本文選題：體外沖擊波 + 骨缺損　； 參考：《重慶醫(yī)科大學(xué)》2015年碩士論文

【摘要】：目的：盡管體外沖擊波(ESW)對(duì)骨缺損的治療有一定的療效,但是臨床應(yīng)用仍然受限。有研究提示骨形態(tài)蛋白(BMP-2)、成纖維生長(zhǎng)因子(bFGF)、血管內(nèi)皮生長(zhǎng)因子(VEGF)可以有效調(diào)控骨形成過程。因此,我們欲探討體外沖擊波聯(lián)合增強(qiáng)型纖維蛋白膠負(fù)載骨生長(zhǎng)因子經(jīng)皮直接注射入骨缺損斷端加速骨缺損愈合、促進(jìn)成骨過程的作用。方法：制備兔橈骨骨缺損模型并行不同方案的治療：A組只給予ESW治療；B組給予ESW聯(lián)合纖維蛋白膠(FG)治療；C組給予ESW聯(lián)合FG/rhBMP-2/rhbFGF治療；D組給予ESW聯(lián)合FG/rhBMP-2/brhFGF/rhVEGF治療,E組為空白對(duì)照組制備骨缺損模型后不給予任何治療。五組實(shí)驗(yàn)兔分別于術(shù)后第四周和第八周,攝X片觀察骨折處的生長(zhǎng)情況。處死后取以骨折處為中心的4mm組織標(biāo)本,利用組織形態(tài)學(xué)檢測(cè)新生骨組織的表達(dá)情況,及生物力學(xué)試驗(yàn)方法檢測(cè)治療后的骨折處抗彎曲能力的情況。組內(nèi)比較,采用樣本均數(shù)比較的t檢驗(yàn),利用SPSS18.0軟件進(jìn)行統(tǒng)計(jì)。結(jié)果：治療后B組與A組(單純ESW)相比,B組(FG+ESW)骨折線稍模糊,骨痂面積開始增多,骨折斷端距離縮短。組織形態(tài)學(xué)顯示大片軟骨形成,軟骨細(xì)胞增生活躍,周圍纖維結(jié)締組織中可見新生血管形成。生物力學(xué)測(cè)定結(jié)果發(fā)現(xiàn)兩組之間并沒有差距,兩者之間沒有統(tǒng)計(jì)學(xué)意義(p0.05)。C組(FG/rhBMP-2/rhbFGF+ESW)骨折線骨折線模糊,纖維骨痂消失,可見明顯增生的骨小梁。C組與B組(FG +ESW)相比,C組(FG/rhBMP-2/rhbFGF+ESW)生物力學(xué)明顯有差異,且具有顯著性統(tǒng)計(jì)學(xué)意義(p0.01)。D組(FG/rhBMP-2/rhbFGF/rhVEGF+ESW)4周時(shí)骨折線明顯模糊,骨小梁明顯增多。8周時(shí)骨折線消失,且愈合后塑形好。組織形態(tài)學(xué)顯示以見正常骨結(jié)構(gòu),大量骨小梁排列規(guī)則,可見髓腔樣組織。D組與C組(FG/rhBMP-2/rhbFGF+ESW)相比,有明顯差異且具有顯著性統(tǒng)計(jì)學(xué)意義(p0.01),說明更能夠提高抗彎曲力度。E組8周仍可見骨折間隙,骨缺損斷端仍為硬化骨。結(jié)論：體外沖擊波聯(lián)合經(jīng)皮注射增強(qiáng)型纖維蛋白膠負(fù)載骨生長(zhǎng)因子具有明顯促進(jìn)骨缺損愈合作用,有望成為一種非手術(shù)治療骨缺損的良好方法。
[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.
【學(xué)位授予單位】：重慶醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2015
【分類號(hào)】：R687.3

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