带骨膜软骨与不带骨膜软骨自体异位移植的实验研究

    移植
　　[摘要]目的：通过软骨及带软骨膜软骨在未成年兔中的自体异位移植后变化的研究，为临床选择合适的移植物提供依据。方法：4周家兔12只，将兔的七、八、九肋软骨带骨膜取出，分别分为等长两段。一段保留骨膜，一段去除骨膜，分别埋置于兔的背部两侧对称部位。分别于4、8、12、16周分别取出所埋置的不同组的软骨。将软骨分别观察大体形态、测量长度、作组织学切片行HE染色及电镜观察其显微结构的变化。结果：4周时带骨膜软骨与周围组织结合较去骨膜软骨更紧密，16周与周围组织结合均紧密，两者无明显差异；4周时，两组软骨的长度无显著性差异，8周以后，带骨膜组较不带骨膜组更长（P＜0.05）； 4～8周两者均增生活跃，带骨膜比不带骨膜的增生更明显；12周后软骨纤维化明显，增生不明显。结论：幼兔中，带骨膜的软骨较不带骨膜的更适于自体移植。
　　[关键词]自体移植；骨膜；软骨
　　[中图分类号]R622[文献标识码]A[文章编号]1008-6455（2008）06-0864-03
　　
　　The experimental study on the autograft cartilages with periosteum and without periosteum
　　ZHANG Zhi-jia1,ZHANG Qing-guo2,ZHANG Jiao1
　　(Department of Plastic Surgery,the Southeast University Medicine College, Nanjing 210009,Jiangsu,China. 2.Plastic Surgery Hospital,Chinese Academy of Medical Science,Beijing 100041,China)
　　
　　Abstract： ObjectiveTo study the changes of the cartilage with and without the periosteum heterotopic transplantation in baby rabbit, in order to choose a suitable graft for clinical transplantation.Methods12 baby rabbits at the age of four weeks, each of them the seventh, eighth and ninth costal cartilages with periosteum were removed, and divided into two segments at the even length, one segment with periosteum the othernon-periosteum. They were buried under the skin of the back at bilaterally symmetrical parts. The different group of cartilages were took out at 4,8,12,16 weeks at random. The morphology of cartilage were observed and their length were measured.Their HE staining histological sections, and microstructure under the electron microscopy were observed.ResultsThe cartilages with periosteum integrate tightly with surrounding tissue at forth week while the cartilages without periosteum integrate tightly with surrounding tissue at sixteenth week and there was no significant difference at that time. The cells of cartilage growth actively at forth and eighth week, and those with periosteum were more actively than that without periosteal.They growthed not so actively and had more cartilage fibrosis after 12 weeks.ConclusionThe cartilage with periosteum had more advantage than thatwithout periosteum in autologoustransplantation in baby rabbits.
　　Key words: autologous transplantation；cartilage；periosteum
　　
　　软骨是一种具有弹性的组织，由于其移植后易于成活，是良好的填充、塑形和支持材料。自体软骨因无排斥反应，抗感染能力强被广泛应用于颌面部的各种修复治疗。软骨移植在临床上常用于隆鼻、小耳再造及半面萎缩等,并取得了良好的效果。临床上移植透明软骨的目的除了填充、塑形外，还有支撑作用。临床取软骨时常面临着带不带软骨膜的选择，本实验对软骨及带软骨膜软骨在幼兔中的自体异位移植后变化的研究，为临床选择合适的移植物提供依据。
　　
　　1材料和方法
　　
　　1.1.1 实验动物：幼兔12只,平均体重1.0～1.5kg,平均兔龄4 周。
　　1.1.2手术方法：2%戊巴比妥钠30～40mg/kg右耳缘静脉注射麻醉后,腹部备皮,消毒、铺巾。沿一侧肋弓作斜形切口，连骨膜一起取出第六、七、八肋肋软骨。腹壁切口用1-0 丝线拉拢间断缝合。麻醉苏醒后将兔放入观察室,分笼饲养,术后3日内,每日肌注青霉素40万U。将取出的肋软骨中间切断，形成等长的两段，其中一段去除骨膜。将各组带骨膜与不带骨膜的软骨于背部对称部位埋置于皮下，带骨膜的埋于一侧，不带骨膜的埋于为一侧。
　　1.2. 标本采集检查：手术后4,8,12，16周在相同的麻醉条件取出一组软骨。软骨标本的测量：以长度作为指标。所获结果用平均数±标准差表示,采用方差分析。光镜检查：在移植软骨固定于10%甲醛溶液中,取横截面，按常规HE 染色方法制成组织切片。电镜检查：将标本切成2mm的小段，用2.5%的戊二醛固定，镀膜后用扫描电镜扫描其横截面。
　　
　　2结果及分析
　　
　　2.1.1大体形态学观察：4周时,带骨膜的软骨表面可见血管长入，与周围组织结合为一体,不带骨膜的软骨周围形成一纤维囊。16周时，两者与周围组织结合的紧密程度无差别。
　　2.1.2 电镜观察结果：
　　2.1.3 光镜观察结果：
　　2.1.4 大体测量结果：见表1。
　　

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