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《中醫(yī)正骨》[ISSN:1001-6015/CN:41-1162/R]

卷:

第25卷

期數(shù):

2013年12期

頁碼:

15-19

欄目:

骨質(zhì)疏松癥

出版日期:

2013-12-30

文章信息/Info

Title:

Study on the biomechanical property and histomorphological changes of fractured vertebrae after percutaneous vertebroplasty

作者:

全仁夫¹; 倪月明¹; 鄭宣²; 謝尚舉²; 李長明²

1.浙江省杭州市蕭山區(qū)中醫(yī)院,浙江 杭州 311201;
2.浙江中醫(yī)藥大學(xué),浙江 杭州 310053

Author(s):

Quan Renfu^*; Ni Yueming; Zheng Xuan; Xie Shangju; Li Changming.^*Xiaoshan

Hospital of Traditional Chinese Medicine,Hangzhou 311201,Zhejiang,China

關(guān)鍵詞:

脊柱骨折 椎體成形術(shù) 生物力學(xué) 組織學(xué) 動物實(shí)驗(yàn)

Keywords:

Spinal fractures;  Vertebroplasty;  Biomechanics;  Histology;  Animal experimentation

摘要:

目的:觀察經(jīng)皮椎體成形術(shù)后骨折椎體的生物力學(xué)性能和組織形態(tài)。方法:將105只新西蘭雌兔隨機(jī)分為3組,每組35只。B 組和C組采用卵巢切除加地塞米松肌肉注射法進(jìn)行骨質(zhì)疏松造模。造模成功后,在所有實(shí)驗(yàn)動物L(fēng)₄和L₅ 椎體上通過手術(shù)造成骨缺損,C組實(shí)驗(yàn)動物在形成骨缺損的椎體中模擬經(jīng)皮椎體成形術(shù)注射調(diào)制好的聚甲基丙烯酸甲酯骨水泥Ⅲ 。分別于模擬經(jīng)皮椎體成形術(shù)完成后2周、4周、8周、12周、16周、24周、48周從各組中隨機(jī)選取5只實(shí)驗(yàn)動物處死,取出進(jìn)行過 手術(shù)的2個(gè)椎體,進(jìn)行生物力學(xué)強(qiáng)度測定。同時(shí),C組作鹽酸四環(huán)素?zé)晒鈽?biāo)記,經(jīng)甲苯胺藍(lán)染色后進(jìn)行椎體組織形態(tài)觀察。結(jié)果:① 椎體軸向壓縮實(shí)驗(yàn)結(jié)果。除48周外[(0.54±0.14)mm,(0.83±0.26)mm,(0.54±0.16)mm,F=3.744,P=0.054],3組椎 體標(biāo)本術(shù)后2周、4周、8周、12周、16周、24周時(shí)的軸向壓縮位移比較,組間差異均有統(tǒng)計(jì)學(xué)意義[(0.62±0.10)mm, (0.92±0.22)mm,(0.43±0.09)mm,F=13.489,P=0.001;(0.65±0.17)mm,(1.01±0.16)mm,(0.44±0.08) mm,F=24.843,P=0.000;(0.61±0.12)mm,(1.27±0.23)mm,(0.50±0.11)mm,F=32.262,P=0.000;(0.61±0.15) mm,(1.10±0.10)mm,(0.49±0.13)mm,F=25.488,P=0.000;(0.58±0.19)mm,(1.17±0.16)mm, (0.54±0.10)mm,F=24.730,P=0.000;(0.55±0.17)mm,(1.10±0.28)mm,(0.53±0.15)mm,F=11.998,P=0.001] 。進(jìn)一步兩兩比較,A組和C組各時(shí)點(diǎn)軸向壓縮位移均小于B組(P=0.009,P=0.001,P=0.000,P=0.000,P=0.000,P=0.001; P=0.000,P=0.000,P=0.000,P=0.000,P=0.000,P=0.001); 除4周時(shí)外(P=0.038),A組各時(shí)點(diǎn)軸向壓縮位移與C組比較,差異均無統(tǒng) 計(jì)學(xué)意義(P=0.062,P=0.328,P=0.208,P=0.648,P=0.894)。②椎體三點(diǎn)彎曲實(shí)驗(yàn)結(jié)果。3組實(shí)驗(yàn)動物椎體標(biāo)本術(shù)后2周、4周、8周 、12周、16周、24周和48周時(shí)的最大載荷比較,組間差異均有統(tǒng)計(jì)學(xué)意義[(178.0±7.7)N,(130.3±6.2)N, (232.0±1.7)N,F=385.253,P=0.000;(178.3±4.4)N,(127.7±7.1)N,(226.0±5.4)N,F=371.286,P=0.000; (182.4±4.4)N,(131.8±5.2)N,(221.0±3.1)N,F=536.544,P=0.000;(184.0±0.8)N,(137.0±6.6)N, (215.0±3.2)N,F=422.579,P=0.000;(182.9±0.9)N,(140.2±1.5)N,(217.0±4.3)N,F=1 006.122,P=0.000; (189.0±3.2)N,(140.6±1.7)N,(194.0±4.9)N,F=351.372,P=0.000;(191.9±3.9)N,(142.4±2.1)N, (191.0±8.1)N,F=139.682,P=0.000]。進(jìn)一步兩兩比較,A組和C組各時(shí)點(diǎn)的最大載荷均大于B組 (P=0.000,P=0.000,P=0.000,P=0.000,P=0.000,P=0.000,P=0.000; P=0.000,P=0.000,P=0.000,P=0.000,P=0.000,P=0.000,P=0.000); 除24周和48周外(P=0.054,P=0.724),C組各時(shí)點(diǎn)的最大載荷均 大于A組(P=0.000,P=0.000,P=0.000,P=0.000,P=0.000)。③椎體抗扭轉(zhuǎn)實(shí)驗(yàn)結(jié)果。3組實(shí)驗(yàn)動物椎體標(biāo)本術(shù)后2周、4周、8周、 12周、16周、24周和48周時(shí)的扭轉(zhuǎn)角度比較,組間差異均有統(tǒng)計(jì)學(xué)意義[(3.8°±0.6°),(5.4°±0.5°), (2.4°±0.6°),F=37.977,P=0.000;(4.0°±1.3°),(5.8°±1.6°),(2.4°±0.7°),F=9.408,P=0.003; (3.7°±0.8°),(5.7°±0.4°),(2.3°±0.7°),F=32.229,P=0.000;(3.5°±0.8°), (5.8°±0.4°),(2.4°±0.5°),F=38.685,P=0.000;(3.5°±0.8°),(5.7°±0.4°), (2.4°±0.4°),F=41.931,P=0.000;(3.4°±0.8°),(5.2°±1.2°),(2.5°±0.8°),F=10.072,P=0.003; (3.0°±0.3°),(5.1°±0.4°),(2.7°±0.4°),F=53.166,P=0.000]。進(jìn)一步兩兩比較,A組和C組各時(shí)點(diǎn)的扭轉(zhuǎn) 角度均小于B組(P=0.001,P=0.045,P=0.000,P=0.000,P=0.000,P=0.012,P=0.000; P=0.000,P=0.001,P=0.000,P=0.000,P=0.000,P=0.001,P=0.000); 除4周、24周和48周外(P=0.057,P=0.171,P=0.347),C組各時(shí) 點(diǎn)的扭轉(zhuǎn)角度均小于A組(P=0.001,P=0.008,P=0.014,P=0.017)。④椎體組織學(xué)觀察結(jié)果。經(jīng)皮椎體成形術(shù)后2周和4周時(shí),聚甲基 丙烯酸甲酯骨水泥Ⅲ與宿主骨交界處有大量軟骨細(xì)胞和成骨細(xì)胞,交界處未見纖維組織; 8周時(shí)骨水泥與宿主骨結(jié)合緊密,軟骨組 織被新生的類骨質(zhì)替代,新生骨組織明顯增加,交界處未見纖維組織; 12周和16周時(shí)可見纖維組織,骨水泥與宿主骨結(jié)合更加緊密 ,界面處類骨質(zhì)減少,礦化骨痂增多,編織骨被板層骨取代; 24周和48周時(shí)可見少量破骨細(xì)胞和骨單位,大部分界面結(jié)合處新生骨 組織與骨水泥結(jié)合緊密。結(jié)論:經(jīng)皮椎體成形術(shù)后,凝固的聚甲基丙烯酸甲酯骨水泥能與骨組織形成骨性結(jié)合,為骨折椎體提供較 好的近期和遠(yuǎn)期生物力學(xué)性能。

Abstract:

Objective:To observe the biomechanical property and histomorphological changes of fractured vertebrae after percutaneous vertebroplasty(PVP).Methods:One hundred and five New Zealand female rabbits were randomly divided into 3 groups,35 cases in each group.The rabbits in group B and group C were administrated with ovariectomy and Dexamethasone muscle injection to build models of osteoporosis.Then,bone defects were created through surgery in the vertebral body of L₄ and L₅ for all rabbits.The vertebral body with bone defects of rabbits in group C were administrated with polymethylmethacrylateⅢ(PMMAⅢ)injection to simulate PVP.At 2,4,8,12,16,24 and 48 weeks after the simulated PVP,5 rabbits were selected from each group and were executed,and their vertebrae of L₄ and L₅ were fetched out for determining the biomechanical strength.Meanwhile,the samples of group C were fluorescent labeled with tetracycline hydrochloride,and the histomorphological changes of vertebrae were observed after toluidine blue staining.Results:The axial compression test showed that there were statistical differences in axial compressional displacement of vertebral specimens between the 3 groups at different post-operative time points (2 weeks:0.62+/-0.10,0.92+/-0.22,0.43+/-0.09 mm,F=13.489,P=0.001; 4 weeks:0.65+/-0.17,1.01+/-0.16,0.44+/-0.08 mm,F=24.843,P=0.000; 8 weeks:0.61+/-0.12,1.27+/-0.23,0.50+/-0.11 mm,F=32.262,P=0.000; 12 weeks:0.61+/- 0.15,1.10+/-0.10,0.49+/-0.13 mm,F=25.488,P=0.000; 16 weeks:0.58+/-0.19,1.17+/-0.16,0.54+/-0.10 mm,F=24.730,P=0.000; 24 weeks:0.55+/-0.17,1.10+/-0.28,0.53+/-0.15 mm,F=11.998,P=0.001),except at 48 weeks (0.54+/-0.14,0.83+/-0.26,0.54+/-0.16 mm,F=3.744,P=0.054).Further pairwise comparison showed that the axial compressional displacement at each time point in group A and group C were all less than those of group B(group A vs group B:P=0.009,P=0.001,P=0.000,P=0.000,P=0.000,P=0.001; group C vs group B:P=0.000,P=0.000,P=0.000,P=0.000,P=0.000,P=0.001),and there were no statistical differences in axial compressional displacement at each time point between group A and group C (P=0.062,P=0.328,P=0.208,P=0.648,P=0.894)except at 4 weeks(P=0.038).The three-point bend test showed that there were statistical differences in maximum load on vertebral specimens between the 3 groups at different post- operative time points(2 weeks:178.0+/-7.7,130.3+/-6.2,232.0+/-1.7 N,F=385.253,P=0.000; 4 weeks:178.3+/- 4.4,127.7+/-7.1,226.0+/-5.4 N,F=371.286,P=0.000; 8 weeks:182.4+/-4.4,131.8+/-5.2,221.0+/-3.1 N,F=536.544,P=0.000; 12 weeks:184.0+/-0.8,137.0+/-6.6,215.0+/-3.2 N,F=422.579,P=0.000; 16 weeks:182.9+/- 0.9,140.2+/-1.5,217.0+/-4.3 N,F=1 006.122,P=0.000; 24 weeks:189.0+/-3.2,140.6+/-1.7,194.0+/-4.9 N,F=351.372,P=0.000; 48 weeks:191.9+/-3.9,142.4+/-2.1,191.0+/-8.1 N,F=139.682,P=0.000).Further pairwise comparison showed that the maximum load at each time point in group A and group C were all greater than those of group B(group A vs group B:P=0.000,P=0.000,P=0.000,P=0.000,P=0.000,P=0.000,P=0.000; group B vs group C:P=0.000,P=0.000,P=0.000,P=0.000,P=0.000,P=0.000,P=0.000),and the maximum load at each time point in group C were all greater than that of group A(P=0.000,P=0.000,P=0.000,P=0.000,P=0.000)except at 24 and 48 weeks (P=0.054,P=0.724).The resist-torsion test showed that there were statistical differences in the torsional angle of vertebral specimens between the 3 groups at different post-operative time points(2 weeks:3.8°+/-0.6°,5.4° +/-0.5°,2.4°+/-0.6°,F=37.977,P=0.000; 4 weeks:4.0°+/-1.3°,5.8°+/-1.6°,2.4°+/-0.7°,F=9.408,P=0.003; 8 weeks:3.7°+/-0.8°,5.7°+/-0.4°,2.3°+/-0.7°,F=32.229,P=0.000; 12 weeks:3.5°+/-0.8°,5.8°+/-0.4°,2.4° +/-0.5°,F=38.685,P=0.000; 16 weeks:3.5°+/-0.8°,5.7°+/-0.4°,2.4°+/-0.4°,F=41.931,P=0.000; 24 weeks:3.4° +/-0.8°,5.2°+/-1.2°,2.5°+/-0.8°,F=10.072,P=0.003; 48 weeks:3.0°+/-0.3°,5.1°+/-0.4°,2.7°+/- 0.4°,F=53.166,P=0.000).Further pairwise comparison showed that the torsional angle at each time point in group A and group C were all less than those of group B(group A vs group B:P=0.001,P=0.045,P=0.000,P=0.000,P=0.000,P=0.012,P=0.000; group B vs group C:P=0.000,P=0.001,P=0.000,P=0.000,P=0.000,P=0.001,P=0.000),and the torsional angle at each time point in group C were all less than those of group A(P=0.001,P=0.008,P=0.014,P=0.017)except at 4,24 and 48 weeks (P=0.057,P=0.171,P=0.347).A great number of chondrocytes and osteoblasts were found at the junction of PMMAⅢand host bone at 2 and 4 weeks after PVP,while no fibrous tissues were found.PMMAⅢwere integrated tightly with the host bones 8 weeks after the surgery,and the cartilage tissues were replaced by the neogenetic osteoid.Meanwhile,the neogenetic bone tissues increased significantly and no fibrous tissues were found at the conjunctive area.At 12 and 16 weeks after the surgery,the fibrous tissues appeared and the PMMAⅢwere integrated more tightly with the host bones.Meanwhile the osteoid decreased and the mineralization bony callus increased,and the woven bone was replaced by the lamellar bone.At 24 and 48 weeks after the surgery,a small number of osteoclasts and bone units appeared and the neogenetic bone tissues were integrated tightly with the PMMAⅢat most of the interfaces.Conclusion:After PVP,the solidified PMMAⅢcan be osseo-integrated with bone tissues,as a result,it can provide good short-term and long-term biomechanical property for the fractured vertebrae.

備注/Memo

備注/Memo:

2013-09-30收稿 2013-10-28修回
基金項(xiàng)目:浙江省醫(yī)學(xué)基金項(xiàng)目(2010C330133)
通訊作者:全仁夫 E-mail:[email protected]

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更新日期/Last Update: 2013-12-30