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題名:The Effect of Platelet Gels on Lumbar Intertransverse Process Spinal Fusion in a Rabbit Model     (16點)
使用血小板纖維蛋白膠在兔子腰椎橫突間融合手術之效果
著者:Sung-Chun Lin(林松俊) ;Shih-Peng Hsieh(謝時鵬) ;Zhi-Hong Wen(溫志宏) ;Chieh-Hsien Tu(杜杰憲) ;Chieng-Hsien Hung(洪慶憲) ;Chi-Chieh Tang(唐紀絜) ;Hsin-Pai Lee(李心白) ;Yen-Hsuan Jean(簡言軒)
出版地區:台灣
出版城市:台北市
學科:醫學綜合
關鍵字:platelet gels ; growth factor ; spinal fusion ; bone graft ; arthrodesis
刊名:Formosan journal of surgery
卷期:41卷1期(2008.2)
頁碼:7-14
語言:英語
摘要: 中文摘要PDF ; 英文摘要PDF

血小板內包含數種生長因子可促進新骨生成,典型代表爲PDGF(血小板衍生因子),TGF-B(組織變形生長因子),VEGF(血管內皮細胞生長因子)以及EGF(表皮生長因子)。其中以血小板衍生因子,組織變形生長因子爲最重要。 但是一般常用的血小板濃厚液缺乏黏合力,因而限制血小板在骨科手術中(骨折或脊椎融合)的應用。在本動物實驗中,利用凝血酶產生器來製造大量的凝血酶,與血小板濃厚液混合後,形成血小板纖維蛋白膠,凝血酶活化血小板內的a-granule,釋放大量生長因子,刺激骨母細胞的生長與分化,這些製備好的血小板纖維蛋白膠被用於脊椎融合手術中以提供促進新骨生成,組織黏合及延長治療時程的作用。 本實驗以十六隻年齡及體重相近的成年大白兔爲材料,隨機分爲兩組,全部接受第五-六腰椎後外側融合手術,手術中取用腸骨脊作自體骨移植,實驗組在自體骨混合製備好的血小板纖維蛋白膠,對照組則用單純的自體骨移植,手術前及手術後每週接受脊椎前後位X光攝影,手術後第六週照X光後將實驗動物犧牲,以肉眼觀察手動(manually Palpation)時脊椎融合部位的穩定度,並摘取兩側融合部位(fusion mass)切片作病理檢查,每個病理切片的骨融合程度以Emery grading scales評估,0代表完全沒有生長,1代表只有纖維組織,2代表纖維組織多於纖維軟骨,3代表纖維軟骨多於纖維組織,4代表只有纖維軟骨,5代表纖維軟骨多於骨小梁,6代表骨小梁多於纖維軟骨,7代表完全是骨小梁,6或7可判斷爲骨融合,所有實驗數據均以Chi-square test及Student's t-test分析。 實驗中一隻實驗組動物於手術後第五日因不明原因死亡,一隻手術部位有輕微感染,共十五隻動物存活至實驗結束(實驗組七隻,對照組八隻)。在X光攝影中,兩側骨融合程度均加以評估,鄰近兩個橫突之間有連續的骨痂形成,即定義爲此側骨融合。實驗組十四側(side)中有十一側達到骨融合(78.6%),對照組十六側中有十側達到骨融合(62.5%)。肉眼觀察手動時,第五一六腰椎之間若沒有任何可見的移動,即定義爲此節穩定骨融合,反之則爲不融合,實驗組七隻中有六隻達到穩定骨融合(87.7%),對照組八隻中有四隻達到穩定骨融合(50%),但這兩項數據均未達統計上有意義的差異水準(p>0.05)。在病理切片Emery grading scales分數,實驗組比對照組有較高的平均值(6.21 vs. 5.06, p=0.03),也有較高的骨融合率(85.7% vs. 31.3%, p=0.002),且在統計上有意義。 結論是血小板纖維蛋白膠在動物實驗中可促進新骨生成並增加脊椎融合手術中的骨融合率,但在人體上的應用,包括用量多少及其標準製備程序,尚須進一步研究。
Objectives: Platelets contain many growth factors which enhance new bone formation. Platelet-rich plasma however has little adhesive strength. This limits its application to some situations in orthopedic surgery such as fracture or spinal fusion. In this study, platelet gels were used in spinal fusion surgery to provide new bone formation and adhesive strength and prolong the effective period of time. Methods: Sixteen adult rabbits received posterolateral intertransverse process fusion at L5-L6 with the use of autogenous bone grafts. Rabbits were randomly divided into experimental and control groups. Two groups of animals received similar surgical procedures. The experimental group received an autogenous bone graft mixed with platelet gels. The control group received an autogenous bone graft only. Posteroanterior radiographs of the spine were taken pre-operatively and then post-operatively every week for 6 weeks. Rabbits were euthanized at 6 weeks after surgery. The spinal fusion was assessed by radiographic analysis and by manual palpation at the level of arthrodesis and at the adjacent proximal and distal levels. Histopathological examination was performed by a biopsy of the bilateral fusion mass and evaluating fusion quality using the Emery grading scales. Results: One rabbit died on the fifth day after the operation for an unknown reason, while the other 15 rabbits (7 in the experimental group and 8 in the control group) survived until the 6th postoperative weeks. Each side of the spine was graded separately, and 11 of the 14 fusion masses (78.6%) in the experimental group and 10 of the 16 fusion masses (62.5%) in the control group had radiographic evidence of fusion. With gross manual palpation, 6 of the 7 motion segments (87.7%) in the experimental group versus 4 of the 8 motion segments (50%) in the control group were determined to have solid fusion. The difference was not statistically significant (p>0.05) for either the radiographic analysis or manual pal


    

本卷期目次
Formosan journal of surgery 41卷1期 (2008.2)
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The Importance of Meticulous Registration during Spinal Navigation for Pedicle Screw Placement/ Feng-Wen SuTao-Chen LeeChun-Chung LuiYu-Ling TingHung-Chen WangYu-Jun LinThung-Ming Su
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Primary Squamous Cell Carcinoma of the Prostate: Report of a Case/ Ping-Ju TsaiChia-Cheng YuJyh-Seng WangTony T WuJong-Khing Huang
原發性攝護腺鱗狀上皮癌:病例報告/ 蔡秉儒余家政王志生吳東霖黃榮慶
使用血小板纖維蛋白膠在兔子腰椎橫突間融合手術之效果/ 林松俊謝時鵬溫志宏杜杰憲洪慶憲唐紀絜李心白簡言軒
The Effect of Platelet Gels on Lumbar Intertransverse Process Spinal Fusion in a Rabbit Model/ Sung-Chun LinShih-Peng HsiehZhi-Hong WenChieh-Hsien TuChieng-Hsien HungChi-Chieh TangHsin-Pai LeeYen-Hsuan Jean
 
   
 
   

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