Yin Qudong, Mao Dong, Rui Yongjun
Department of Orthopaedics, Wuxi No.9 People's Hospital Affiliated to Soochow University, Wuxi Jiangsu, 214062, P. R. China.
Orthopedic Research Institute, Wuxi No.9 People's Hospital Affiliated to Soochow University, Wuxi Jiangsu, 214062, P. R. China.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2024 Oct 15;38(10):1254-1260. doi: 10.7507/1002-1892.202403021.
To investigate the causes of spontaneous osteogenesis of Masquelet technique induced membrane.
Forty-two male Sprague-Dawley rats aged 7-9 weeks were selected to establish a critical-sized bone defect of the right middle femur model. Then the rats were randomly divided into 4 groups, with 12 rats in groups A-C and 6 rats in group D. The bone defects in groups A-C were filled with vancomycin-loaded polymethyl methacrylate bone cement spacers. Then the Kirschner wires were used for intramedullary fixation in groups A and B, and the bone cement was used to connect the bone cement spacers and the bone ends in group B. The steel plate was used to fixation in group C. The bone defect in group D was only fixed with steel plate as a blank control group. The general condition was observed after operation. At 5 weeks after operation, 6 rats in groups A-C were selected for STRO-1 immunohistochemical staining to observe the content of mesenchyme stem cells (MSCs) in the induced membrane (STRO-1 cells). At 12 weeks after operation, the remaining rats in groups A-D were taken for X-ray observation, gross observation, and histological observation (HE, safranin O-green staining) to observe the spontaneous osteogenesis of the membrane.
All rats in the 4 groups survived until the completion of the experiment. At 5 weeks after operation, the immunohistochemical staining showed that group B was negative, while the contents of MSCs in the induced membrane in groups A and C were 14.20%±1.92% and 5.00%±0.71%, respectively, with a significant difference ( <0.05). At 12 weeks after operation, group A showed that the new bone formed at the osteotomy site and growth towards the center of the bone defect, with an average length of 3.1 mm on one side; and the presence of bone, cartilage lesions, fibers, and a small amount of neovascularization were observed in the induced membrane. Group C only had a small amount of new bone at the osteotomy site, and a small amount of neovascularization in the induced membrane. Groups B and D did not have any new bone, but bone resorption or atrophy at the osteotomy site.
Although the Masquelet technique induced membrane has osteogenesis, the key factor for the spontaneous osteogenesis is the bone marrow overflow from the bone marrow cavity providing MSCs. The spontaneous osteogenesis of the induced membrane belongs to endochondral ossification.
探讨Masquelet技术诱导膜自发成骨的原因。
选取42只7 - 9周龄雄性Sprague-Dawley大鼠，建立右侧股骨中段临界尺寸骨缺损模型。然后将大鼠随机分为4组，A - C组每组12只，D组6只。A - C组骨缺损处植入载万古霉素的聚甲基丙烯酸甲酯骨水泥间隔物。A组和B组采用克氏针髓内固定，B组用骨水泥连接骨水泥间隔物与骨端。C组采用钢板固定。D组骨缺损仅用钢板固定作为空白对照组。术后观察一般情况。术后5周，选取A - C组6只大鼠进行STRO-1免疫组化染色，观察诱导膜中间充质干细胞（MSCs）含量（STRO-1阳性细胞）。术后12周，对A - D组剩余大鼠进行X线观察、大体观察及组织学观察（苏木精-伊红染色、番红O - 固绿染色），观察诱导膜的自发成骨情况。
4组大鼠均存活至实验结束。术后5周，免疫组化染色显示B组为阴性，A组和C组诱导膜中MSCs含量分别为14.20%±1.92%和5.00%±0.71%，差异有统计学意义（P<0.05）。术后12周，A组显示截骨部位有新骨形成并向骨缺损中心生长，一侧平均长度为3.1 mm；诱导膜中有骨、软骨病变、纤维及少量新生血管。C组截骨部位仅有少量新骨，诱导膜中有少量新生血管。B组和D组均无新骨形成，但截骨部位有骨吸收或萎缩。
虽然Masquelet技术诱导膜有成骨作用，但自发成骨的关键因素是骨髓腔溢出的骨髓提供了MSCs。诱导膜的自发成骨属于软骨内成骨。
