糖尿病患者骨不连断端组织中成骨活性的差异性研究  

The Difference of Osteogenic Activity in Nonunion Broken end Tissue of Diabetic Patients

作　　者：刘伟[1] 张翠影[2] 杨帆[1] 栾富均[1] 何盛江[1] 赵强 LIU Wei;ZHANG Cuiying;YANG Fan;LUAN Fujun;HE Shengjiang;ZHAO Qiang(Department of orthopedics,Yongchuan hospital affiliated to chongqing medical university,Chongqing 402160;Department of gynecology,Yongchuan hospital affiliated to chongqing medical university)

机构地区：[1]重庆医科大学附属永川医院创伤骨科,重庆402160 [2]重庆医科大学附属永川医院妇科

出　　处：《中国伤残医学》2024年第2期10-14,共5页Chinese Journal of Trauma and Disability Medicine

基　　金：重庆市永川区自然科学基金项目(Ycstc,2020nb0246)。

摘　　要：目的:探讨糖尿病患者骨不连断端组织的成骨活性,为提高糖尿病患者骨折愈合质量提供参考。方法:选取2021年6月-2022年6月重庆医科大学附属永川医院收治的60例行胫骨中下段骨折闭合复位髓内钉固定术的老年AO/OTA 1型骨折患者为研究对象,依据世界卫生组织(WHO)关于2型糖尿病的诊断标准,将患者分为2型糖尿病组(n=27)与非糖尿病组(n=33)。治疗后随访,拍摄骨折区X线片,观察2组骨折断端成骨变化,统计骨不连发生率,基于Lane-Sandhu x射线评分标准评价骨折愈合情况。采集2组骨不连患者骨折断端组织进行活检,观察骨组织形态,免疫组织化学检测骨形态发生蛋白-2(BMP-2)、核心蛋白多糖(DCN)与成纤维细胞生长因子(BFGF)的染色情况,计算平均灰度值。结果:2型糖尿病组骨不连发生率高于非糖尿病组,Lane-Sandhu X线评分低于对照组,组间差异有统计学意义(P<0.05)。骨不连患者组织形态学以断端中心纤维瘢痕组织为主要表现,少见编织骨与新生血管。免疫组织化学检测结果显示,2型糖尿病组骨生长因子BMP-2、DCN与BFGF的染色阳性率与平均恢复值均低于非糖尿病组,组间差异有统计学意义(P<0.05)。结论:合并糖尿病的骨折患者断端组织成骨活性不高,易发生骨不连,成骨质量差,可能与骨不连断端组织BMP-2、DCN与BFGF表达低有关,辅以骨生长因子诱导成骨,有望提高糖尿病患者的骨折愈合质量,预防和减少骨不连。Objective:To investigate the osteogenic activity of nonunion broken end tissue in patients with diabetes,and to provide reference for improving the quality of fracture healing in patients with diabetes.Methods:60 elderly AO/OTA type 1 fracture patients admitted to Yongchuan Hospital Affiliated to Chongqing Medical University from June 2021 to June 2022 undergoing closed reduction and intramedullary nail-fixation of middle and lower tibial fractures were selected as the study objects.According to the diagnostic criteria of type 2 diabetes set by the World Health Organization(WHO).Patients were divided into type 2 diabetes group(n=27)and non-diabetes group(n=33).After treatment,X-ray films were taken at the fracture area to observe the osteogenic changes at the broken end of the two groups,and the incidence of bone nonunion was calculated.The fracture healing was evaluated based on Lane-Sandhu X-ray scoring criteria.The broken end tissues of the two groups of non-union patients were biopsied to observe the bone morphology,and the staining of bone morphogenetic protein-2(BMP-2),core proteoglycan(DCN)and fibroblast growth factor(BFGF)were detected by immunohistochemistry,and the average gray value was calculated.Results:The incidence of bone nonunion in type 2 diabetes group was higher than that in non-diabetes group,and Lane-Sandhu X-ray score was lower than that in control group,with statistical significance(P<0.05).The histomorphology of nonunion patients is mainly characterized by fibrous scar tissue in the center of the broken end,and braided bone and neovascularization are rare.Immunohistochemical test results showed that the staining positive rate and mean recovery value of bone growth factor BMP-2,DCN and BFGF in type 2 diabetes group were lower than those in non-diabetes group,and the differences were statistically significant(P<0.05).Conclusion:In fracture patients with diabetes mellitus,the osteogenic activity of broken end tissue is not high,which is prone to nonunion and poor osteogenic quality,which may

关 键 词：糖尿病 骨不连 成骨活性 骨生长因子 

分 类 号：R587.1[医药卫生—内分泌]