【作者】 孙磊；

【导师】 程庆书； 韩勇；

【作者基本信息】 第四军医大学 ， 外科学， 2009， 硕士

【摘要】 目的:创伤、肿瘤、感染、放射性坏死及先天性畸形等均可造成胸壁缺损,其中大块缺损尤其是前胸壁和侧胸壁缺损可导致胸壁塌陷,胸廓完整性、稳定性受到破坏,产生反常呼吸、呼吸功能障碍等。因此,对胸壁大块缺损的治疗及重建十分重要。近年来多种人工材料陆续被应用到胸壁重建中,但尚无理想的修复材料问世,大块缺损的修复一直是临床尚待解决的难题。钛及其合金因具有无毒、质轻、良好的生物相容性、机械强度和耐腐蚀性能,以及对X线检查影响较小等特性而被广泛应用到颌面外科与整形科。本实验将钛合金经过表面喷砂、酸蚀处理后制备成人工肋骨,用于兔胸壁缺损的修复重建,研究钛板人工肋骨对于胸壁大块缺损的骨性修复作用,探讨其用于临床修复胸壁缺损的可行性。方法:采用表面喷砂、酸蚀处理制备钛板人工肋骨。建立20只3cm×3cm的胸壁骨性缺损家兔模型,随机分为两组:钛板人工肋骨组(实验组)和带骨膜的自体肋骨组(对照组)。实验组应用钛板人工肋骨修复骨性缺损(n=10),对照组采用带骨膜的自体肋骨移植修复骨性缺损(n=10)。术前及术后第1、2、4、6、8、10、12周检测血清碱性磷酸酶、血钙及血磷;术后4、8和12周行胸部X片、病理组织学检查,动态观察肋骨愈合情况。结果:所有实验兔均无手术及术后死亡,术后无胸壁塌陷、反常呼吸、感染及其它并发症发生。术前至术后12周,实验组与对照组血清碱性磷酸酶均于术后第1周显著下降,至第6周达最低值,后逐渐升高;钙磷乘积术后第1周均出现高峰值,维持约6周后缓慢下降,两组血清碱性磷酸酶和钙磷乘积变化均无显著性差异(P＞0.05)。实验组钛板与肋骨断端连接成一个整体,固定牢靠,界面大量新生骨组织,无纤维组织介入,人工肋骨与自体骨达到了较为理想的骨整合;对照组肋骨断端处骨增生明显,有连续性骨痂生成,显示骨愈合满意。结论:应用表面粗化处理的钛板人工肋骨重建家兔胸壁骨性缺损,能够对胸壁提供有效的支撑作用,其具有良好的生物相容性、机械强度和耐腐蚀性能,且能与自体肋骨达到较为理想的骨整合。通过进一步实验研究,钛板人工肋骨有望成为重建胸壁骨性缺损的材料之一。更多还原

【Abstract】 Objective:The most common etiological factors of chest wall defects include trauma,tumor,infection,radiation necrosis and congenital deformities.Large defects of the anterior or lateral chest walls can lead to the damage of thoracic integrity and stability,resulting in paradoxical respiration and other respiratory dysfunctions.Therefore,it’s important for the reconstruction of large chest wall defects to attain a fine functional and cosmetic result.In recent years,a variety of artificial materials have been applied to the chest wall reconstruction in clinics.However,there is no ideal repair material available until now.The reconstruction of large defects remains a challenging problem for thoracic surgeons.Titanium and its alloys have been widely used in several surgical fields,such as craniofacial reconstruction and orthopedic prosthesis.This prosthesis has been proved to be not only good biocompatibility,mechanical strength and corrosion resistance,but also light weight and low radiological interference.In this study,we repaired chest wall defects with the prosthetic titanium ribs by means of coarsening surface with sandblasting and acid etching(SLA)in rabbits.The purpose of this experiment was to investigate the application of prosthetic titanium ribs for reconstruction of large chest wall defects,so as to assess its feasibility in clinical chest wall reconstruction.Methods:Prosthetic titanium ribs were prepared by means of coarsening surface with sandblasting and acid etching(SLA).Large chest wall defects of 3cm×3cm were created in 20 rabbits and then randomly divided into 2 groups: the study group and the control group.In the study group(n=10),the defects were repaired by the titanium implants,while in the control group(n=10),the defects were replaced with the autogenous ribs with periosteum.Biochemical blood parameters such as serum levels of alkaline phosphatase(ALP),calcium and phosphorus were measured before surgery(time 0)and 1,2,4,6,8,10,12 weeks after operation.Chest radiography and pathohistological examinations were performed in 4,8,12 weeks after operation to dynamically observe the progress of Bone healing.Results:No intraoperative and postoperative deaths were observed in both groups;flail chest,paradoxical breathing and infections were not found in all the rabbits.The serum ALP concentrations followed the same pattern in both groups, decreased from 1 weeks to 6 weeks,lowest at 6 weeks and then increased.The calcium-phosphorus products reached peak value at 1 week and then gradually decreased from 6 weeks.No significant differences were found in both the serum ALP concentrations and the calcium-phosphorus products in the two groups(P＞0.05).In the study group,expected bone-to-implant contact was achieved,with a large amount of new bone tissues appeared in the interface without forming the fibrous tissue;while in the control group,osteogenesis in the broken ends of the ribs was evident with continuous callus formation.Conclusion:The results of this study demonstrated that chest wall reconstruction using prosthetic titanium ribs with the coarsening surface could provide an effective support to the defected chest wall.This prosthesis has fine biocompatbility,mechanical strength and corrosion resistance.After the implantation into the defects,the prosthetic titanium rib can achieve successful osseointegration,which makes it a promising prosthesis for the reconstruction of large chest wall defects and deserves further researches in the clinical application.更多还原