本文選題：超聲造影 + 珊瑚羥基磷灰石��； 參考：《南方醫(yī)科大學(xué)》2017年碩士論文

【摘要】：研究背景:骨移植在骨損傷治療中有著重要地位,以自體骨移植療效最佳但取材有限,目前移植替代物已逐漸應(yīng)用于臨床,其成敗取決于移植物的血管化程度,現(xiàn)評(píng)估方法主要有病理組織學(xué)及影像學(xué)檢測(cè)(SPECT、CT、MRI等),但超聲對(duì)移植骨的血管化的評(píng)價(jià)未有報(bào)道。目的:采用常規(guī)超聲及超聲造影評(píng)估人工骨血管化程度,探討其臨床應(yīng)用價(jià)值。材料和方法:1、對(duì)15只新西蘭兔分別行經(jīng)典雙前肢橈骨大段骨缺損模型造模,植入珊瑚羥基磷灰石人工骨(CHA)。分別于5天、7天、11天、15天、30天、45天對(duì)雙側(cè)CHA行常規(guī)超聲及超聲造影檢查。縱、橫切面觀察CHA兩端及中央平分兩點(diǎn)的情況,運(yùn)用TIC-Analysis(GK)測(cè)量以上部位的基礎(chǔ)強(qiáng)度(BI)、峰值強(qiáng)度(PI)、增強(qiáng)強(qiáng)度(△SI,PI與BI的差值)、1B1/P1及達(dá)峰時(shí)間(TTP),分析結(jié)果與病理進(jìn)行對(duì)照。2、對(duì)15只新西蘭兔分別行經(jīng)典雙前肢橈骨大段骨缺損模型造模,左肢植入重組人骨形態(tài)發(fā)生蛋白2(rhBMP-2)CHA,右肢植入CHA,檢測(cè)時(shí)間分別為5天、7天、11天、15天、30天、45天,檢測(cè)部位、方法及定量參數(shù)同上,分析結(jié)果與病理進(jìn)行對(duì)照。3、以上兩組實(shí)驗(yàn)均采用SPSS 22.0進(jìn)行數(shù)據(jù)分析,計(jì)量資料采用均數(shù)士標(biāo)準(zhǔn)差表示。實(shí)驗(yàn)一各組間對(duì)比均采用配對(duì)樣本t檢驗(yàn),實(shí)驗(yàn)二各組間對(duì)比均采用秩和檢驗(yàn).,兩實(shí)驗(yàn)的時(shí)間與△SI、BI/PI、TTP關(guān)系,均采用雙變量相關(guān)分析(Pearson),以p0.05為差異有統(tǒng)計(jì)學(xué)意義。結(jié)果:1、常規(guī)超聲灰階超聲:rhBMP-2 CHA組及CHA組3天起,灰階超聲均呈圓柱形實(shí)性稍高回聲,內(nèi)見(jiàn)篩孔樣點(diǎn)狀無(wú)回聲,顯示清晰,肉眼難以分辨兩者區(qū)別。前者11天及后者15天起,CDFI顯示移植骨體內(nèi)見(jiàn)點(diǎn)狀血流信號(hào),PW測(cè)得低阻低速動(dòng)脈血流頻譜。前者30天及后者45天起,表面反射較前明顯,骨質(zhì)顯示較前增強(qiáng),篩孔樣結(jié)構(gòu)顯示欠清。2、超聲造影rhBMP-2 CHA 3天及CHA 7天起周邊見(jiàn)少量增強(qiáng),中央無(wú)增強(qiáng)。前者11天及后者15天起周邊及中央見(jiàn)明顯增強(qiáng)。前者30天及后者45天起后方出現(xiàn)明顯聲衰減。3、定量分析兩種CHA各觀察時(shí)間組間對(duì)比,△SI、BI/PI、TTP值比較均有統(tǒng)計(jì)學(xué)意義,△SI與時(shí)間呈顯著正相關(guān);BI/PI、TTP與時(shí)間呈顯著負(fù)相關(guān)。rhBMP-2 CHA與CHA組間對(duì)比,△SI、BI/PI、TTP值比較均有統(tǒng)計(jì)學(xué)意義,相同時(shí)間內(nèi)前者血管化程度比后者強(qiáng),前者血管化時(shí)間比后者提前。兩種CHA四個(gè)觀察點(diǎn)間對(duì)比,各值均無(wú)統(tǒng)計(jì)學(xué)意義。4、病理HE染色結(jié)果顯示rhBMP-2 CHA 3天及CHA 7天起周邊見(jiàn)大量紅細(xì)胞,中央見(jiàn)少量紅細(xì)胞;前者11天及后者15天起周邊及中央見(jiàn)大量紅細(xì)胞及成骨細(xì)胞;前者30天及后者45天起周邊及中央細(xì)胞數(shù)均減少、纖維結(jié)構(gòu)增加,提示超聲造影與病理一致。結(jié)論:超聲造影能較好的顯示CHA早期血流灌注情況,準(zhǔn)確評(píng)估rhBMP-2應(yīng)用后CHA血管化程度的變化,有望成為臨床移植骨血管化評(píng)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.
【學(xué)位授予單位】：南方醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類(lèi)號(hào)】：R445.1;R68

【參考文獻(xiàn)】

相關(guān)期刊論文 前10條

1 許瑾;吳晶晶;王曉冬;王秀梅;韓倩倩;;羥基磷灰石復(fù)合骨組織工程支架的研究進(jìn)展[J];生物骨科材料與臨床研究;2016年02期

2 吳驍偉;王黔;曹誼林;肖苒;;組織工程骨血管化策略的研究進(jìn)展[J];組織工程與重建外科雜志;2015年05期

3 陳凱;張超;王路;毛雨彥;盧建熙;陳雷;;骨組織工程中促進(jìn)血管化策略的研究進(jìn)展[J];中國(guó)骨傷;2015年04期

4 金光輝;張馨雯;孫曉飛;章云童;夏琰;楊國(guó)士;謝楊;;組織工程化納米羥基磷灰石/聚己內(nèi)酯人工骨支架修復(fù)兔橈骨大段骨缺損的實(shí)驗(yàn)研究[J];中華損傷與修復(fù)雜志(電子版);2015年01期

5 夏遠(yuǎn)軍;章瑩;李麗華;尹慶水;黃顯華;謝會(huì)斌;夏虹;;rhBMP-2/殼聚糖/硫酸葡聚糖復(fù)合微球制備及生物安全性研究[J];中國(guó)骨科臨床與基礎(chǔ)研究雜志;2013年06期

6 顧繼英;白敏;張學(xué)梅;杜聯(lián)芳;胡宏慧;;甲狀腺單發(fā)結(jié)節(jié)超聲造影與微血管密度的相關(guān)性[J];中國(guó)醫(yī)學(xué)影像技術(shù);2011年10期

7 辛雷;蘇佳燦;;人工骨修復(fù)材料的現(xiàn)狀與展望[J];創(chuàng)傷外科雜志;2011年03期

8 宋會(huì)平;王志強(qiáng);;骨移植的過(guò)去、現(xiàn)在和未來(lái)[J];中國(guó)修復(fù)重建外科雜志;2009年05期

9 戴晴;姜玉新;;超聲造影的臨床應(yīng)用[J];中國(guó)醫(yī)學(xué)科學(xué)院學(xué)報(bào);2008年01期

10 尹慶水,張余,李兆麟,徐國(guó)洲,夏虹,黃華揚(yáng),權(quán)日;復(fù)合珊瑚羥基磷灰石人工骨的研制和臨床應(yīng)用[J];骨與關(guān)節(jié)損傷雜志;2003年03期

相關(guān)博士學(xué)位論文 前1條

1 朱輝;數(shù)字化載銀珊瑚羥基磷灰石人工骨的制備及生物學(xué)研究[D];南方醫(yī)科大學(xué);2012年

，

本文編號(hào)：1775455