Klotch D W, Ganey T M, Slater-Haase A, Sasse J
Department of Surgery, University of South Florida College of Medicine, Tampa 33606.
Otolaryngol Head Neck Surg. 1995 Feb;112(2):291-302. doi: 10.1016/S0194-59989570252-0.
Distraction osteoneogenesis, callotasis, has been demonstrated to be an effective means of lengthening long bones. A variation of Ilizarov's technique produces a transport disk from one cut surface of bone within a defect and advances the disk to the opposite surface to close the defect. This process, previously described by Costantino et al. (Arch Otolaryngol Head Neck Surg 1990; 116:535-45), demonstrated bone formation within the distraction site. The precise mechanism of bone formation has not yet been described for the mandible. Four conditioned beagles were studied, with one control dog maintained in neutral fixation and three dogs distracted at 0.25 mm every 8 hours. A two-cm defect was closed, and dogs were kept in fixation for 1 week after closure, after which they were killed. Three sites were evaluated: (1) the distraction seam, (2) the interface of the cortical and distracted bone, and (3) the cortexes at the closed defect. Each site was bisected, and one half was decalcified for immunohistochemical and hematoxylin and eosin pathologic evaluation. The vascular basement membrane was labeled for laminin and type IV collagen. Both of these substances demonstrate the differentiation of the vascular matrix component predisposing primary bone formation. Labels were intense at the distraction seam where intense angiogenesis occurred. No hyalin cartilage was observed at the distraction site, which indicates that the fixation was stable and that ossification occurred primarily without intermediate callous formation. This model demonstrated that osteoclasts within the canine model produce bone through primary bone formation within an angiogenic matrix rich in basement membrane laminin and type IV collagen. Likewise, bone is species specific in mineral composition for dog mandible. Understanding the formation and composition of distracted bone is essential for understanding application of this technique within the clinical setting.
牵引成骨术，即骨痂延长术，已被证明是延长长骨的有效方法。伊利扎罗夫技术的一种变体是在缺损内从骨的一个切割面制作一个运输盘，并将该盘推进到相对的表面以闭合缺损。这个过程，先前由科斯坦蒂诺等人描述过（《耳鼻咽喉头颈外科文献》1990年；116:535 - 45），显示了牵引部位有骨形成。下颌骨骨形成的确切机制尚未有描述。对四只成年比格犬进行了研究，一只对照犬保持中立固定，三只犬每8小时牵引0.25毫米。一个2厘米的缺损被闭合，犬在闭合后固定1周，之后处死。评估了三个部位：（1）牵引缝，（2）皮质骨与牵引骨的界面，以及（3）闭合缺损处的皮质骨。每个部位均一分为二，其中一半进行脱钙处理，用于免疫组织化学以及苏木精和伊红病理评估。对血管基底膜用层粘连蛋白和IV型胶原进行标记。这两种物质都显示了血管基质成分的分化，有利于原发性骨形成。在发生强烈血管生成的牵引缝处标记强烈。在牵引部位未观察到透明软骨，这表明固定是稳定的，骨化主要是在没有中间骨痂形成的情况下发生的。该模型表明，犬模型中的破骨细胞通过在富含基底膜层粘连蛋白和IV型胶原的血管生成基质内的原发性骨形成来产生骨。同样，犬下颌骨的骨在矿物质组成上具有物种特异性。了解牵引骨的形成和组成对于理解该技术在临床环境中的应用至关重要。
