Kojimoto H, Yasui N, Goto T, Matsuda S, Shimomura Y
Department of Orthopaedic Surgery, National Defense Medical College, Saitama, Japan.
J Bone Joint Surg Br. 1988 Aug;70(4):543-9. doi: 10.1302/0301-620X.70B4.3403595.
The histology and mechanics of leg lengthening by callus distraction were studied in 27 growing rabbits. Tibial diaphyses were subjected to subperiosteal osteotomy, held in a neutral position for 10 days and then slowly distracted at 0.25 mm/12 hours, using a dynamic external fixator. Radiographs showed that the gap became filled with callus having three distinct zones. Elongation appeared to occur in a central radiolucent zone; this was bounded by two sclerotic zones. Histologically, the radiolucent zone consisted of longitudinally arranged cartilage and fibrous tissue while the sclerotic zones were formed by fine cancellous bone. New bone occasionally contained islands of cartilage, suggesting it had been formed by endochondral ossification. After completion of distraction, the two sclerotic zones fused, shrank and were eventually absorbed, leaving tubular bone with a new cortex. When the periosteum had been removed at the operation, callus formation was markedly disturbed and there was failure of bone lengthening. Scraping of endosteum, in contrast, did not have a pronounced effect. These results suggest that the preservation of periosteum is essential if bone lengthening by callus distraction is to succeed, and that preservation of the periosteum is more important than careful corticotomy.
对27只生长中的兔子进行了骨痂牵张延长腿部的组织学和力学研究。胫骨骨干接受骨膜下截骨，保持中立位10天，然后使用动力外固定器以0.25毫米/12小时的速度缓慢牵张。X线片显示，间隙被具有三个不同区域的骨痂填充。延长似乎发生在中央透光区；该区域由两个硬化区界定。组织学上，透光区由纵向排列的软骨和纤维组织组成，而硬化区由细的松质骨形成。新骨偶尔含有软骨岛，提示其通过软骨内成骨形成。牵张完成后，两个硬化区融合、缩小并最终被吸收，留下具有新皮质的管状骨。手术时去除骨膜后，骨痂形成明显受干扰，骨延长失败。相比之下，刮除骨内膜没有明显影响。这些结果表明，如果要通过骨痂牵张成功延长骨骼，保留骨膜至关重要，并且保留骨膜比仔细的皮质切开术更重要。
