Alper GÜLTEKİN, A. Meriç ÜNAL, Mehtat ÜNLÜ, Safa SATOĞLU

THE EFFECTS OF HUMAN AMNİOTİC FLUİD AND MEMBRANE ON FRACTURE HEALİNG ON RAT FRACTURE MODEL

ObjectiveHuman amniotic fluid contains several growth factorsand hyaluronic acid. It has positive effect in healing the tendon, nerve and bone injuries. Human amniotic membrane has positive effects on tendon, nervehealing and is also used for skin healing in burns andcomplex wounds. We hypothesized that human amniotic fluid and human amniotic membrane have positive stimulating effects on fracture healing. The aim ofthis study is to investigate the effects of human amniotic fluid and human amniotic membrane on bonehealing in rat tibial bone fracture model.Materials and MethodsA 72 open fracture model was created for both tibial bones of 36 male Wistar rats. They were dividedinto three groups. Group-1 was the control group. InGroup-2, human amniotic fluid which was taken fromamniocentesis of seronegative pregnants in their second trimester was injected to the fracture site. Ingroup-3, human amniotic membrane which was takenfrom normal seronegative term pregnants after their caesarean sections was wrapped around fracturesite and then human amniotic fluid was injected tothe fracture site. Radiological fracture union patternsand histopathological evaluations with Modified Lane-Sandhu classification were performed with Modified Lane-Sandhu classification at the end of third andsixth weeks.ResultsAt third week, Group-2 and Group-3 had better histopathological results than Group-1. At sixth week,Group-2 had significantly better results than Group-1.Group-3 had also better results than Group-1 although there was no statistical significance. At third andsixth weeks, histopathological scores of Group-2 weresignificantly better than Group-3(p=0.021, p=0.019).ConclusionOur data suggested that human amniotic fluid had positive effect itself but with human amniotic membrane,it had no positive effect on bone healing. With its lowimmunity and easy delivery, human amniotic membrane can also be used to stimulate bone healing incombination with human amniotic fluid with differentapplication techniques.

İNSAN AMNİOTİK SIVISI VE MEMBRANININ SIÇAN KIRIK MODELİNDE KIRIK İYİLEŞMESİNE ETKİLERİ

Amaç İnsan amniotik sıvısı çeşitli büyüme faktörleri ve hyaluronik asit içermektedir. Tendon, sinir ve kemik yaralanmalarının iyileşmesi üzerine pozitif etkiye sahiptir. İnsan amniotik membranı da tendon ve sinir iyileşmesi üzerine etkili olmakla birlikte yanık ve kompleks yaralarda deri iyileşmesi üzerine de pozitif etkiye sahiptir. Çalışmanın hipotezi insan amniotik sıvısı ve insan amniotik membranının kırık iyileşmesini pozitif yönde uyarmasıdır. Çalışmanın amacı, rat tibia kırık modelinde insan amniotik sıvı ve membranının kırık iyileşmesine etkisinin araştırılmasıdır. Gereç ve Yöntem 36 erkek Wistar ratın her iki tibiaları kullanılarak 72 açık kırık modeli oluşturuldu ve üç gruba ayrıldı. Grup1 kontrol grubu olarak alındı. Grup-2’de, seronegatif gebelerin ikinci trimesterde yapılan amniosentezlerinden alınan insan amniotik sıvısı kırık bölgesine enjekte edildi. Grup-3’te ise seronegatif term gebelerin sezaryanları sonrası alınan insan amniotik membranı kırık bölgesine sarıldı ve sonrasında insan amniotik sıvı enjeksiyonu yapıldı. Uygulamalar sonrası üçüncü ve altıncı haftalarda radyolojik kırık kaynama paternleri ve Modifiye Lane-Sandhu sınıflaması kullanılarak yapılan histopatolojik ölçümler değerlendirildi. Bulgular Üçüncü hafta sonunda, Grup-2 ve Grup-3’te Grup1’e gore daha iyi histopatolojik sonuçlar elde edildi. Altıncı haftada ise Grup-2’nin sonuçları Grup-1’den daha iyi bulundu. Grup-3’ün de sonuçları Grup-1’den iyi olmakla birlikte istatistiksel olarak anlamlı fark saptanmadı. Üçüncü ve altıncı haftalarda Grup-2’nin histopatolojik skoları Grup-3’ten anlamlı derecede daha iyi bulundu(p=0.021, p=0.019). Sonuç Mevcut sonuçlara gore insan amniotik sıvısının kırık iyileşmesi üzerine pozitif etkisi olmakla birlikte insan amniotik membranının pozitif etkisi saptanamamıştır. Düşük immünitesi ve temin kolaylığı nedeni ile insan amniotik membranı da insan amniotik sıvısı ile kombine bir şekilde kırık iyileşmesinde farklı uygulama teknikleri ile kullanılabilir.

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