Brueton R N, Brookes M, Heatley F W
Department of Orthopaedic Surgery, St. Thomas's Hospital, London, England.
Clin Orthop Relat Res. 1990 Aug(257):286-304.
The vascular repair of a lower tibial transverse osteotomy in the New Zealand white rabbit held in an external fixator was studied in three groups. In the first group, composed of 18 animals, the osteotomy gap was maintained throughout repair. Three animals were killed every two weeks up to 12 weeks postoperatively. In the second group, composed of three animals killed at six weeks, the fragments were brought into contact. In a third and similar group, the osteotomy was compressed. Plain roentgenograms were taken weekly, and intraarterial perfusion with Micropaque was performed when the animals were killed. Roentgenography using fine-grain film, microradiography, and histology were carried out on a midsagittal tibial slice. The results showed that following transverse osteotomy in which the gap was maintained, vascular union of the proximal and distal cortices and associated external callus masses had usually occurred by ten weeks postoperatively. However, an occasional hypovascular zone at the osteotomy site at 12 weeks was associated with fibrous delayed union. In contrast, when apposition or compression of the fragments was used, repair was accelerated, and cortical bone union was established at six weeks. Vascular union of the fragments occurred predominantly through the medullary vessels. The results emphasize the overriding clinical importance of abolition of a fracture gap to achieve rapid revascularization of a fracture and its union by bone.
在三组新西兰白兔中研究了采用外固定器固定的胫骨下段横行截骨术的血管修复情况。第一组由18只动物组成，在整个修复过程中保持截骨间隙。术后每两周处死3只动物，直至术后12周。第二组由3只在6周时处死的动物组成，使骨块接触。在第三组类似的动物中，对截骨进行加压。每周拍摄普通X线片，在处死动物时进行微显影剂动脉灌注。对胫骨矢状面切片进行细颗粒胶片X线摄影、微放射摄影和组织学检查。结果显示，在保持间隙的横行截骨术后，近端和远端皮质以及相关骨痂块的血管连接通常在术后10周时出现。然而，在12周时截骨部位偶尔出现的低血管区与纤维性延迟愈合有关。相比之下，当采用骨块对接或加压时，修复加速，在6周时实现皮质骨愈合。骨块的血管连接主要通过髓内血管发生。这些结果强调了消除骨折间隙对于实现骨折快速再血管化及其骨愈合的首要临床重要性。
