国产人工颈椎间盘界面压力对假体-骨界面骨整合的影响

发布时间：2018-03-17 06:08

  本文选题：人工颈椎间盘置换　切入点：界面压力　出处：《中国修复重建外科杂志》2017年04期 　论文类型：期刊论文

【摘要】：目的探讨国产人工颈椎间盘置换术后,界面压力对假体终板-骨界面骨整合的影响。方法取国产人工颈椎间盘置换术后1周的山羊行颈椎CT扫描,建立C_(3、4)椎体及假体三维有限元模型,分析静态模式下假体上、下终板压力分布情况,并根据压力分布范围分区。取人工颈椎间盘置换术后6、12个月山羊,行MircoCT扫描及三维重建,测量各个压力区骨体积分数(bone volume fraction,BVF)、骨小梁数目(trabecular number,Tb.N)、骨小梁厚度(trabecular thickness,Tb.Th)、骨小梁间隙(trabecular separation,Tb.Sp)、骨密度(bone mineral density,BMD)、骨表面积体积比(bone surface/bone volume,BS/BV)、骨小梁模型因子(trabecular pattern factor,Tb.Pf),并进行比较。另取4只正常山羊,切取C_3椎体下终板和C_4椎体上终板标本,制备直径2 mm圆柱形骨块,于取材后即刻以及培养24、48 h行实时荧光定量PCR检测NF-κB受体活化因子配体(nuclear factorκB ligand,RANKL)、骨保护素(osteoprotegerin,OPG)、巨噬细胞集落刺激因子(macrophage colony-stimulating factor,M-CSF)、TGF-β基因表达。根据结果选择合适培养时间的样本进行力学加载后,同上法检测RANKL、OPG、M-CSF、TGF-β基因相对表达量;以同时间点未行力学加载标本作为正常对照。结果 C_(3、4)节段三维有限元模型建立并给予25 N载荷后,在静止状态时人工颈椎间盘上终板压力较大区域在终板中央偏后,下终板压力较大区域在终板中部的前方及两条固定轨道上。按照压力值大小,将终板分为5个区域。Micro-CT扫描观察,假体植入后12个月,上、下终板各区域BMD、Tb.Th、BVF、Tb.N均较6个月时增加(P0.05),而BS/BV、Tb.Sp、Tb.Pf均降低(P0.05)。培养24、48 h RANKL、OPG及TGF-β基因相对表达量与取材后即刻比较,差异均有统计学意义(P0.05);培养24、48 h之间以上基因相对表达量比较差异均无统计学意义(P0.05)。选择培养24 h样本进行力学加载测试。与对应正常对照组相比,C_3下终板及C_4上终板压力组RANKL、OPG基因相对表达量以及OPG/RANKL明显上调(P0.05);TGF-β、M-CSF基因相对表达量比较,差异无统计学意义(P0.05)。结论国产人工颈椎间盘终板压力分布特点不同,其中下终板受到压力稍大。压力不同区域对局部骨整合有重要影响,压力大的区域骨整合情况更佳。在假体终板-骨界面最大压力作用下成骨细胞增殖分子含量增加,有利于局部骨整合。
[Abstract]:Objective to investigate the artificial cervical disc replacement, effects of interface pressure on the endplate prosthesis bone interface bone integration method. Goats for cervical CT scan domestic artificial cervical intervertebral disc replacement 1 weeks after the establishment of C_ (3,4) vertebral prosthesis model and 3D finite element analysis, the static mode of prosthesis, distribution under the condition of endplate pressure, and according to the pressure distribution range partition. 6,12 months after artificial cervical disc replacement goat, underwent MircoCT scanning and 3D reconstruction, the bone volume fraction measurement of pressure (bone volume fraction, BVF), trabecular number (trabecular, number, Tb.N), Liang Houdu trabecular (small bone thickness, Tb.Th), Liang Jianxi (trabecular separation, trabecular bone mineral density (Tb.Sp), bone mineral density, BMD), bone surface area volume ratio (bone surface/bone volume, BS/BV), trabecular pattern factor (trabecular pattern factor, Tb.Pf), and For comparison. Another 4 normal goat, cut C_3 vertebral endplate and C_4 vertebral body endplate specimens, preparation of 2 mm diameter cylindrical bone block was drawn immediately after training and 24,48 h real time fluorescence quantitative PCR detection of NF- kappa B ligand of receptor activator (nuclear factor kappa B ligand, RANKL), bone osteoprotegerin (osteoprotegerin, OPG), macrophage colony stimulating factor (macrophage colony-stimulating, factor, M-CSF), the expression of TGF- beta gene. According to the selection of appropriate incubation time samples after mechanical loading, the detection of RANKL, OPG M-CSF, the same method, the relative expression of TGF- beta gene; at the same time point without mechanical loading of specimens as a normal control. Results C_ (3,4) three dimensional finite element model of the segment is established and treated with 25 N load, in the static state of artificial cervical disc endplate pressure area in the center of endplate, under pressure in the end region of endplate In front of the middle and two fixed track. According to the pressure value of the endplate is divided into 5 observation area of.Micro-CT scanning, 12 months after the implantation, the lower endplate regions BMD, Tb.Th, BVF, Tb.N were increased at 6 months (P0.05), BS/BV, Tb.Sp, Tb.Pf decreased (P0.05). 24,48 h RANKL culture, the relative expression of OPG and TGF- gene were compared and immediately after, the differences were statistically significant (P0.05); 24,48 h training among the above relative gene expression showed no significant difference (P0.05). Samples were cultured for 24 h and the corresponding mechanical loading test. Compared with normal control group, C_4 and C_3 under the pressure of endplate endplate group RANKL, and relative expression of OPG/RANKL up-regulated OPG gene (P0.05); TGF- beta, relative expression of M-CSF gene was compared, the difference was not statistically significant (P0.05). Conclusion the domestic artificial cervical intervertebral disc endplate pressure distribution characteristics In different regions, the lower endplate is slightly stressed. Different regions of pressure have important influence on the regional bone integration. The area of pressure is larger. The osseointegration is better. At the end of the prosthesis, the increase of the molecular weight of osteoblast proliferation is beneficial to local osseointegration.

【作者单位】： 四川大学华西医院骨科;第三军医大学附属西南医院骨科;
【分类号】：R687.3;R318.17
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本文编号：1623475