本文選題：骨質(zhì)疏松　切入點：體外沖擊波　出處：《第四軍醫(yī)大學》2008年碩士論文

【摘要】： 骨質(zhì)疏松骨折是目前嚴重威脅老年人生活的疾病之一。骨質(zhì)疏松癥以骨量減少、骨組織微結構破壞、骨脆性增加而極易發(fā)生骨折為特征,一旦發(fā)生骨折,其臨床治療非常困難,且預后不佳,極大的影響病人的生活質(zhì)量,甚至導致病人傷殘、死亡。因此,對骨質(zhì)疏松的防治越來越受到重視。目前對于骨質(zhì)疏松的防治主要采用藥物治療,但是,藥物治療周期長、副作用明顯、見效慢,很難在短時間內(nèi)迅速提高骨密度及骨強度。研究證明,體外沖擊波療法(Extracorporeal Shock Wave Treatment, ESWT)在骨折及骨不連等疾病的治療中發(fā)揮著重要的作用,特別在骨形成過程中起著重要的作用,而骨質(zhì)疏松表現(xiàn)為骨吸收的增強和骨形成的減弱。因此,本研究擬采用體外沖擊波處理骨質(zhì)疏松局部骨組織,根據(jù)體外沖擊波的成骨作用,觀察其能否影響骨小梁改建過程,增加骨礦含量和改善骨質(zhì)量。 實驗一:去勢加地塞米松肌肉注射兔骨質(zhì)疏松模型建立的實驗研究目的:探究應用去勢加肌肉注射地塞米松的方法建立兔骨質(zhì)疏松模型的可行性。方法:將24只5月齡雌性新西蘭兔隨機分成假手術+肌注生理鹽水組(A組)、去勢+肌注生理鹽水組(B組)和去勢+肌注地塞米松組(C組),每組8只動物。后兩組動物行雙側卵巢切除術。術前和術后2、3月時采用雙能X線吸收骨密度測量儀及術后3月應用micro-CT進行測量分析。結果:術后3月雙能X線測得C組兔腰椎和股骨近端的BMD分別較A組降低30.45%和35.49%,micro-CT三維重建分析表明,在術后3月時,C組股骨遠端BMD、BMC和骨小梁立體測量學的一些指標與A組的差值有統(tǒng)計學意義,B組和C組骨小梁稀疏、斷裂、排列紊亂,但后者更為明顯。結論:去勢+肌注地塞米松法建立新西蘭兔骨質(zhì)疏松癥模型切實可行,造模時間較單純?nèi)莘ǜ?3個月即可。 實驗二:體外沖擊波對骨質(zhì)疏松兔股骨髁部松質(zhì)骨影響的實驗研究目的:觀察體外沖擊波對骨質(zhì)疏松兔股骨髁部松質(zhì)骨的成骨作用。方法:30只5月齡雌性新西蘭兔,采用卵巢切除(OVX)去勢加地塞米松肌肉注射的方法建立骨質(zhì)疏松模型,3個月時BMD檢測確定模型建立。將所有骨質(zhì)疏松兔隨機分為三組,每組10只,其中一組為空白對照組(A組),其余兩組(B組和C組)動物右側股骨髁部進行體外沖擊波(ESW)處理,沖擊波能流密度為0.47mJ/mm2,脈沖2000次。于處理前(A組)、處理后4周(B組)、8周(C組)時分別處死動物,分離右側股骨遠端,進行micro-CT測量分析和HE染色觀察。結果:micro-CT三維重建分析表明,沖擊波處理后4周(B組)及8周(C組)時實驗組的BMD、BMC和骨小梁立體測量學的指標與對照組的差別有統(tǒng)計學意義,其中C組的BMD分別比A組和B組增高79.9%和14.0%,盡管C組在BMD、BMC和骨小梁立體測量學等指標方面均較B組優(yōu),但兩組測量結果的差別無統(tǒng)計學意義。結論:體外沖擊波可以促進骨質(zhì)疏松被處理局部骨小梁的改建,改善骨小梁的三維結構,增加骨質(zhì)密度。 實驗三:不同能流密度體外沖擊波對骨質(zhì)疏松兔股骨髁部松質(zhì)骨影響的實驗研究 目的:觀察不同能流密度體外沖擊波對骨質(zhì)疏松兔股骨髁部松質(zhì)骨成骨作用的差異。方法:30只5月齡雌性新西蘭兔,采用卵巢切除(OVX)去勢加地塞米松肌肉注射的方法建立骨質(zhì)疏松模型,3個月時BMD檢測確定模型建立。將所有骨質(zhì)疏松兔隨機分為三組,每組10只,其中一組為空白對照組(A組),一組為體外沖擊波能流密度0.28mJ/mm2處理組(B組),另一組為體外沖擊波能流密度0.47mJ/mm2處理組(C組),脈沖次數(shù)為2000次,在實驗組兔右側股骨髁部進行體外沖擊波(ESW)處理。于處理后4周、8周時分二批每組處死5只動物,分離右側股骨遠端,進行micro-CT測量分析。結果:micro-CT三維重建分析表明,不同能流密度沖擊波處理后4周時B組和C組在BV/TV、Tb.N等指標之間的差異有統(tǒng)計學意義;8周時B組和C組分別在BMD、BMC和BV/TV、BS/BV、骨小梁連接密度等指標之間的差別有統(tǒng)計學意義,其中C組的BMD和BMC分別較B組增高16.8%和10.6%,盡管C組在其他骨小梁立體測量學等指標方面均較B組優(yōu),但兩組測量結果的差別無統(tǒng)計學意義。結論:在一定范圍內(nèi)不同能流密度體外沖擊波對于骨質(zhì)疏松局部松質(zhì)骨的作用結果不同,較高能流密度的體外沖擊波在促進骨質(zhì)疏松被處理局部骨小梁的改建,改善骨小梁的三維結構,增加骨密度中優(yōu)于較低能流密度體外沖擊波。
[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.

【學位授予單位】：第四軍醫(yī)大學
【學位級別】：碩士
【學位授予年份】：2008
【分類號】：R580;R-332

【參考文獻】

相關期刊論文 前10條

1 張立,趙麗娟,葛煥琦,白立煒;糖尿病并發(fā)去卵巢骨質(zhì)疏松癥大鼠模型的建立[J];吉林大學學報(醫(yī)學版);2003年04期

2 裴育;睪丸切除大鼠骨質(zhì)疏松動物模型的研究及應用[J];國外醫(yī)學.內(nèi)分泌學分冊;2002年04期

3 廖慧娟;骨質(zhì)疏松癥動物模型[J];國外醫(yī)學(內(nèi)分泌學分冊);2004年01期

4 蔣誼,魏啟幼;顯微CT在骨質(zhì)疏松癥病理診斷中的應用[J];國外醫(yī)學.內(nèi)分泌學分冊;2005年05期

5 李良,吳文超,陳槐卿,譚建三,鄭虎,翁玲玲;去勢雌山羊骨組織形態(tài)學變化的動態(tài)觀察[J];華西醫(yī)科大學學報;1997年04期

6 馬振國;等離子體工業(yè)的崛起與發(fā)展[J];科技導報;1995年02期

7 韋永中,陶松年,楊國平,包麗華;去勢對不同月齡雌性大鼠骨丟失的影響[J];南京醫(yī)科大學學報;1999年03期

8 喬偉偉,許蘭文,楊幼明,柳啟沛,周文江,黃靈紅,潘華;大鼠營養(yǎng)干預性骨質(zhì)疏松癥模型的研究[J];上海實驗動物科學;2002年03期

9 楊霞,蔡桂英,魏玲,候靜,李炯,鄭虎,翁玲玲;去勢兔骨質(zhì)疏松模型建立的初探[J];生物醫(yī)學工程學雜志;1997年04期

10 王彤,丁曉蓉,龐瑩,于濤,劉慶忠,王舒,韓景獻;針刺對快速老化腦萎縮及癡呆模型小白鼠(SAMP10)行為學影響的實驗研究[J];天津中醫(yī)藥;2003年02期

，

本文編號：1668813