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

【摘要】： 骨質(zhì)疏松骨折是目前嚴(yán)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(jié)構(gòu)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(yù)后不佳,極大的影響病人的生活質(zhì)量,甚至導(dǎo)致病人傷殘、死亡。因此,對(duì)骨質(zhì)疏松的防治越來(lái)越受到重視。目前對(duì)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(zhǎng)、副作用明顯、見(jiàn)效慢,很難在短時(shí)間內(nèi)迅速提高骨密度及骨強(qiáng)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(guò)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(qiáng)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(guò)程,增加骨礦含量和改善骨質(zhì)量。 實(shí)驗(yàn)一:去勢(shì)加地塞米松肌肉注射兔骨質(zhì)疏松模型建立的實(shí)驗(yàn)研究目的:探究應(yīng)用去勢(shì)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(jī)分成假手術(shù)+肌注生理鹽水組(A組)、去勢(shì)+肌注生理鹽水組(B組)和去勢(shì)+肌注地塞米松組(C組),每組8只動(dòng)物。后兩組動(dòng)物行雙側(cè)卵巢切除術(shù)。術(shù)前和術(shù)后2、3月時(shí)采用雙能X線吸收骨密度測(cè)量?jī)x及術(shù)后3月應(yīng)用micro-CT進(jìn)行測(cè)量分析。結(jié)果:術(shù)后3月雙能X線測(cè)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(shù)后3月時(shí),C組股骨遠(yuǎn)端BMD、BMC和骨小梁立體測(cè)量學(xué)的一些指標(biāo)與A組的差值有統(tǒng)計(jì)學(xué)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(jié)論:去勢(shì)+肌注地塞米松法建立新西蘭兔骨質(zhì)疏松癥模型切實(shí)可行,造模時(shí)間較單純?nèi)?shì)法更短,3個(gè)月即可。 實(shí)驗(yàn)二:體外沖擊波對(duì)骨質(zhì)疏松兔股骨髁部松質(zhì)骨影響的實(shí)驗(yàn)研究目的:觀察體外沖擊波對(duì)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(shì)加地塞米松肌肉注射的方法建立骨質(zhì)疏松模型,3個(gè)月時(shí)BMD檢測(cè)確定模型建立。將所有骨質(zhì)疏松兔隨機(jī)分為三組,每組10只,其中一組為空白對(duì)照組(A組),其余兩組(B組和C組)動(dòng)物右側(cè)股骨髁部進(jìn)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(shí)分別處死動(dòng)物,分離右側(cè)股骨遠(yuǎn)端,進(jìn)行micro-CT測(cè)量分析和HE染色觀察。結(jié)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(shí)實(shí)驗(yàn)組的BMD、BMC和骨小梁立體測(cè)量學(xué)的指標(biāo)與對(duì)照組的差別有統(tǒng)計(jì)學(xué)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(cè)量學(xué)等指標(biāo)方面均較B組優(yōu),但兩組測(cè)量結(jié)果的差別無(wú)統(tǒng)計(jì)學(xué)意義。結(jié)論:體外沖擊波可以促進(jìn)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(jié)構(gòu),增加骨質(zhì)密度。 實(shí)驗(yàn)三:不同能流密度體外沖擊波對(duì)骨質(zhì)疏松兔股骨髁部松質(zhì)骨影響的實(shí)驗(yàn)研究 目的:觀察不同能流密度體外沖擊波對(duì)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(shì)加地塞米松肌肉注射的方法建立骨質(zhì)疏松模型,3個(gè)月時(shí)BMD檢測(cè)確定模型建立。將所有骨質(zhì)疏松兔隨機(jī)分為三組,每組10只,其中一組為空白對(duì)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(shí)驗(yàn)組兔右側(cè)股骨髁部進(jìn)行體外沖擊波(ESW)處理。于處理后4周、8周時(shí)分二批每組處死5只動(dòng)物,分離右側(cè)股骨遠(yuǎn)端,進(jìn)行micro-CT測(cè)量分析。結(jié)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(shí)B組和C組在BV/TV、Tb.N等指標(biāo)之間的差異有統(tǒng)計(jì)學(xué)意義;8周時(shí)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(biāo)之間的差別有統(tǒng)計(jì)學(xué)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(cè)量學(xué)等指標(biāo)方面均較B組優(yōu),但兩組測(cè)量結(jié)果的差別無(wú)統(tǒng)計(jì)學(xué)意義。結(jié)論:在一定范圍內(nèi)不同能流密度體外沖擊波對(duì)于骨質(zhì)疏松局部松質(zhì)骨的作用結(jié)果不同,較高能流密度的體外沖擊波在促進(jìn)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(jié)構(gòu),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(xué)位授予單位】：第四軍醫(yī)大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2008
【分類號(hào)】：R580;R-332

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