椎体成形术后骨水泥-骨界面相关生物学研究  

Related biological research in the interface between bone cement and bone after percutaneous vertebroplasty

作　　者：胡侦明[1] 赵刚[2] 汪礼军 浦波[2] 杨庆秋[2] 郝杰[1] 劳汉昌[2] 

机构地区：[1]重庆医科大学附属第一医院骨科,重庆400016 [2]昆明医学院第二附属医院骨科,昆明650101 [3]重庆市大足区人民医院骨科,重庆402360

出　　处：《中华骨质疏松和骨矿盐疾病杂志》2012年第1期41-48,共8页Chinese Journal Of Osteoporosis And Bone Mineral Research

基　　金：重庆市自然科学基金(CSTC;2008BB5080)

摘　　要：目的观察椎体成形术后椎体内骨水泥(PMMA)-骨界面生物学变化。方法模仿人椎体成形术,将PMMA复合生物骨水泥注入兔椎体内,利用组织形态学、RT-PCR及Western-blotting等方法动态观察骨水泥-骨界面骨组织中血管内皮生长因子(VEGF)及Ⅰ型胶原表达及周围骨组织反应和修复情况,应用免疫组织化学法观察骨钙素(osteocalcin,OC)动态表达。结果 PMMA术后1h及24hVEGF的表达减少,术后3dVEGF表达明显增加,至7d时再次降低,4～12周VEGF表达明显增加。PMMA注入后1h胶原表达增加,24h～3d持续升高,7d～12周Ⅰ型胶原均高表达,12周时仍有较高表达,与正常的表达时间有一定区别,主要表现为时间延后;7d时OC表达逐渐升高,术后4周时对照组OC明显升高。HE染色显示此时骨化已完全。结论 PVP术后PMMA灌注剂对界面骨小梁组织有一定损伤。VEGF及Ⅰ型胶原参予PMMA骨水泥-骨界面损伤的修复;骨水泥未造成界面骨小梁组织的不可逆性损伤及骨组织的矿化。Objective This study aimed to observe the biological changes on PMMA cement and bone interface after the operation of PVP.Methods 72 old female rabbits,each age 3.0-3.5 years were assigned randomly to two groups of thirty-six each.PMMA cement were injected into vertebral body in rabbits via mimic PVP,sacrificed at 1 h、24 h、3 d、7 d、4 w、12 w.The expression of VEGF and collagen type I,the tissue response and repair reaction in the interface between PMMA and bone tissue were observed dynamically with RT-PCR and Western blotting technique.The osteocalcin expression level were studied by immunohistochemistry.Results Compared with the control group,the expression of collagen I increased at 1 hour,and was higher from 24 h to 3 d.From 4 weeks to 12 weeks,expression of Collagen type Ⅰ was always higher after injection of PMMA.The expression of VEGF decreased at 1 hour and 24 hours,significantly increased at 3 days posto-vertebroplasty,decreased once again at 7 days,then increased significantly at 4,12 weeks.The osteocalcin expression continued to increase during 4 to 12 week,lamellar bone formation at 4 weeks.Conclusion PMMA would not cause local bone permanent necrosis.Interface injury repairing cycle could be prolonged in a vertebroplasty.

关 键 词：椎体成形术 骨水泥 骨界面 血管内皮生长因子 Ⅰ型胶原 骨钙素 

分 类 号：R681[医药卫生—骨科学]