复合重组人骨形态发生蛋白-2的可注射磷酸钙骨水泥在椎体成形术中的生物力学研究  

Biomechanical feasibility of using injectable recombinant human bone morphogenetic protein-2/calci-um phosphate cement and polymethyimethacrylate in vertebroplasty in rhesus monkeys

作　　者：徐谦[1] 白波[1] 陈艺[1] 叶建东[1] 吴景明[1] 陈东峰[1] 

机构地区：[1]广州医学院第一附属医院骨科,510120

出　　处：《中华创伤骨科杂志》2007年第8期721-724,共4页Chinese Journal of Orthopaedic Trauma

基　　金：国家自然科学基金（50172015）

摘　　要：目的探讨自主研发的复合重组人骨形态发生蛋白-2（rhBMP-2）的可注射磷酸钙骨水泥（CPC）应用于猕猴椎体成形术早期和后期生物力学性能。方法①将2只成年猕猴尸体作为I组，4只成年猕猴分为Ⅱ、Ⅲ两组，每组猕猴T10-L7的20个椎体分为A、B、C三组，经皮穿刺。A组：8个椎体，灌注复合rhBMP-2的可注射CPC；B组：6个椎体，灌注注射型PMMA；C组：6个椎体，手术空白对照组，穿刺后灌注生理盐水。②I组于术后立即进行测试，Ⅱ、Ⅲ组分别于术后2个月和6个月处死，解剖出单个椎体制成标本，在轴向压缩载荷下测定单个椎体的抗压强度和刚度。分析两种材料强化椎体的早期和后期效果及变化。结果C组椎体抗压强度和刚度于术后、术后2个月和6个月比较差异无统计学意义（P〉0．05）。A组椎体的抗压强度比C组椎体增加了29．1％（P〈0．05），术后2个月变为25．5％（P〈0．05），术后6个月与C组差异无统计学意义（P〉0．05）；抗压强度随时间逐渐下降（P均〈0．05），刚度始终无明显增高（P〉0．05）。B组椎体的抗压强度和刚度分别增加了55．2％和22．8％（P均〈0．05），2个月后变为52．7％和25．9％（P均〈0．05），6个月后仍增强48．6％和28．7％（P均〈0．05）。结论复合rhBMP-2的CPC材料强化椎体的力学性能良好并能始终维持适中的力学强度，可避免PMMA过高强度带来的远期邻近椎体骨折和椎间盘退行性变加速的危险。Objective To investigate the biomechanical behavior of injectable recombinant human bone morphogenetic protein-2（rhBMP-2）/calcium phosphate cement （CPC） used in vertebroplasty in primate models. Methods Two fresh cadavers of adult rhesus were used as group I, and 4 adult rhesuses were divided into groups II and 111. In each rhesus, TIO to L7 were used for vertebroplasty. In each group, 20 vertebral bodies （VBs） were used and divided into sub-groups A, B and C. In sub-group A, 8 VBs were filled with rhBMP-2/CPC; in sub-group B, 6 VBs were filled with injectable PMMA; in sub-group C, 6 VBs were filled with normal saline. Vertebral specimen preparation and biomechanical tests were performed immediately after vertebroplasty for Group I. Groups II and 111 were sacrificed in 2 and 6 months after vertebroplasty respectively for vertebral specimen preparation and biomechanical tests. Each vertebral specimen was tested for its compressive strength and stiffness under axial compression. The biomechanical performances of rhBMP-2/ CPC and PMMA at early and late stages after vertebroplasty were compared statistically. Results The compressive strength and stiffness differed little after operation in sub-group C （sham group） （ P 〉 O. 05） . Compared with the sham group, the compressive strength in rhBMP-2/CPC group （sub-group A） increased 29. 1% （ P 〈 0. 05） after operation, 25.5% in 2 months（ P 〈 0. 05）, and insignificantly in 6 months（ P 〉 0. 05）, but the stiffness showed no obvious increase（ P 〉 0. 05） . In PMMA group, the compress strength and stiffness increased, respectively, 55.2% and 22. 8% （ P 〈 0. 05） after operation, 52. 7% and 25.9% in 2 months （P 〈0.05）, and 48.6% and 28.7% in 6 months（P 〈0.05）. Conclusion The rhBMP-2/ CPC can maintain permanent and moderate mechanic strength in vertebroplasty on nonhuman primate models, avoiding the potential risk of contiguous vertebral fracture or annulus degeneration caused by long-term adverse effects of PMMA.

关 键 词：磷酸钙类 骨形态发生蛋白质类 生物力学 椎体成形术 

分 类 号：R686[医药卫生—骨科学]