不同剂量万古霉素与髂骨植骨混合对腰椎融合动物模型生物力学的影响  

Biomechanical study of iliac bone graft with different dosage of vancomycin for bone fusion and internal fixation in rabbit model

作　　者：刘斌[1] 王华富[2] 甘维[1] 金掌[1] 崔国鹏[1] LIU Bin;WANG Huafu;GAN Wei;JIN Zhang;CUI Guopeng(Department of Orthopedics,Lishui People’s Hospital,Lishui 323000,China)

机构地区：[1]丽水市人民医院脊柱外科,323000 [2]丽水市人民医院药学部,323000

出　　处：《浙江医学》2020年第17期1828-1832,I0004,共6页Zhejiang Medical Journal

基　　金：浙江省公益技术应用研究项目(2017C37158);丽水市科技计划项目(2017GYX16、2018RC08);丽水市人民医院人才搭梯工程项目(2017TC006)。

摘　　要：目的比较不同剂量万古霉素与髂骨植骨混合对腰椎融合动物模型生物力学的影响,筛选出万古霉素与髂骨植骨的最佳混合比例。方法选择健康成年雄性新西兰大白兔78只,采用随机数字表法选取6只纳入正常组;根据混合万古霉素的剂量,另外72只采用随机数字表法分为模型组、万古霉素125 mg组、万古霉素250 mg组和万古霉素500 mg组,每组18只,分别采用0、125、250、500 mg万古霉素与自体髂骨植骨颗粒(2 g)混合进行L5~L6节段双侧横突间植骨后外侧融合,术后每日肌肉注射青霉素160万U,连续3 d。术后4、8、12周,正常组各处死2只,模型组、万古霉素125 mg组、万古霉素250 mg组和万古霉素500 mg组各处死6只。取融合段腰椎组织,检测融合段腰椎组织前屈、后伸、左右侧屈、左右旋转活动度(ROM)值、最大载荷和弹性模量,并于术后8周对融合段腰椎组织进行组织学和Micro-CT检查。结果与正常组比较,模型组、万古霉素125 mg组、万古霉素250 mg组和万古霉素500 mg组术后8、12周前屈、后伸、左右侧屈、左右旋转ROM值均减少,术后4、8、12周最大载荷均增加,弹性模量均减少(均P<0.05)。与模型组比较,万古霉素250 mg组和万古霉素500 mg组术后8、12周前屈、后伸、左右侧屈、左右旋转ROM值均减少,术后4、8、12周最大载荷均减少,弹性模量均增加(均P<0.05)。与万古霉素125 mg组比较,万古霉素250 mg组和万古霉素500 mg组术后8、12周前屈、后伸、左右侧屈、左右旋转ROM值均减少,术后4、8、12周最大载荷均减少,弹性模量均增加(均P<0.05)。融合段腰椎组织术后8周组织学检查和Micro-CT影像学表现具有良好的对应关系,结果显示万古霉素250 mg组和万古霉素500 mg组融合效果优于万古霉素125 mg组和模型组。结论250、500 mg万古霉素与髂骨植骨混合促进了椎体间植入物骨化的进程,融合效果好,具有较好的生物力学稳定�Objective To investigate the biomechanical effects of different doses of vancomycin with iliac bone graft on lumbar fusion in animal model.Methods Seventy-eight adult male New Zealand white rabbits were used in experiments:6 rabbit had no treatment(normal group),72 rabbits were randomly divided into 4 groups with 18 animals in each group,and treated by 0(model group),125,250 and 500 mg vancomycin with autologous iliac bone graft particles(2 g)for posterolateral fusion of L5-L6 segments,respectively.At 4,8 and 12 weeks after operation,2 animals in normal group,and 6 animals in each treatment groups were sacrificed,and the lumbar vertebrae of the fusion segment were harvested.The biomechanics,maximum load and elastic modulus of flexion,extension,left and right flexion,left and right rotation of the fusion site were measured,and histology and Micro-CT examination of the fusion site were performed 8 weeks after operation.Results Compared with the normal group,the ROM values of flexion,extension,lateral flexion and rotation decreased in the model group,vancomycin 125 mg group,250 mg group and 500 mg group were decreased,the maximum load increased and the elastic modulus decreased at 4,8 and 12 weeks after operation(all P<0.05).Compared with the model group,Rom values of flexion,extension,left and right lateral flexion and left and right rotation decreased in 250 mg and 500 mg groups at 8 and 12 weeks after operation,maximum load decreased and elastic modulus increased at 4,8 and 12 weeks after operation(all P<0.05).Compared with 125 mg group,ROM values of flexion,extension,left and right lateral flexion and left and right rotation decreased in 250 mg and 500 mg groups at 8 and 12 weeks after oreration,maximum load decreased and elastic modulus inased at 4,8 and 12 weeks after operation(all P<0.05).There was a good correlation between histological examination and Micro-CT imaging at 8 weeks after fusion.The results showed that the fusion of vancomycin 250 mg group and vancomycin 500 mg group was better than that of van

关 键 词：万古霉素 髂骨植骨 腰椎融合 

分 类 号：R687.3[医药卫生—骨科学] R-332[医药卫生—外科学]