椎体成形术骨水泥与松质骨的近期与远期改变的实验研究  

The study of near and long term changes Of bone cement and cancellous bone after percutaneous vertebroplasty

作　　者：全仁夫 倪月明 郑宣[2] 谢尚举[2] 李长明[2] 

机构地区：[1]浙江省萧山中医院,311201 [2]浙江中医药大学

出　　处：《中华骨科杂志》2013年第11期1155-1163,共9页Chinese Journal of Orthopaedics

基　　金：浙江省医学基金项目（2010C330133）

摘　　要：目的观察聚甲基丙烯酸甲酯骨水泥Ⅲ（polymethylmethacrylate，PMMA）植入兔椎体内其近期与远期生物力学性能、界面微观形态学的改变以及植入骨水泥后周围骨组织的反应修复情况。方法新西兰兔采用去势加地塞米松肌肉注射法制成骨质疏松模型，分为骨质骨质疏松组（35只，造模成功不做处理）和实验组（35只，腰椎椎体内注入骨水泥），另取正常新西兰兔（35只）作为正常对照组。于椎体成形术后不同时间点对离体椎体进行轴向压缩试验、三点弯曲试验、抗扭转试验观察整体生物力学改变，采用光学显微镜、荧光显微镜及扫描电镜观察微观骨水泥一松质骨界面改变，并进行纳米压痕试验。结果通过生物力学测试发现骨水泥组在早期生物力学性能明显优于正常对照组和骨质疏松组，但随着术后时间延长，远期骨水泥组生物力学性能有所下降，略优于正常对照组，明显优于骨质疏松组。组织形态学观察显示在骨质疏松状态下骨生长较缓慢、骨改建时间延长，后期主体骨的持续骨质疏松状态对界面有所影响。骨组织、骨界面与骨水泥三者之间纳米压痕性能差异明显，在各时间点差异均有统计学意义，以骨水泥最佳，骨界面次之，骨组织最低。结论骨水泥能进入椎体骨小梁间的微小间隙，早期即与宿主骨组织形成牢固的结合，具有较好的可塑性和流动性。在术后即能迅速恢复椎体的强度和刚度，起到稳定脊柱的作用；在远期其生物力学性能虽有所下降，但仍可达到满意的效果。Objective To observe the research of the biologically performance, interface micro-structure and nano-in-dentation situation when polymethyl methacrylate bone cement-PMMA injected into rabbit in the near future and far future indi-vidually. Methods New Zealand white rabbits were used ovariectomy plus dexamethasone intramuscular injection to establish osteoporosis animal model. All animal models were divided into 3 groups with 35 in each osteoporosis group, testing group, and normal group. Execute the lumbar centrum of New Zealand rabbit as osteoporosis bone defect model, injected bone cement, with the help of material dynamo experiment machine to do the axial compression tests, three point bending test, and torsion test in order to observe the biological dynamic changes. Optical microscope, fluorescence microscope and scanning electron microscope were used to observe the changes of micro bone cement and the changes of bone looseness. Nano-indentation testing was applied by the triboindenter to study the critical load. Results PMMA can rapidly establish the strong support with stable function in the near future. Biomechanical experiments showed that biomechanical properties of bone cement group was significantly higher than those in the other two groups. Biomechanical properties of bone cement group may decline with the time, but which were still better than those of OP in the control group. Histo-morphological observation result shows that under osteoporosis state the bone grows slower, bone＇s rebuilding time also extended. And in the later period, main bone＇s continuous osteoporosis had some impact on the interface. Nano-indentation testing showed that the young modulus and stiffness of the interface among bone, mate-rial and interface were significantly differences. Bone cement had showen the best nano indentation hardness, then was interface and bone tissue. Conclusion The polymethyl methacrylate bone cement Ⅲ has a good effect in filling, on account of it has great plasticity and liquidity and can penet

关 键 词：骨质疏松性骨折 椎体成形术 聚甲基异丁烯酸 生物力学 

分 类 号：R687.3[医药卫生—骨科学]