The Experimental Study Of Repairing Osteomyelitic Bone Defect By Ossification Of Muscle Flap

一BackgroundOsteomyelitic bone defection(OBD) is very suffering to patients and formidable to doctors.Many patients with the OBDs have to receive amputation.The therapis for the OBD are anti-infection and repair bone defection(BD).These years,there are many articles about repairing the BD by Muscle flap with vessel pedicle(MFVP) and inducing muscle cells to bone cells by Ad-rhBMP-2.There was no article about the course of muscle flap ossification and transferring Ad-rhBMP-2 for curing the OBD.My study is to cure the OBD by the ossification of the MFVP,then transferring Ad-rhBMP-2 accelerating inducing muscle flap ossification.Provide a new effect therapy for the CO.二ObjectiveEvaluate and compare the therapy effect of the two ways:①using the technology of microsurgery transferring the MFVP,②combining the technology of microsurgery transferring the MFVP to OBD with geneⅣtransferring the Ad-rhBMP-2 to MFVP.三Method(一) Make OBD modals of the Wistar rats.We put a carbasus with 0.3 ml Staphylococcus aureus(SA)(3×106CFU) and injected 5%SM in the bone defection,and covered by bone wax.14 days later,we got the modals.(二) The treatment of OBD1 GroupingThe 120 Wistar rats modals were meanly divided into 3 groups randomly.The 1st group:Control group.The 2nd group:Muscle flap group.The 3rd group:with transferring Ad-rhBMP-2 group.2 DebridingMorbid soft tissue and necrotic bone were debrided until we can see the normal hemodiapedesis and infected bone was remained.The containing cavum medulla was penetrated by high speed electrical drill. 3 OperationsThe 1st group:we had not any proposal after debriding.The 2nd group:Before debriding,We did an incision about 4cm from inguina on, finding the superficial abdominal vessel and take the adaptive MFSAVP through a latent tunnel to fill the OBD,then sutured skin.The 3rd group:The 1st step was transferring muscle flap.It is the same as the 2nd group.The 2nd step was that we injected Ad-rhBMP-2 in the muscle flap from 4 points, and then sutured skin.4 Post-operation treatmentsViewed the rats condition of all over the body and vulnus timedly everyday.Muscle injection the Papaverine(10mg/kg/d) avoids artery spasm in 3 days and the Cefuroxime (100mg/kg/d) for anti-infection until intention.We executed 8 rats respectively at 7,14,28, 42,56day after theoperation to get the appearance of local tissue condition,the rectal temperature,the leuk-analysis,the tibias DR and pathological section for evaluating the course of ossification.四Result(一) ModalTemperature,lencocyte count,weight,CR and pathological section under light microscope showed at the 7 day after modal making,it is acute osteomyelitis stage,and 14 day after modal making,it is chronic osteomyelitis stage,so we got the modal.(二) TherapyThe intention time of the 1 st group was longer than that of the 2nd and 3rd.The 1st group:56 days later,bone defection is clear with its verge smooth and bone density higher while its area diminished to 1/2 of it was.The 2nd group at the 56 day and the 3rd group at the 42 day after operation:the OBDs were repaired by the ossification of the muscle flap.五Conclusion(一) The Wistar rats tibia acute osteomyelitic bone defection modal was made by injecting Staphylococcus aureus(3×10~6CFU),sodium morrhuate(5%) in bone defection then which was covered by absorbing film 7 days later.(二) The acute stage of osteomyelitis turned to chronic stage after 7 days effective antibiotic therapy.(三) The letter "d" means the diameter of the bone which the OBD occurred.The letter "m" means the OBD area.The natural cure is impossible if m＞d×2d.(四) muscle flap ossification repair OBD after transferred to it with vessel pedicle.(五) There is no obvious rejection during the ossification course sinceⅣtransferring Ad-rhBMP-2(5×10~8PFU/ml) in muscle flap byⅣway.(六) Transferring Ad-rhBMP-2 in muscle flap byⅣway,induce it ossification to repair the OBD.(七) Ad-rhBMP-2 shorten the time of ossification when use the muscle flap with vessel pedicle repairing the OBD.