Ni Ming, Tang Peifu, Wang Yan, Li Gang
Department of Orthopedics, General Hospital of Chinese PLA, Beijing 100853, PR China.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2011 Jun;25(6):661-7.
To investigate whether combining use of platelet-rich plasma (PRP) and decalcified bone matrix (DBM) has synergistic action on promoting bone consolidation and healing.
Forty male New Zealand rabbits (weighing 2.2-2.8 kg) were randomly divided into 4 groups (n = 10). The whole blood was extracted from the central aural artery and PRP was prepared with the Landesberg's method. An 1 cm-defect was made below the tibiofibular joint of the left tibia through osteotomy. In group A, defect was repaired by distraction osteogenesis (1 cm); in group B, defect was repaired with 0.5 cm DBM and then by distraction osteogenesis (0.5 cm); in group C, defect was repaired by distraction osteogenesis (1 cm) and local injection of 1 mL PRP; in group D, defect was repaired by 0.5 cm DBM combined with 1 mL PRP and then by distraction osteogenesis (0.5 cm). Then lengthening started at 7 days after operation, at a rate of 1 mm/day and 0.5 mm every time for 10 days (groups A and C) or for 5 days (groups B and D). After the lengthening, the consolidation was performed. The X-ray films were taken at 0, 12, 17, 27, and 37 days after operation. At 37 days after operation, the tibial specimens were harvested for Micro-CT scanning, three-dimensional reconstruction and biomechanical test.
The X-ray films showed that new bone formation in groups B and C was obviously better than that in groups A and D at 37 days. The bone mineral density (BMD), bone mineral content (BMC), and bone volume fraction (BVF) of groups B and C were significantly higher than those of groups A and D (P < 0.05); the BMD and BMC of group C were significantly higher than those of group B (P < 0.05); the BVF had no significant difference between groups B and C (P > 0.05). There was no significant difference in BMD, BMC, and BVF between groups A and D (P > 0.05). The trabecula number (Tb.N) of group C was significantly more than that of other groups (P < 0.05), and the trabecula spacing (Tb.Sp) of group C was significantly smaller than that of other groups (P < 0.05), but no significant difference was found among other groups (P > 0.05). There was no significant difference in the trabecula thickness among 4 groups (P > 0.05). The ultimate angular displacement had no significant difference among 4 groups (P > 0.05). The maximum torque of groups B and C was significantly higher than that of groups A and D (P < 0.05); the maximum torque of group C was significantly higher than that of group B (P < 0.05); no significant difference was found between groups A and D (P > 0.05).
In the rabbit bone defect/lengthening model, local injection of PRP can enhance bone consolidation effectively during consolidation phase. In normal distraction rate, DBM can promote bone consolidation during distraction osteogenesis. In the early stage of distraction osteogenesis, combining use of DBM and PRP can not further promote bone consolidation and healing.
探讨富血小板血浆（PRP）与脱钙骨基质（DBM）联合应用对促进骨愈合和巩固是否具有协同作用。
将40只雄性新西兰兔（体重2.2 - 2.8 kg）随机分为4组（n = 10）。从耳中央动脉抽取全血，采用Landesberg法制备PRP。通过截骨在左胫骨胫腓关节下方制造1 cm的骨缺损。A组通过牵张成骨修复缺损（1 cm）；B组先用0.5 cm DBM修复缺损，然后通过牵张成骨修复（0.5 cm）；C组通过牵张成骨修复缺损（1 cm）并局部注射1 mL PRP；D组先用0.5 cm DBM联合1 mL PRP修复缺损，然后通过牵张成骨修复（0.5 cm）。术后7天开始延长，延长速度为1 mm/天，每次0.5 mm，A组和C组延长10天，B组和D组延长5天。延长结束后进行巩固。术后0、12、17、27和37天拍摄X线片。术后37天，采集胫骨标本进行Micro-CT扫描、三维重建和生物力学测试。
X线片显示，术后37天时，B组和C组的新骨形成明显优于A组和D组。B组和C组的骨密度（BMD）、骨矿物质含量（BMC）和骨体积分数（BVF）显著高于A组和D组（P < 0.05）；C组的BMD和BMC显著高于B组（P < 0.05）；B组和C组的BVF无显著差异（P > 0.05）。A组和D组的BMD、BMC和BVF无显著差异（P > 0.05）。C组的骨小梁数量（Tb.N）显著多于其他组（P < 0.05），C组的骨小梁间距（Tb.Sp）显著小于其他组（P < 0.05），但其他组之间无显著差异（P > 0.05）。4组的骨小梁厚度无显著差异（P > 0.05）。4组的最终角位移无显著差异（P > 0.05）。B组和C组的最大扭矩显著高于A组和D组（P < 0.05）；C组的最大扭矩显著高于B组（P < 0.05）；A组和D组之间无显著差异（P > 0.05）。
在兔骨缺损/延长模型中，局部注射PRP可在巩固期有效增强骨愈合。在正常牵张速率下，DBM可在牵张成骨过程中促进骨愈合。在牵张成骨早期，DBM与PRP联合应用不能进一步促进骨愈合和巩固。
