Sansone Jason M, Wilsman Norman J, Leiferman Ellen M, Noonan Kenneth J
Department of Orthopaedics and Rehabilitation, University of Wisconsin-Madison, Madison 53792, WI, USA.
J Pediatr Orthop. 2009 Jan-Feb;29(1):61-7. doi: 10.1097/BPO.0b013e3181929c71.
Disruption of the periosteum, whether traumatic or elective, has long been known to accelerate growth in the developing skeleton. However, the extent, timing, and mechanism of the resultant increase in growth velocity (if any) remain undefined. The primary research questions were: Does periosteal resection result in a change (increase) in growth velocity of a long bone at the growth plate? When does the effect start after the resection and for how long? Finally, which of several cellular mechanisms is most likely responsible for the change in growth velocity?
Five lambs underwent proximal tibial growth plate periosteal resection with subsequent measurement of growth velocity by implantable microtransducers or fluorochrome labeling. This former technique provided real-time growth velocity data with a resolution of about 10 microm (width of a proliferative zone chondrocyte). These measurements were accurate at up to 4 weeks postoperative, as verified by fluorochrome labeling, and radiographic measurement. Two lambs were continued on the study for an additional 3 weeks. Histomorphometric and stereological assessments of chondrocytic kinetic parameters were performed on control and experimental tibiae after euthanasia.
Periosteal resection increased growth velocity in every lamb, at every time point, and in a consistent and sustained manner. Histomorphometric correlation to this phenomenon indicated that the cellular basis of this acceleration was most likely the result of hypertrophic chondrocyte axial elongation rather than changes in chondrocyte proliferation, magnitude of hypertrophic chondrocytic swelling, or increased matrix production.
Periosteal resection creates immediate and sustained acceleration of growth resulting from axial elongation of the hypertrophic chondrocyte. Although the increase in growth velocity was consistent, the absolute magnitude of the acceleration suggests that periosteal resection be considered as an adjunct to other primary procedures. Periosteal resection may serve as a useful clinical adjunct to provide a modest growth stimulus in cases of hemihypertrophy or angular limb deformity or to counteract the growth inhibition seen when performing distraction osteogenesis.
长期以来，人们一直认为，无论是外伤性还是选择性的骨膜破坏，都会加速发育中骨骼的生长。然而，由此导致的生长速度增加（如果有的话）的程度、时间和机制仍不明确。主要研究问题是：骨膜切除是否会导致生长板处长骨的生长速度发生变化（增加）？切除后效果何时开始，持续多久？最后，几种细胞机制中哪一种最有可能导致生长速度的变化？
对5只羔羊进行胫骨近端生长板骨膜切除术，随后通过植入式微传感器或荧光染料标记测量生长速度。前一种技术提供了分辨率约为10微米（增殖区软骨细胞宽度）的实时生长速度数据。荧光染料标记和放射学测量证实，这些测量在术后4周内都是准确的。另外两只羔羊继续研究3周。对安乐死后的对照胫骨和实验胫骨进行软骨细胞动力学参数的组织形态计量学和体视学评估。
骨膜切除在每个时间点都使每只羔羊以一致且持续的方式生长速度增加。与该现象的组织形态计量学相关性表明，这种加速的细胞基础最有可能是肥大软骨细胞轴向伸长的结果，而不是软骨细胞增殖、肥大软骨细胞肿胀程度或基质产生增加的变化。
骨膜切除会立即并持续加速生长，这是肥大软骨细胞轴向伸长所致。虽然生长速度的增加是一致的，但加速的绝对幅度表明，骨膜切除可被视为其他主要手术的辅助手段。在半侧肥大或肢体成角畸形的情况下，骨膜切除可作为一种有用的临床辅助手段，提供适度的生长刺激，或抵消进行牵张成骨时出现的生长抑制。
