Yoshizaki K
Nihon Seikeigeka Gakkai Zasshi. 1984 Aug;58(8):813-28.
Advancements of microsurgery opened up a new horizon in various facets of surgery. Vascularized bone grafting is one of them and promised viable bone grafting with superb results. Whether this bone grafting along with the epiphyseal growth plate yields continuous bone growth is a matter of great concern and the purpose of the present study. Thirty-nine puppies were used for the experiment, and they were divided into two groups. The proximal portion of the fibula was resected with the popliteal artery and vein including their branches to the epiphysis and the metaphysis, and then, the fibula was returned to the original place and fixed with two Kirschner wires. In group 1, the artery and vein were anastomosed with 10-0 Nylon sutures under operative microscope. In group 2, the bone was treated in a same fashion, but without vascular anastomosis. The roentgenological and histopathological changes were sequentially studied in the both groups. Results were summarized as follows: In group 1, 13 dogs were followed until the epiphyseal closure completed. In two dogs, the treated fibula was of equal length with the non-treated opposite fibula, whereas in five dogs there was slight hypogrowth (average 1.8 mm) and in six dogs there was slight overgrowth (average 2.2 mm). Otherwise, The roentgenological appearance was essentially normal. There was no significant difference in the histopathology of the epiphyseal plates in the treated and the non-treated fibulas. In group 2, all the treated fibulas failed to show epiphyseal growth. Roentgenologically destruction and absorption appeared as early as in the first and second week postoperatively, followed by a fracture line through the metaphysis with displacement and nearly complete absorption of the grafted bone. Histopathological findings consisted of early destruction of the growth plate and early necrosis of the bone marrow as well as the bone trabeculae of the epiphysis, metaphysis and diaphysis. Some reparative new bone formation was noted in the grafted area. In conclusion, the results of the experiment showed the possibility of normal bone growth when a bone is grafted with its epiphyseal growth plate provided the vascular supply to them is reconstructed.
显微外科的进步在外科手术的各个方面开辟了新的视野。带血管蒂骨移植就是其中之一，并有望实现可行的骨移植且效果极佳。这种骨移植连同骨骺生长板是否能产生持续的骨生长是一个备受关注的问题，也是本研究的目的。39只幼犬被用于实验，它们被分为两组。切除腓骨近端及其腘动脉和静脉，包括其至骨骺和干骺端的分支，然后将腓骨放回原位并用两根克氏针固定。在第1组中，在手术显微镜下用10-0尼龙缝线吻合动脉和静脉。在第2组中，对骨进行相同方式的处理，但不进行血管吻合。对两组依次进行X线和组织病理学变化研究。结果总结如下：在第1组中，13只狗被随访至骨骺闭合完成。在2只狗中，处理后的腓骨与未处理的对侧腓骨长度相等，而在5只狗中有轻微生长不足（平均1.8毫米），在6只狗中有轻微过度生长（平均2.2毫米）。否则，X线表现基本正常。处理后的和未处理的腓骨骨骺板的组织病理学没有显著差异。在第2组中，所有处理后的腓骨均未显示骨骺生长。X线检查显示，早在术后第一周和第二周就出现破坏和吸收，随后通过干骺端出现骨折线并伴有移位，移植骨几乎完全吸收。组织病理学发现包括生长板早期破坏、骨髓早期坏死以及骨骺、干骺端和骨干的骨小梁坏死。在移植区域注意到一些修复性新骨形成。总之，实验结果表明，当移植带有骨骺生长板的骨并重建其血管供应时，骨有正常生长的可能性。
