体外冲击波联合增强型纤维蛋白胶负载骨生长因子治疗兔骨缺损的研究

发布时间：2018-05-08 11:11

本文选题：体外冲击波 + 骨缺损　；参考：《重庆医科大学》2015年硕士论文

【摘要】：目的：尽管体外冲击波(ESW)对骨缺损的治疗有一定的疗效,但是临床应用仍然受限。有研究提示骨形态蛋白(BMP-2)、成纤维生长因子(bFGF)、血管内皮生长因子(VEGF)可以有效调控骨形成过程。因此,我们欲探讨体外冲击波联合增强型纤维蛋白胶负载骨生长因子经皮直接注射入骨缺损断端加速骨缺损愈合、促进成骨过程的作用。方法：制备兔桡骨骨缺损模型并行不同方案的治疗：A组只给予ESW治疗；B组给予ESW联合纤维蛋白胶(FG)治疗；C组给予ESW联合FG/rhBMP-2/rhbFGF治疗；D组给予ESW联合FG/rhBMP-2/brhFGF/rhVEGF治疗,E组为空白对照组制备骨缺损模型后不给予任何治疗。五组实验兔分别于术后第四周和第八周,摄X片观察骨折处的生长情况。处死后取以骨折处为中心的4mm组织标本,利用组织形态学检测新生骨组织的表达情况,及生物力学试验方法检测治疗后的骨折处抗弯曲能力的情况。组内比较,采用样本均数比较的t检验,利用SPSS18.0软件进行统计。结果：治疗后B组与A组(单纯ESW)相比,B组(FG+ESW)骨折线稍模糊,骨痂面积开始增多,骨折断端距离缩短。组织形态学显示大片软骨形成,软骨细胞增生活跃,周围纤维结缔组织中可见新生血管形成。生物力学测定结果发现两组之间并没有差距,两者之间没有统计学意义(p0.05)。C组(FG/rhBMP-2/rhbFGF+ESW)骨折线骨折线模糊,纤维骨痂消失,可见明显增生的骨小梁。C组与B组(FG +ESW)相比,C组(FG/rhBMP-2/rhbFGF+ESW)生物力学明显有差异,且具有显著性统计学意义(p0.01)。D组(FG/rhBMP-2/rhbFGF/rhVEGF+ESW)4周时骨折线明显模糊,骨小梁明显增多。8周时骨折线消失,且愈合后塑形好。组织形态学显示以见正常骨结构,大量骨小梁排列规则,可见髓腔样组织。D组与C组(FG/rhBMP-2/rhbFGF+ESW)相比,有明显差异且具有显著性统计学意义(p0.01),说明更能够提高抗弯曲力度。E组8周仍可见骨折间隙,骨缺损断端仍为硬化骨。结论：体外冲击波联合经皮注射增强型纤维蛋白胶负载骨生长因子具有明显促进骨缺损愈合作用,有望成为一种非手术治疗骨缺损的良好方法。
[Abstract]:Objective: although extracorporeal shock wave (ESWs) is effective in the treatment of bone defect, its clinical application is still limited. It is suggested that bone morphogenetic protein (BMP-2), fibroblast growth factor (BFGF) and vascular endothelial growth factor (VEGF) can effectively regulate the process of bone formation. Therefore, we would like to explore the effect of extracorporeal shock wave combined with enhanced fibrin glue loaded bone growth factor (BGF) directly injected into the broken end of bone defect to accelerate the healing of bone defect and promote the process of osteogenesis. Methods: the model of rabbit radial bone defect was established and treated with different schemes. Group A was treated with ESW only. Group B was treated with ESW combined with fibrin glue. Group C was treated with ESW and FG/rhBMP-2/rhbFGF. Group D was treated with ESW and FG/rhBMP-2/brhFGF/rhVEGF as blank. The model of bone defect in the control group was made without any treatment. Five groups of rabbits were taken X-ray to observe the growth of fracture at the fourth week and the eighth week after operation. The expression of new bone tissue was detected by histomorphology, and the anti-bending ability of treated fracture was detected by biomechanical test. T test was used to compare the mean of samples and SPSS18.0 software was used to carry out the statistics. Results: after treatment, the fracture line of group B was slightly blurred, the area of callus began to increase and the distance between fracture end and end was shortened compared with group A (simple ESWs). Histomorphology showed the formation of chondrocytes, the proliferation of chondrocytes and the formation of neovascularization in peripheral fibrous connective tissues. The biomechanical results showed that there was no difference between the two groups. There was no statistical significance between the two groups. In group C, the line of fracture line of FG / rhBMP-2 / rhbFGF ESWs was blurred, and the fibrous callus disappeared. There was significant difference in biomechanics between group C and group B in terms of biomechanics of FG / rhBMP-2 / rhbFGF ESW.There was significant statistical significance between group C and group B (P < 0.01). The fracture line of group FG / rhBMP-2 / rhbFGF- / rhVEGF ESW)4 was obviously blurred at the week of increase of bone trabeculae, and the fracture line disappeared at 8 weeks after the increase of bone trabecula. And after healing, the shape is good. Histomorphology showed normal bone structure and regular arrangement of bone trabeculae. Compared with group C (FG / rhBMP-2 / rhbFGF ESWs), the medullary luminal tissue in group D was similar to that in group C. There was significant difference and significant statistical significance (p0.01), which indicated that the fracture space could still be seen in group E. the broken end of bone defect was still sclerosed. Conclusion: extracorporeal shock wave combined with percutaneous injection of enhanced fibrin glue loaded bone growth factor can obviously promote the healing of bone defect, which is expected to be a good non-operative method for the treatment of bone defect.
【学位授予单位】：重庆医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R687.3

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