骨关节炎早期软骨下骨三维结构变化及二磷酸盐的干预效应  

Variation of three-dimensional structure of subchondral bone in early stage osteoarthritis and interventive effect of diphosphonate

作　　者：陈海南[1] 董启榕[1] 姜伟[2] 杨侃[3] 

机构地区：[1]苏州大学附属第二医院骨科,215004 [2]泸州医学院附属医院康复医学科 [3]苏州市第七人民医院骨科

出　　处：《中华创伤杂志》2013年第8期790-795,共6页Chinese Journal of Trauma

基　　金：国家自然科学基金资助项目（81171730）

摘　　要：目的观察膝关节不稳早期软骨下骨三维结构变化及二磷酸盐的干预作用，探讨骨性关节炎（osteoarthritis，OA）早期软骨下骨三维结构的变化在OA发生发展中的作用。方法健康雄性新西兰大白兔60只，按随机数字表法分为模型组（24只）、二磷酸盐组（24只）、对照组（12只）。采用兔膝关节不稳模型（切断前交叉韧带）右膝造模。二磷酸盐组每天皮下注射二磷酸盐（利塞磷酸钠）0．01mg／kg；模型组和对照组给予等体积的等渗盐水皮下注射。术后分别于4，8，12周处死动物后，切取保留关节面上下各2cm骨的手术侧膝关节，行Micro—CT检查。检测骨体积分数（bone volume fraction，BVF）、骨小梁厚度（trabecular thickness，Tb．Th）、骨小梁间隙（trabecularspacing，Tb．Sp）、骨小梁数目（trabecular number，Tb．N）、体积骨密度（volumetric bonemin—eraldensity，vBMD）、组织骨密度（tissue BMD，tBMD），并进行统计学分析。结果术后第4周模型组BVF、Tb．N、Tb．Th较对照组明显降低（P〈0．01）；BVF较二磷酸盐组也降低（P〈0．05）；二磷酸盐组BVF较对照组亦降低（P〈0．05）；模型组Tb．sp较二磷酸盐及对照组均增加（P〈0．01），二磷酸盐组较对照组明显增大（P〈0．01）。模型组vBMD较二磷酸盐及对照组明显降低（P〈0．05），而二磷酸盐组与对照组差异无统计学意义。12周时模型组BVF、Tb．Th、Tb．N较二磷酸盐及对照组增加（P〈0．05），Tb．Sp明显减少（P〈0．05），而vBMD显著增加（P〈0．01）。结论膝关节不稳软骨下骨早期以骨破坏为主，后期出现明显的骨形成。二磷酸盐可通过抑制骨吸收，保护软骨下骨的骨结构。Objective To observe the three-dimensional structure changes of subchondral bone in early stage knee joint instability and the effect of diphosphonate intervention so as to test the role of early three-dimensional structure changes of subchondral bone in pathogenesis of osteoarthritis （OA）. Methods Sixty healthy male New Zealand white rabbits were assigned to model group （ n = 24 ） , diphosphonate group （n = 24 ） and control group （n = 12） according to random number table. Rabbit right knee destabilization （anterior crueiate ligament transection ） is used to induce OA. Rabbits in diphosphonate group received subcutaneous injection of 0.01 mg/kg diphosphonate （risedronate） per day. Instead, isotonic saline solution of the same volume was subcutaneously given to rabbits in model and control groups. One third of the animals in each group were killed at week 4, 8 and 12 respectively. Surgical knee joint with preservation of each 2 cm bone above and below joint surface was dissected to perform Micro-CT. Bone volume fraction （ BVF ）, trabecular thickness （ Tb. Th ）, trabecular spacing （Tb. Sp）, trabecular number （Tb. N）, volumetric bone mineral density （vBMD） and tissue BMD （tBMD） were measured and analyzed statistically. Results At week 4 following operation, BVF, Tb. N and Tb. Th were lowered significantly in model group as compared to control group （ P 〈 0.01 ） ; BVF was lower in model group than in diphosphonate group （ P 〈 0.05 ） and lower in diphosphonate group than in control group （P 〈 0.05） ; Tb. Sp was increased in model group as compared to diphosphonate group and control group （ P 〈 0.01 ） and had obvious increase in diphosphonate group as compared to control group （P 〈 0.01 ） ; vBMD was significantly lower in model group than in diphosphonate group and control group （P 〈 0.05 ）, but there was no statistical difference between diphosphonate group and control group. At week 12 following operation, model group presented higher

关 键 词：骨关节炎 二磷酸盐类 软骨下骨 

分 类 号：R684.3[医药卫生—骨科学]