富血小板血浆(PRP)对兔早期椎间盘退变(IDD)的干预作用  

Interentional effect of platelet-rich plasma(PRP)on a rabbit model of early-stage intervertebral disc degeneration(IDD)

作　　者：桂柯科[1] 俞永林[2] 任伟民[3] 李新[4] 董加纯[1] 尹望平[1] 

机构地区：[1]复旦大学附属金山医院骨科,上海201508 [2]复旦大学附属华山医院骨科,上海200040 [3]复旦大学附属金山医院病理科,上海201508 [4]复旦大学附属金山医院放射科,上海201508

出　　处：《复旦学报（医学版）》2015年第2期204-211,229,共9页Fudan University Journal of Medical Sciences

基　　金：上海市金山区科技创新基金(2012-03-05)~~

摘　　要：目的采用纤维环穿刺法建立兔椎间盘退变(intervertebral disc degeneration,IDD)模型,进行椎间盘内注射自体富血小板血浆(platelet-rich plasma,PRP)干预,评价影像学及组织学干预效果。方法健康成年新西兰大白兔16只,随机分为PRP干预组(A组)、磷酸盐缓冲液(phosphate buffered saline,PBS)注射组(B组)、造模对照组(C组)和单纯对照组(D组),每组4只。A、B和C组采用纤维环穿刺法建立L4/5、L5/6IDD模型。在造模后2周,对各组实验动物进行二次干预。A组取耳中央动脉血,采用Landesberg法制备PRP,于L4/5、L5/6椎间隙分别注入0.1mL PRP;B组于L4/5、L5/6椎间隙分别注入0.1mL PBS;C组暴露椎间隙后不作特殊处理。干预后2周,进行X线及MRI检查。处死实验动物,取椎间盘组织进行HE染色、Masson染色、番红O染色以及Ⅱ型胶原免疫组织化学染色,观察组织学改变。结果所有实验动物均存活至实验结束。PRP血小板计数约为外周血的3.69倍。随着时间推移,B组和C组的椎间隙高度逐渐下降、椎间盘信号逐渐降低,各时间点组内椎间盘高度指数百分数(disc height index percentage,%DHI)和MRI分级差异有统计学意义(P<0.05);A组和D组的椎间隙高度、椎间盘信号无明显变化,在初次手术后4周的时间点与B组和C组相比,差异均有统计学意义(P<0.05)。B组和C组的椎间盘组织病理学表现为髓核软骨细胞退行性变、坏死,形态不规则,分布不均匀,软骨基质逐步被纤维束取代,可见蛋白聚糖及Ⅱ型胶原减少;A组和D组的椎间盘组织形态变化不明显,在初次手术后4周的时间点与B组和C组相比,差异均有统计学意义(P<0.05)。结论自体PRP注射治疗兔早期IDD模型的影像学及组织学评价满意,PRP早期干预可以有效抑制IDD进程。Objective To evaluate imaging and histological outcomes of a new approach for repair of degenerative intervertebral discs in rabbit models by annular puncture injection of autologous plateletrich plasma（PRP）into the discs. Methods Sixteen healthy adult New Zealand white rabbits were randomly divided into 4groups：group A,PRP intervention group（n=4）;group B,phosphate buffered saline（PBS）injection group（n=4）;group C,modeling group（n=4）;group D,control group（n=4）.Rabbits in A,B and C group were treated by intervertebral disc degeneration（IDD）models L4/5and L5/6by annular puncture.The intervention was repeated two weeks later.The animals in group A were administered PRP prepared from the arterial blood of rabbit ears according to a method developed by Landesberg.Next,0.1 mL PRP was injected into the discs according to models L4/5and L5/6.Animals in group B were additionally injected with 0.1mL PBS into the same intervertebral spaces,while no further steps were taken for animals in group C.Two weeks after the second intervention,Xray and magnetic resonance imaging（MRI）were performed.The animals were then euthanized and experimental disc tissues were removed.HE staining,Masson′s trichrome,Safranin O staining,and immunohistochemical staining of type Ⅱ collagen were performed to demonstrate the histological changes. Results All animals survived to the end of the experiment.The platelet count of PRP was approximately 3.69 times as much as that of peripheral blood.Over time,intervertebral space heights and disc signals decreased in group B and C,the differences of disc height index percentage（%DHI）and IDD classification of MRI between each time points were statistically significant（P〈0.05）.In group A and D,intervertebral space heights and disc signals had no significant changes,while at the time point of 4weeks after first operation,the differences were statistically significant compared with group B and C（P〈0.05）.In group B and C,degeneration,necrosis,irregular,and unev

关 键 词：富血小板血浆(PRP) 椎间盘退变(IDD) 生物学治疗 兔 

分 类 号：R681.5[医药卫生—骨科学]