992, 26(12): 1553-1567.
19.	Mackool R, Yim J, McCarthy JG. Delayed degradation in a resorbable plating system. J Craniofacial Surg, 2006, 17(1): 197-198.
20.	Yerit KC, Hainich S, Turhani D, et al. Stability of biodegradable implants in treatment of mandibular fractures. Plast Reconstr Surg, 2005, 115(7): 1863-1870.
21.	Spoliti M. Glenoid osteolysis after arthroseopie labrum repair with a bioabsorbable suture anchor. Acta Orthop Belg, 2007, 73(1): 107-110.
22.	Böstman OM. Osteoarthritis of the ankle after foreign-body reaction to absorbable pins and screws: a three-to nine-year follow-up study. J Bone Joint Surg (Br), 1998, 80(2): 333-338.
23.	Mukherjee DP, Pietrzak WS. Bioabsorbable fixation: scientific, technical, and clinical concepts. J Craniofac Surg, 2011, 22(2): 679-689.
24.	Pietrzak WS, Sarver DR, Verstynen ML. Bioabsorbable polymer science for the practicing surgeon. J Craniofac Surg, 1997, 8(2): 87-91.

1. Jayabalan M, Shalumon KT, Mitha MK, et al. Effect of hydroxyapatite on the biodegradation and biomechanical stability of polyester nanocomposites for orthopaedic applications. Acta Biomaterialia J, 2010, 6(3): 763-775.
2. 白雁斌, 黄晓琴, 雷自强. 聚乳酸类医用生物降解材料的研究进展. 高分子通报, 2006, (3): 46-51.
3. Cordewener FW, Bos RR, Rozema FR, et al. Poly (L-lactide) implants for repair of human orbital floor defects: clinical and magnetic resonance Imaging evaluation of long-term results. J Oral Maxillofac Surg, 1996, 54(1): 9-13.
4. 李庆, 庞秀炳, 蒋柳云, 等. 可吸收骨内植入材料及其制备方法: 中国, CN102085397A. 2011-06-08.
5. Friend G, Grace K, Stone HA. L-osteotomy with absorbable fixation for correction of tailor’s bunion. J Foot Ankle Surg, 1993, 32(1): 14-19.
6. 徐又佳, 郑祖根, 王晓东, 等. 可吸收内固定材科对实验性骨折愈合影响的超微结构观察. 中华骨科杂志, 1996, 16(10): 653-655.
7. 黄福龙, 戴红莲, 方园, 等. HA/PDLLA复合材料的制备及其降解性能研究. 无机材料学报, 2007, 22(2): 333-337.
8. Fan Y, Xiu K, Duan H, et al. Biomechanical and histological evalution of the application of biodegradable poly-L-lactic cushion to the plate internal fixation for bone fracture healing. Clin Biomech (Bristol, Avon), 2008, 23 Suppl 1: S7-S16.
9. Hasegawa S, Neo M, Tamura J, et al. In vivo evaluation of a porous hydroxyaptite poly-DL-lactide composite for bone tissue engineering. J Biomed Mater Res A, 2007, 81(4): 930-938.
10. Hasegawa S, Tamura J, Neo M, et al. In vivo evaluation of a porous hydroxyapatite poly-DL-laetide composite for use as a bone substitute. J Biomed Mate Res A, 2005, 75(3): 567-579.
11. 赵建华, 廖维宏, 王远亮, 等. 消旋聚乳酸/轻基磷灰石/脱钙骨基质的制备及其体外降解特性研究. 中国修复重建外科杂志, 2003, 17(1): 61-64.
12. Dong J, Kojima H, Uemura T, et al. In vivo evaluation of a novel porou hydroxyapatite to sustain osteogenesis of transplanted bone marrow-derived osteoblastic cells. J Biomed Mater Res, 2001, 57(2): 208-216.
13. Hoffman GO. Biodegradable implants in traumatology: a review on the state-of-the-art. Arch Orthop Trauma Surg, 1995, 114(3): 123-132.
14. Hoffmann JF. Update on biodegradable plating systems: theory and results. Otolaryngol Head Neck Surg, 2000, 8(4): 288-293.
15. Ashammakhi N, Suuronen R, Tiainen J, et al. Spotlight on naturally absorbable osteofixation devices. J Craniofacial Surg, 2003, 14(2): 247-259.
16. Palmer RH. Biological osteosynthesis. Vet Clin North Am Small Anim Pract, 1999, 29(5): 1171-1185.
17. Cotton NJ, Egan MJ, Brunelle JE. Composites of poly (DL-lactide-co-glycolide) and calcium carbonate: in vitro evaluation for use in orthopedic applications. J Biomed Mater Res A, 2008, 85(1): 195-205.
18. Matsusue Y, Yamamuro T, Oka M, et al. In vitro and in vivo studies on bioabsorbable ultra-high-strength poly (L-lactide) rods. J Biomed Mater Res, 1992, 26(12): 1553-1567.
19. Mackool R, Yim J, McCarthy JG. Delayed degradation in a resorbable plating system. J Craniofacial Surg, 2006, 17(1): 197-198.
20. Yerit KC, Hainich S, Turhani D, et al. Stability of biodegradable implants in treatment of mandibular fractures. Plast Reconstr Surg, 2005, 115(7): 1863-1870.
21. Spoliti M. Glenoid osteolysis after arthroseopie labrum repair with a bioabsorbable suture anchor. Acta Orthop Belg, 2007, 73(1): 107-110.
22. Böstman OM. Osteoarthritis of the ankle after foreign-body reaction to absorbable pins and screws: a three-to nine-year follow-up study. J Bone Joint Surg (Br), 1998, 80(2): 333-338.
23. Mukherjee DP, Pietrzak WS. Bioabsorbable fixation: scientific, technical, and clinical concepts. J Craniofac Surg, 2011, 22(2): 679-689.
24. Pietrzak WS, Sarver DR, Verstynen ML. Bioabsorbable polymer science for the practicing surgeon. J Craniofac Surg, 1997, 8(2): 87-91.

《中国修复重建外科杂志》

聚乳酸-乙醇酸共聚物/羟基磷灰石可吸收空心螺钉治疗犬股骨外髁骨折的实验研究

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《中国修复重建外科杂志》

聚乳酸-乙醇酸共聚物/羟基磷灰石可吸收空心螺钉治疗犬股骨外髁骨折的实验研究

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