超声造影评估兔人工骨微血管生长的实验研究

发布时间：2018-04-20 00:32

本文选题：超声造影 + 珊瑚羟基磷灰石　；参考：《南方医科大学》2017年硕士论文

【摘要】：研究背景:骨移植在骨损伤治疗中有着重要地位,以自体骨移植疗效最佳但取材有限,目前移植替代物已逐渐应用于临床,其成败取决于移植物的血管化程度,现评估方法主要有病理组织学及影像学检测(SPECT、CT、MRI等),但超声对移植骨的血管化的评价未有报道。目的:采用常规超声及超声造影评估人工骨血管化程度,探讨其临床应用价值。材料和方法:1、对15只新西兰兔分别行经典双前肢桡骨大段骨缺损模型造模,植入珊瑚羟基磷灰石人工骨(CHA)。分别于5天、7天、11天、15天、30天、45天对双侧CHA行常规超声及超声造影检查。纵、横切面观察CHA两端及中央平分两点的情况,运用TIC-Analysis(GK)测量以上部位的基础强度(BI)、峰值强度(PI)、增强强度(△SI,PI与BI的差值)、1B1/P1及达峰时间(TTP),分析结果与病理进行对照。2、对15只新西兰兔分别行经典双前肢桡骨大段骨缺损模型造模,左肢植入重组人骨形态发生蛋白2(rhBMP-2)CHA,右肢植入CHA,检测时间分别为5天、7天、11天、15天、30天、45天,检测部位、方法及定量参数同上,分析结果与病理进行对照。3、以上两组实验均采用SPSS 22.0进行数据分析,计量资料采用均数士标准差表示。实验一各组间对比均采用配对样本t检验,实验二各组间对比均采用秩和检验.,两实验的时间与△SI、BI/PI、TTP关系,均采用双变量相关分析(Pearson),以p0.05为差异有统计学意义。结果:1、常规超声灰阶超声:rhBMP-2 CHA组及CHA组3天起,灰阶超声均呈圆柱形实性稍高回声,内见筛孔样点状无回声,显示清晰,肉眼难以分辨两者区别。前者11天及后者15天起,CDFI显示移植骨体内见点状血流信号,PW测得低阻低速动脉血流频谱。前者30天及后者45天起,表面反射较前明显,骨质显示较前增强,筛孔样结构显示欠清。2、超声造影rhBMP-2 CHA 3天及CHA 7天起周边见少量增强,中央无增强。前者11天及后者15天起周边及中央见明显增强。前者30天及后者45天起后方出现明显声衰减。3、定量分析两种CHA各观察时间组间对比,△SI、BI/PI、TTP值比较均有统计学意义,△SI与时间呈显著正相关;BI/PI、TTP与时间呈显著负相关。rhBMP-2 CHA与CHA组间对比,△SI、BI/PI、TTP值比较均有统计学意义,相同时间内前者血管化程度比后者强,前者血管化时间比后者提前。两种CHA四个观察点间对比,各值均无统计学意义。4、病理HE染色结果显示rhBMP-2 CHA 3天及CHA 7天起周边见大量红细胞,中央见少量红细胞;前者11天及后者15天起周边及中央见大量红细胞及成骨细胞;前者30天及后者45天起周边及中央细胞数均减少、纤维结构增加,提示超声造影与病理一致。结论:超声造影能较好的显示CHA早期血流灌注情况,准确评估rhBMP-2应用后CHA血管化程度的变化,有望成为临床移植骨血管化评估的新手段。
[Abstract]:Background: bone transplantation plays an important role in the treatment of bone injury. Autogenous bone graft has the best curative effect but limited material use. At present, the graft substitute has been gradually used in clinic, and its success or failure depends on the degree of vascularization of the graft. The main methods of evaluation are histopathology and imaging examination, but the evaluation of vascularization of grafts by ultrasound has not been reported. Objective: to evaluate the vascularization of artificial bone by conventional ultrasound and contrast-enhanced ultrasound. Materials and methods 15 New Zealand rabbits were used to model the large segmental radial bone defect model and implanted with coral hydroxyapatite artificial bone. Bilateral CHA were examined by conventional ultrasonography and contrast-enhanced ultrasonography respectively on 5 days, 7 days, 11 days, 15 days and 30 days and 45 days, respectively. Longitudinal and cross-sectional observations of the two ends and the center of the CHA, The basic strength and peak intensity of the above sites were measured by TIC-AnalysisGK, the peak intensity was measured by Pi, the enhancement intensity (the difference between SI Pi and BI was 1B1 / P1 and the time to reach the peak). The results were compared with pathology. The results were compared with pathology. Fifteen New Zealand rabbits were treated with classical double forelimb radial segment. Model of bone defect, Recombinant human bone morphogenetic protein 2rhBMP-2 was implanted in the left limb and CHA was implanted in the right limb. The detection time was 5 days, 7 days, 11 days, 15 days, 30 days and 45 days, respectively. The location, method and quantitative parameters were the same. The results of analysis were compared with pathology. The data of the two groups were analyzed by SPSS 22.0, and the measurement data were expressed by the standard deviation of mean value. In experiment one, the paired sample t test was used for the contrast, and the rank sum test was used in the second group. The relationship between the time of the two experiments and SIBI / PII TTP was analyzed by bivariate correlation analysis (Pearsonia). The difference was statistically significant (p0.05). Results 1: 1, the gray scale ultrasound of routine ultrasound: rhBMP-2 CHA group and CHA group all showed cylindrical solid hyperechoic echo after 3 days, and there was no echo in the ethmoid hole. The difference between the two was difficult to distinguish with the naked eye. CDFI showed point blood flow signal in grafts and low velocity arterial blood flow spectrum measured by PW at 11 days and 15 days later. After 30 days and 45 days of the former, the surface reflex was more obvious, the bone was enhanced, the ethmoid structure was not clear, the rhBMP-2 CHA showed a little enhancement at the 3rd day and the CHA at the 7th day, but no enhancement was found in the central part. The former 11 days and the latter 15 days from the peripheral and central obviously strengthened. The former 30 days and the latter 45 days after the obvious sound attenuation. 3, quantitative analysis of the two CHA observation time group comparison, SIBI / Pi TTP comparison was statistically significant. There was a significant positive correlation between SI and time. There was a significant negative correlation between the time and SI / Pi. The comparison between rhBMP-2 CHA and CHA group showed that there was significant difference between the two groups. The degree of vascularization of the former was stronger than that of the latter in the same time, and the vascularization time of the former was earlier than that of the latter. The results of HE staining showed that a large number of red blood cells appeared in the periphery of rhBMP-2 CHA 3 days and CHA 7 days, and a small number of red blood cells were seen in the center. A large number of erythrocytes and osteoblasts were seen in the periphery and center of the former 11 days and the latter 15 days, while the number of peripheral and central cells in the former 30 days and the latter 45 days decreased, and the fiber structure increased, suggesting that the contrast-enhanced ultrasound was consistent with pathology. Conclusion: contrast-enhanced ultrasound can show the early blood flow perfusion of CHA and accurately evaluate the degree of vascularization of CHA after the application of rhBMP-2. It is expected to be a new method for evaluating vascularization of bone grafts.
【学位授予单位】：南方医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R445.1;R68

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