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肥大型骨不连断端组织成骨潜能的实验研究
Experimental Study of Bone Formation Potential of the Intervening Tissue at the Hypertrophic Nonunion Site
【作者】 陆联松；
【导师】 康庆林；
【作者基本信息】 苏州大学 ， 外科学， 2013， 硕士
【摘要】 目的观察肥大型骨不连断端及其周围区域组织的结构特点，评估其成骨潜能。方法收集2009年至2012年因肥大型骨不连在我院行手术治疗患者的骨不连断端标本共25例，将切取的标本按距离骨不连断端中心的远近分为中心区、周围区及骨痂区三组，通过光学显微镜及透射电镜观察不同区域的组织结构特点和微观特征。采用免疫组织化学方法检测这些组织内BMP-2、DCN及VEGF的表达，在高倍镜下观察阳性细胞并计数，进而作统计分析。结果肥大型骨不连断端区域呈现出不同的组织类型，中心区主要是纤维化组织，其内可见大量的成纤维样细胞；周围区可见大量的软骨细胞，可见少量的新生血管形成；骨痂区见有一定量的成骨细胞及丰富的新生血管。免疫组化染色显示肥大型骨不连断端中心区、周围区及骨痂区组织BMP-2、DCN及VEGF的表达明显不同（P<0.05）。骨痂区BMP-2、VEGF的表达明显高于中心区和周围区（P<0.05），周围区组织DCN的含量则明显高于中心区及贴骨瘢痕区（P<0.05）。结论肥大型骨不连在形成的过程中组织结构发生变化，其断端区域的组织类型、细胞类型不同，BMP-2、DCN的含量减少，断端组织的抗纤维化和成骨能力下降，断端区域不同部位组织的成骨潜能不同。
【Abstract】 Objective To observe the structure of the intervening and surrounding tissue at thehypertrophic nonunion site, to assess the potential of bone formation.Methods Tissue from the nonunion site and its surroundings was extracted from25patients with hypertrophic nonunion within2009to2012. Each sample was classified bythe distance to the center of the nonunion site as three teams:central area, surrounding areaand callus area. Tissue structure and microscopic characteristics of the three regions wereinvestigated by using optical microscope, transmission electron micros-cope. Detect theexpression of BMP-2、DCN and VEGF by immunohistochemistry. Assess the potential ofbone formation by analyzing the differences of each group.Results The area of hypertrophic nonunion ends displayed different non-uniformhistological features. The central area mainly displayed fibrotic tissue which contained alarge number of fibroblast-like cells; The surrounding area contained masses ofchondrocytes without neovascularization; The scar area contained a certain amount ofosteoblasts with rich neovascularization. The results of immunohistochemistry showeddiscrepant expression of BMP-2、DCN and VEGF. The expression of BMP-2and VEGFwas more intense in the scar area than in the center area or in the surrounding area(P<0.05).However, The content of DCN in the surrounding area was significantly higherthan the central area or the scar area.Conclusion The tissue structure of hypertrophic nonunion changed in the process ofits formation. The stump region contained different tissue types and cell types, the contentof BMP-2, DCN decreased. The anti-fibrosis and ossification ability of the nonunion tissuedecreased. The different parts of stump region had different osteogenic potential.