骨质疏松兔模型的建立与体外冲击波在骨质疏松局部治疗中的可行性研究

发布时间：2018-03-26 17:19

本文选题：骨质疏松　切入点：体外冲击波　出处：《第四军医大学》2008年硕士论文

【摘要】： 骨质疏松骨折是目前严重威胁老年人生活的疾病之一。骨质疏松症以骨量减少、骨组织微结构破坏、骨脆性增加而极易发生骨折为特征,一旦发生骨折,其临床治疗非常困难,且预后不佳,极大的影响病人的生活质量,甚至导致病人伤残、死亡。因此,对骨质疏松的防治越来越受到重视。目前对于骨质疏松的防治主要采用药物治疗,但是,药物治疗周期长、副作用明显、见效慢,很难在短时间内迅速提高骨密度及骨强度。研究证明,体外冲击波疗法(Extracorporeal Shock Wave Treatment, ESWT)在骨折及骨不连等疾病的治疗中发挥着重要的作用,特别在骨形成过程中起着重要的作用,而骨质疏松表现为骨吸收的增强和骨形成的减弱。因此,本研究拟采用体外冲击波处理骨质疏松局部骨组织,根据体外冲击波的成骨作用,观察其能否影响骨小梁改建过程,增加骨矿含量和改善骨质量。实验一:去势加地塞米松肌肉注射兔骨质疏松模型建立的实验研究目的:探究应用去势加肌肉注射地塞米松的方法建立兔骨质疏松模型的可行性。方法:将24只5月龄雌性新西兰兔随机分成假手术+肌注生理盐水组(A组)、去势+肌注生理盐水组(B组)和去势+肌注地塞米松组(C组),每组8只动物。后两组动物行双侧卵巢切除术。术前和术后2、3月时采用双能X线吸收骨密度测量仪及术后3月应用micro-CT进行测量分析。结果:术后3月双能X线测得C组兔腰椎和股骨近端的BMD分别较A组降低30.45%和35.49%,micro-CT三维重建分析表明,在术后3月时,C组股骨远端BMD、BMC和骨小梁立体测量学的一些指标与A组的差值有统计学意义,B组和C组骨小梁稀疏、断裂、排列紊乱,但后者更为明显。结论:去势+肌注地塞米松法建立新西兰兔骨质疏松症模型切实可行,造模时间较单纯去势法更短,3个月即可。实验二:体外冲击波对骨质疏松兔股骨髁部松质骨影响的实验研究目的:观察体外冲击波对骨质疏松兔股骨髁部松质骨的成骨作用。方法:30只5月龄雌性新西兰兔,采用卵巢切除(OVX)去势加地塞米松肌肉注射的方法建立骨质疏松模型,3个月时BMD检测确定模型建立。将所有骨质疏松兔随机分为三组,每组10只,其中一组为空白对照组(A组),其余两组(B组和C组)动物右侧股骨髁部进行体外冲击波(ESW)处理,冲击波能流密度为0.47mJ/mm2,脉冲2000次。于处理前(A组)、处理后4周(B组)、8周(C组)时分别处死动物,分离右侧股骨远端,进行micro-CT测量分析和HE染色观察。结果:micro-CT三维重建分析表明,冲击波处理后4周(B组)及8周(C组)时实验组的BMD、BMC和骨小梁立体测量学的指标与对照组的差别有统计学意义,其中C组的BMD分别比A组和B组增高79.9%和14.0%,尽管C组在BMD、BMC和骨小梁立体测量学等指标方面均较B组优,但两组测量结果的差别无统计学意义。结论:体外冲击波可以促进骨质疏松被处理局部骨小梁的改建,改善骨小梁的三维结构,增加骨质密度。实验三:不同能流密度体外冲击波对骨质疏松兔股骨髁部松质骨影响的实验研究目的:观察不同能流密度体外冲击波对骨质疏松兔股骨髁部松质骨成骨作用的差异。方法:30只5月龄雌性新西兰兔,采用卵巢切除(OVX)去势加地塞米松肌肉注射的方法建立骨质疏松模型,3个月时BMD检测确定模型建立。将所有骨质疏松兔随机分为三组,每组10只,其中一组为空白对照组(A组),一组为体外冲击波能流密度0.28mJ/mm2处理组(B组),另一组为体外冲击波能流密度0.47mJ/mm2处理组(C组),脉冲次数为2000次,在实验组兔右侧股骨髁部进行体外冲击波(ESW)处理。于处理后4周、8周时分二批每组处死5只动物,分离右侧股骨远端,进行micro-CT测量分析。结果:micro-CT三维重建分析表明,不同能流密度冲击波处理后4周时B组和C组在BV/TV、Tb.N等指标之间的差异有统计学意义;8周时B组和C组分别在BMD、BMC和BV/TV、BS/BV、骨小梁连接密度等指标之间的差别有统计学意义,其中C组的BMD和BMC分别较B组增高16.8%和10.6%,尽管C组在其他骨小梁立体测量学等指标方面均较B组优,但两组测量结果的差别无统计学意义。结论:在一定范围内不同能流密度体外冲击波对于骨质疏松局部松质骨的作用结果不同,较高能流密度的体外冲击波在促进骨质疏松被处理局部骨小梁的改建,改善骨小梁的三维结构,增加骨密度中优于较低能流密度体外冲击波。
[Abstract]:Osteoporotic fracture is one of the most serious threat to the life of elderly people. The disease of osteoporosis with bone loss, damage micro structure of bone tissue, bone fragility and prone to fracture characteristics, once the fracture, the clinical treatment is very difficult, and the prognosis is poor, affect the patient's quality of life greatly, and even lead to disability of patients and death. Therefore, the prevention and treatment of osteoporosis has been paid more and more attention. At present, for the prevention and treatment of osteoporosis by drug treatment, but treatment cycle is long, slow, obvious side effect, it is difficult to quickly improve bone mineral density and bone strength in a short time. Research shows that extracorporeal shock wave therapy (Extracorporeal Shock Wave Treatment, ESWT) in fracture and nonunion in the treatment of disease plays an important role, especially plays an important role in the formation of bone and osteoporosis showed bone absorption The purpose of this study is to use extracorporeal shock wave to treat osteoporotic bone tissue. According to the ossification effect of extracorporeal shock wave, we can observe whether it can affect trabecular remodeling process, increase bone mineral content and improve bone quality.
Experiment one: ovariectomy plus dexamethasone intramuscular injection to establish experimental rabbit model of osteoporosis: feasibility research methods by ovariectomy plus dexamethasone intramuscular injection to establish the rabbit model of osteoporosis. Methods: 24 male 5 month old female New Zealand rabbits were randomly divided into sham operation + intramuscular injection of saline group (A group), OVX + intramuscular saline group (group B) and OVX + dexamethasone group (C group), 8 rats in each group. Two groups of animal animal after bilateral oophorectomy. Preoperative and postoperative 2,3 months when using dual energy X-ray absorptiometry and after March should be measured and analyzed by micro-CT. Results: after March, dual energy X-ray measured in group C of the lumbar spine and proximal femur BMD were lower than group A 30.45% and 35.49% micro-CT, 3D reconstruction analysis shows that after March, C group and BMC BMD of distal femur, bone trabecula stereology refers to some of the difference between calibration and A group Statistically significant. In group B and group C, trabecular bone is sparse, broken and arranged in disorder, but the latter is more obvious. Conclusion: the establishment of New Zealand rabbit osteoporosis model by castration plus dexamethasone is feasible and the molding time is shorter than that of the simple castration method, 3 months.
Experiment two: extracorporeal shock wave on Experimental Study on osteoporosis rabbit femoral condyle cancellous bone of bone: To observe the effect of extracorporeal shock wave on osteoporosis rabbit femoral condyle cancellous bone. Methods: 30 male 5 month old female New Zealand white rabbits by ovariectomy (OVX) ovariectomy and dexamethasone intramuscular injection to establish the model of osteoporosis, 3 months BMD testing to determine the model. All osteoporotic rabbits were randomly divided into three groups, 10 rats in each group, one group was the control group (A group), the other two groups (B group and C group) animal right femoral condyles in extracorporeal shock wave (ESW), shock wave energy is 0.47mJ/mm2 current density, pulse 2000 times. Before treatment (A group), 4 weeks of postprocessing (B group), 8 weeks (C group) were sacrificed animal, right femur, micro-CT analysis and HE staining. Results: micro-CT analysis showed that the 3D reconstruction, shock wave at After 4 weeks of treatment (B group) and 8 weeks (group C) BMD group, there was statistical significance in BMC and bone trabecula stereology indicators and control group differences in C group BMD was higher than A group and B group increased 79.9% and 14%, while in group C, BMD, BMC and the bone trabecula stereology and other indicators were better than B group, but the two groups had no statistically significant difference. Conclusion: the measurement results of extracorporeal shock wave can promote osteoporosis treatment by local reconstruction of trabecular bone, improve the three-dimensional structure of trabecular bone and increase bone density.
Experiment three: the experimental study on the effect of different energy flow density extracorporeal shock wave on the cancellous bone of the femoral condyle of rabbits with osteoporosis
Objective: To observe the effects of different energy density extracorporeal shock wave on osteoporosis rabbit femoral condyle with difference of bone formation effects. Methods: 30 male 5 month old female New Zealand white rabbits by ovariectomy (OVX) method of ovariectomy plus dexamethasone intramuscular injection to establish the model of osteoporosis, 3 months BMD detection model is established. All osteoporotic rabbits were randomly divided into three groups, 10 rats in each group, one group was the control group (A group), a group of extracorporeal shock wave energy density 0.28mJ/mm2 treatment group (B group), another group of extracorporeal shock wave energy density 0.47mJ/mm2 treatment group (C group), pulse number for the 2000 time, extracorporeal shock wave in the experimental group rabbit right femoral condyles (ESW). After treatment for 4 weeks, 8 weeks when the two batch of 5 rats in each group were sacrificed animal, right femur, micro-CT measurement analysis. Results: micro-CT three-dimensional reconstruction analysis shows that different energy flow density Shock wave treatment at 4 weeks after B in BV/TV group and C group, there was significant difference between Tb.N and other indicators; at 8 weeks, B group and C group respectively in BMD, BMC and BV/TV, BS/BV, there was statistical significance between trabecular density index difference, C group BMD and BMC compared with the B group increased 16.8% and 10.6%, while the C group in other bone trabecula stereology and other indicators were better than B group, but the two groups had no statistically significant difference. Conclusion: the measurement results in a range of different energy density extracorporeal shock wave for osteoporotic cancellous bone of the local not the same, the higher the energy flow density of extracorporeal shock wave in treatment of osteoporosis by promoting local bone trabecular remodeling, improve the three-dimensional structure of trabecular bone, increase bone density better than lower density extracorporeal shock wave.

【学位授予单位】：第四军医大学
【学位级别】：硕士
【学位授予年份】：2008
【分类号】：R580;R-332

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