椎体成形术后椎体界面骨血管内皮生长因子mRNA表达的实验研究  

Experimental study on the expression of VEGF mRNA on interface bone tissue after percutaneous vertebroplasty

作　　者：赵刚[1] 胡侦明[2] 舒钧[3] 劳汉昌[3] 

机构地区：[1]昆明医学院第二附属医院急诊科创伤骨科组,云南昆明650101 [2]重庆医科大学第一附属医院骨科,四川重庆400016 [3]昆明医学院第二附属医院骨科,云南昆明650101

出　　处：《云南医药》2011年第5期470-474,共5页Medicine and Pharmacy of Yunnan

摘　　要：目的探讨植入聚甲基丙烯酸甲酯骨水泥(PMMA)后椎体骨水泥-骨界面周围骨组织中血管内皮生长因子(VEGF)表达,了解骨质疏松性椎体压缩骨折行椎体成形术后PMMA骨水泥周围骨组织的损伤及修复情况。方法 1.模仿经皮穿刺椎体成形术,在72只兔椎体制成0.3cm×0.3cm×0.3cm的骨缺损模型,36只分别注入PMMA骨复合材料,实验组及对照组分别于术后1h,24h,3d,7d,4w,12w处死动物后取骨水泥-骨界面交界处骨组织,检测界面周围骨组织中VEGFmRNA扩增及蛋白表达情况,并与骨质疏松组作对比;2.组织切片HE染色观察,了解周围骨组织增生修复情况。结果 PMMA植入后1h及24h界面骨组织中VEGF的表达减少且低于对照组,术后3d明显增加,7d时再次降低,4～12w明显增加;HE染色提示,PMMA植入后1h可见巨噬细胞趋附,24h有多量炎性细胞浸润,3d时达高峰,7d后逐渐减少,4w时可见软骨细胞增生活跃已有软骨化骨形成,而12w则有板层骨形成。结论 1.PMMA植入椎体后有一定炎性反应,但骨水泥放热反应不会导致骨组织缺血坏死;2.界面周围骨组织修复过程中有VEGF表达,表达高峰比正常推迟4w左右。Objective To probe the expression of VEGF on interface between polymethylomethacrylate（PMMA） and bone tissue after percutaneous vertebroplasty（PVP）in order to evaluate repairing ability of bone tissue around bone cement after PVP in osteoporotic vertebral compression fracture patients.Methods The bone defect of 0.3cm×0.3cm×0.3cm in vertebral body was made in 72 rabbits.36 rabbits were in experimental group and the anothers were in control group.PMMA were implanted into the lumbar vertebral body by PVP in experimental group rabbits.mRNA in bone tissue of interface between bone cement and bone tissue were detected at 1h,24h,3d,7d,4w and 12w after operation.Comparision of the difference of expression betwween the control group and the experimental group had been done.Additionally,proliferation around bone tissue was studied by HE stain.Results（1） Expression of VEGF at 1h and 24h was lower than the control group,then become higher at 3d,lower again at 7d,but from 4w to 12w period expression of VEGF was always higher.（2）Inflammation was obviousely more and more from 1 hour to 7 days postoperation,then decreasing at 7 days.Active proliferation of cartilage was observed at 4w,and bone tissue formation was observed at 12 weeks postoperation.Conclusion（1） PMMA implanting into vertebral body leads to inflammation reaction but there is no lasting ischemic necrosis.Inflammation reaction decreases after seven days and disappears after twenty-eight days.（2） There is intense expression of VEGF in interface between PMMA bone cement and bone tissue delaying for 4 weeks.

关 键 词：骨质疏松性骨折 椎体成形术 聚甲基丙烯酸甲酯 血管内皮生长因子 

分 类 号：R687.3[医药卫生—骨科学]