發(fā)布時間：2018-03-17 06:08

  本文選題：人工頸椎間盤置換　切入點：界面壓力　出處：《中國修復(fù)重建外科雜志》2017年04期 　論文類型：期刊論文

【摘要】：目的探討國產(chǎn)人工頸椎間盤置換術(shù)后,界面壓力對假體終板-骨界面骨整合的影響。方法取國產(chǎn)人工頸椎間盤置換術(shù)后1周的山羊行頸椎CT掃描,建立C_(3、4)椎體及假體三維有限元模型,分析靜態(tài)模式下假體上、下終板壓力分布情況,并根據(jù)壓力分布范圍分區(qū)。取人工頸椎間盤置換術(shù)后6、12個月山羊,行MircoCT掃描及三維重建,測量各個壓力區(qū)骨體積分?jǐn)?shù)(bone volume fraction,BVF)、骨小梁數(shù)目(trabecular number,Tb.N)、骨小梁厚度(trabecular thickness,Tb.Th)、骨小梁間隙(trabecular separation,Tb.Sp)、骨密度(bone mineral density,BMD)、骨表面積體積比(bone surface/bone volume,BS/BV)、骨小梁模型因子(trabecular pattern factor,Tb.Pf),并進(jìn)行比較。另取4只正常山羊,切取C_3椎體下終板和C_4椎體上終板標(biāo)本,制備直徑2 mm圓柱形骨塊,于取材后即刻以及培養(yǎng)24、48 h行實時熒光定量PCR檢測NF-κB受體活化因子配體(nuclear factorκB ligand,RANKL)、骨保護(hù)素(osteoprotegerin,OPG)、巨噬細(xì)胞集落刺激因子(macrophage colony-stimulating factor,M-CSF)、TGF-β基因表達(dá)。根據(jù)結(jié)果選擇合適培養(yǎng)時間的樣本進(jìn)行力學(xué)加載后,同上法檢測RANKL、OPG、M-CSF、TGF-β基因相對表達(dá)量;以同時間點未行力學(xué)加載標(biāo)本作為正常對照。結(jié)果 C_(3、4)節(jié)段三維有限元模型建立并給予25 N載荷后,在靜止?fàn)顟B(tài)時人工頸椎間盤上終板壓力較大區(qū)域在終板中央偏后,下終板壓力較大區(qū)域在終板中部的前方及兩條固定軌道上。按照壓力值大小,將終板分為5個區(qū)域。Micro-CT掃描觀察,假體植入后12個月,上、下終板各區(qū)域BMD、Tb.Th、BVF、Tb.N均較6個月時增加(P0.05),而BS/BV、Tb.Sp、Tb.Pf均降低(P0.05)。培養(yǎng)24、48 h RANKL、OPG及TGF-β基因相對表達(dá)量與取材后即刻比較,差異均有統(tǒng)計學(xué)意義(P0.05);培養(yǎng)24、48 h之間以上基因相對表達(dá)量比較差異均無統(tǒng)計學(xué)意義(P0.05)。選擇培養(yǎng)24 h樣本進(jìn)行力學(xué)加載測試。與對應(yīng)正常對照組相比,C_3下終板及C_4上終板壓力組RANKL、OPG基因相對表達(dá)量以及OPG/RANKL明顯上調(diào)(P0.05);TGF-β、M-CSF基因相對表達(dá)量比較,差異無統(tǒng)計學(xué)意義(P0.05)。結(jié)論國產(chǎn)人工頸椎間盤終板壓力分布特點不同,其中下終板受到壓力稍大。壓力不同區(qū)域?qū)植抗钦嫌兄匾绊?壓力大的區(qū)域骨整合情況更佳。在假體終板-骨界面最大壓力作用下成骨細(xì)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.

【作者單位】： 四川大學(xué)華西醫(yī)院骨科;第三軍醫(yī)大學(xué)附屬西南醫(yī)院骨科;
【分類號】：R687.3;R318.17
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本文編號：1623475