Greksa Ferenc, Tóth Kálmán, Boros Mihály, Szabó Andrea
Szegedi Tudományegyetem, Általános Orvostudományi Kar Ortopédiai Klinika Szeged.
Magy Seb. 2012 Aug;65(4):178-83. doi: 10.1556/MaSeb.65.2012.4.2.
INTRODUCTION/AIMS: Our aim was to characterize the periosteal microvascular reaction induced by the destruction of endosteal vasculature by reaming, and to monitor the time sequence of the events. We have also compared the microcirculatory effects of different implant materials that are most frequently employed in human endoprosthetics.
The right tibia of male Wistar rats was reamed by microsurgical means and implanted with titanium, steel-alloy or polyethylene nails. Intravital videomicroscopic examinations of the anteromedial and anterolateral surfaces of the tibial periosteum were performed to evaluate the changes in the overall vascular and capillary densities. Microscopic mechanical tests were used to assess the stability of the implants. In control groups, reaming without nailing was performed and the microvascular changes were examined 6 and 12 weeks after surgery.
Reaming alone caused a significant increase in the vascular density of the anteromedial periosteum and a bilateral increase in capillary density. Vascular density at the anteromedial side was increased after all of the implant materials applied, while only polyethylene induced remarkable increases in the capillary and vascular densities at the anterolateral side. Furthermore, polyethylene did not bring about osseointegration.
Enhanced periosteal angiogenesis could be demonstrated after 12 weeks following tibial reaming. The compensatory microvascular reactions evoked by destruction of endosteal microcirculation of long bones are not influenced by osseo-integrative implant materials, but materials of poor osseointegration properties induce considerable compensatory increases in the microvascular density of the periosteum.
引言/目的:我们的目的是描述扩髓破坏骨内膜血管系统所引发的骨膜微血管反应,并监测这些事件的时间顺序。我们还比较了人类假体中最常用的不同植入材料的微循环效应。
采用显微外科方法对雄性Wistar大鼠的右胫骨进行扩髓,并植入钛钉、钢合金钉或聚乙烯钉。通过活体显微镜检查胫骨骨膜的前内侧和前外侧表面,以评估总体血管密度和毛细血管密度的变化。采用微观力学测试来评估植入物的稳定性。在对照组中,进行不植入钉子的扩髓操作,并在术后6周和12周检查微血管变化。
单纯扩髓导致前内侧骨膜的血管密度显著增加,毛细血管密度双侧增加。应用所有植入材料后,前内侧的血管密度均增加,而只有聚乙烯能显著增加前外侧的毛细血管和血管密度。此外,聚乙烯未实现骨整合。
胫骨扩髓12周后可证明骨膜血管生成增强。长骨骨内膜微循环破坏所引发的代偿性微血管反应不受骨整合植入材料的影响,但骨整合性能较差的材料会导致骨膜微血管密度出现相当大的代偿性增加。