聚乳酸-乙醇酸共聚物/羥基磷灰石可吸收空心螺釘治療犬股骨外髁骨折的實驗研究_《中國修復重建外科雜志》

作者：

鄭果 ¹ , 劉東 ² , 唐新 ¹ , 李棋 ¹ , 李箭 ¹ , 李慶 ³ , 肖建平 ³

1四川大學華西醫院骨科（成都，610041）;;
2 遂寧市中心醫院骨科;;
3中國科學院成都有機化學有限公司;

關鍵詞：

聚乳酸-乙醇酸共聚物/羥基磷灰石可吸收空心螺釘股骨外髁骨折內固定生物降解犬

DOI：

10.7507/1002-1892.20130151

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目的探討聚乳酸-乙醇酸共聚物/羥基磷灰石（polylactic-co-glycolic acid/ hydroxyapatite，PLGA/HA）可吸收空心螺釘治療犬股骨外髁骨折的內固定效果、體內降解過程及生物相容性，為其進一步改進和臨床應用提供參考。方法成年雄性比格犬16只，體重9～12 kg，制備雙側股骨外髁骨折（AO分型為B1型）模型。左側采用PLGA/HA可吸收空心螺釘固定，作為實驗組；右側采用金屬螺釘固定，作為對照組。術后觀察實驗動物一般情況，于2、4、8、12周分別處死4只動物，大體觀察并攝X線片觀察骨折愈合情況，測量骨密度；取骨折端及螺釘周圍組織行組織學觀察；檢測可吸收空心螺釘降解性能。結果所有實驗動物均存活至實驗完成。大體觀察兩組骨折無移位，均于12周時愈合；12周內實驗組可吸收空心螺釘形狀完整，無松動、移位及斷裂。X線片示，實驗組可吸收空心螺釘不顯影，對照組可見金屬螺釘X線顯影；隨時間延長，兩組骨折均逐漸愈合。兩組骨折部位骨密度均于8周時達峰值，但各時間點兩組比較以及組內比較，差異均無統計學意義（P gt; 0.05）。組織學觀察示術后各時間點兩組骨折愈合進程相似，實驗組可吸收空心螺釘周圍未見明顯炎性反應。可吸收空心螺釘降解性能檢測示，特性黏度及分子量分布術后2周內明顯下降；數均分子量和重均分子量術后4周內顯著下降；最大剪切力于術后8周內下降不明顯，之后顯著下降。各指標不同時間點間比較，差異均有統計學意義（P lt; 0.05）。結論PLGA/HA可吸收空心螺釘固定犬股骨外髁骨折后，骨折愈合進程與金屬螺釘相似，且具有良好的生物相容性。植入8周內最大剪切力無明顯下降，保證了骨折的充分愈合。

引用本文： 鄭果,劉東,唐新,李棋,李箭,李慶,肖建平. 聚乳酸-乙醇酸共聚物/羥基磷灰石可吸收空心螺釘治療犬股骨外髁骨折的實驗研究. 中國修復重建外科雜志, 2013, 27(6): 680-685. doi: 10.7507/1002-1892.20130151 復制

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, 黃曉琴, 雷自強. 聚乳酸類醫用生物降解材料的研究進展. 高分子通報, 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.	李慶, 龐秀炳, 蔣柳云, 等. 可吸收骨內植入材料及其制備方法: 中國, 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, 鄭祖根, 王曉東, 等. 可吸收內固定材科對實驗性骨折愈合影響的超微結構觀察. 中華骨科雜志, 1996, 16(10): 653-655.
7.	黃福龍, 戴紅蓮, 方園, 等. HA/PDLLA復合材料的制備及其降解性能研究. 無機材料學報, 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.	趙建華, 廖維宏, 王遠亮, 等. 消旋聚乳酸/輕基磷灰石/脫鈣骨基質的制備及其體外降解特性研究. 中國修復重建外科雜志, 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, 黃曉琴, 雷自強. 聚乳酸類醫用生物降解材料的研究進展. 高分子通報, 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. 李慶, 龐秀炳, 蔣柳云, 等. 可吸收骨內植入材料及其制備方法: 中國, 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, 鄭祖根, 王曉東, 等. 可吸收內固定材科對實驗性骨折愈合影響的超微結構觀察. 中華骨科雜志, 1996, 16(10): 653-655.
7. 黃福龍, 戴紅蓮, 方園, 等. HA/PDLLA復合材料的制備及其降解性能研究. 無機材料學報, 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. 趙建華, 廖維宏, 王遠亮, 等. 消旋聚乳酸/輕基磷灰石/脫鈣骨基質的制備及其體外降解特性研究. 中國修復重建外科雜志, 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.

《中國修復重建外科雜志》

聚乳酸-乙醇酸共聚物/羥基磷灰石可吸收空心螺釘治療犬股骨外髁骨折的實驗研究

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《中國修復重建外科雜志》

聚乳酸-乙醇酸共聚物/羥基磷灰石可吸收空心螺釘治療犬股骨外髁骨折的實驗研究

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