直接复位与延期复位对骨折愈合过程的生物力学和组织学分析

Biomechanical and histological analyses of the fracture healing process after direct or prolonged reduction.

机构信息

Hannover Medical School (MHH) -Trauma Department, Carl-Neuberg-Str. 1, 30625, Hannover, Germany.

Institute for Robotics and Process Control, Technical University Braunschweig, Mühlenpfordtstraße 23, 38106, Brunswick, Germany.

出版信息

Eur J Med Res. 2018 Sep 4;23(1):39. doi: 10.1186/s40001-018-0337-6.

DOI:10.1186/s40001-018-0337-6

PMID:30180907

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC6122772/

Abstract

BACKGROUND

Reduction of femoral shaft fractures remains a challenging problem in orthopaedic surgery. Robot-assisted reduction might ease reduction and fracture treatment. However, the influence of different reduction pathways on patients' physiology is not fully known yet. Therefore, the aim of this study was to examine the biomechanics and histology of fracture healing after direct and prolonged robot-assisted reduction in an in vivo rat model.

METHODS

144 male CD rats were randomly assigned to 12 groups. Each animal received an external fixator and an osteotomy on the left femoral shaft. On the fourth postoperative day, the 1× reduction groups received a single reduction maneuver, whereas the 10× reduction groups received the same reduction pathway with ten repetitions. The control groups did not undergo any reduction maneuvers. Animals were killed after 1, 2, 3 and 4 weeks, respectively, and the composition of the fracture gap was analyzed by µCT and non-decalcified histology. Biomechanical properties were investigated by a three-point bending test, and the bone turnover markers PINP, bCTx, OPG, sRANKL, TRACP-5b, BALP, and OT/BGP were measured.

RESULTS

One week after the reduction maneuver, µCT analysis showed a higher cortical bone volume in the 1× reduction group compared to the 10× reduction group. Biomechanically, the control group showed higher maximum force values measured by three-point bending test compared to both reduction groups. Furthermore, less collagen I formation was examined in the 10× reduction group compared to the control group after 1 week of fracture healing. PINP concentration was decreased in 10× reduction group after 1 week compared to control group. The same trend was seen after 3 weeks.

CONCLUSION

A single reduction maneuver has a beneficial effect in the early phase of the fracture healing process compared to repeated reduction maneuvers. In the later phase of fracture healing, no differences were found between the groups.

摘要

背景

减少股骨干骨折仍然是骨科手术中的一个具有挑战性的问题。机器人辅助复位可能会简化复位和骨折治疗。然而，不同复位途径对患者生理的影响尚未完全了解。因此，本研究旨在检查直接和延长机器人辅助复位对活体大鼠模型骨折愈合的生物力学和组织学影响。

方法

将 144 只雄性 CD 大鼠随机分为 12 组。每组动物均接受左股骨干外固定器和截骨术。术后第 4 天，1× 复位组接受单次复位操作，而 10× 复位组则接受相同的复位途径重复 10 次。对照组不进行任何复位操作。分别于术后 1、2、3 和 4 周处死动物，通过 µCT 和非脱钙组织学分析骨折间隙的组成。通过三点弯曲试验研究生物力学性能，并测量骨转换标志物 PINP、bCTx、OPG、sRANKL、TRACP-5b、BALP 和 OT/BGP。

结果

复位操作后 1 周，µCT 分析显示 1× 复位组皮质骨体积高于 10× 复位组。生物力学方面，与 2 个复位组相比，对照组三点弯曲试验的最大力值更高。此外，与对照组相比，1 周骨折愈合时 10× 复位组的胶原 I 形成减少。与对照组相比，10× 复位组的 PINP 浓度在第 1 周后降低。第 3 周后也出现了同样的趋势。