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目的观察对火器伤造成的骨缺损行一期原位骨延长术治疗的病理学和影像学变化,分析在骨膜损伤条件下行骨延长术治疗骨缺损的可行性及其生物学基础。方法成年犬38只,随机分成两组,制造犬股骨火器伤骨缺损模型,对两组动物分别采用外固定器行一期原位骨延长术和单纯骨折固定术治疗,治疗全程行X线检查、病理学检查和放射性核素骨显像分析。结果骨延长组动物8周内骨延长长度为(2.82±0.94)cm,平均为伤前股骨全长的19.3%(15.8%～21.4%)。骨延长组动物骨缺损区的延迟相放射性计数逐渐增加。两组动物骨折端的延迟相和血池相变化趋势一致,其放射性计数无统计学差异。骨延长主要的成骨方式是软骨化骨。残存骨碎片可能具有成骨能力。结论残存骨膜和骨碎片在骨延长的成骨过程中有明显作用。但在骨膜损伤的条件下,骨延长技术仍可用于其骨缺损的治疗,骨折端周围组织新生血管不仅为骨愈合提供了血供,而且为其提供了骨细胞的来源。操作正确的骨延长术对骨折端血供和骨代谢无明显的不良影响。
OBJECTIVE: To observe the pathological and radiological changes of primary bone defects caused by firearm injuries and to evaluate the feasibility and biological basis of treating bone defects under periosteal injury. Methods Thirty-eight adult dogs were randomly divided into two groups to make a model of femoral cannibal firearm bone defect. Two groups of animals were treated by external fixation with a single-stage orthotopic bone augmentation and simple fracture fixation respectively. All the patients underwent X-ray examination , Pathological examination and radionuclide bone imaging analysis. Results The length of bone extension within 8 weeks was (2.82 ± 0.94) cm in bone extension group, averaging 19.3% (15.8% -21.4%) of the total length of pre-injury femur. In the bone-lengthening group, the delayed phase radioactive counts gradually increased. There was no significant difference between the two groups in the delayed phase of the fracture and the change of blood pool phase. The main way of osteogenesis is osteochondrosis. Residual bone fragments may have osteogenic ability. Conclusion Residual periosteum and bone fragments play an important role in the process of osteogenesis. However, under the condition of periosteum injury, bone elongation can still be used for the treatment of bone defects. The tissue surrounding the fracture end not only provides blood supply for bone healing, but also provides the source of bone cells. Correct operation of bone elongation on the fracture side of the blood supply and bone metabolism had no significant adverse effects.