【作者】 郝福良；

【导师】 董福生； 石培凯；

【作者基本信息】 河北医科大学 ， 口腔临床医学， 2003， 硕士

【摘要】 目的：通过建立大鼠骨质疏松模型，观察补肾方剂对骨质疏松大鼠纯钛种植体骨结合的影响，探讨补肾方剂促进纯钛种植体骨结合的机制。为临床上提高骨质疏松患者牙种植体的骨性愈合率提供理论依据。方法：选用纯种8月龄雌性SD大鼠54只，随机分为3组：假手术组，卵巢切除组，卵巢切除加中药治疗组（简称中药组），每组18只。切除卵巢切除组及中药组大鼠双侧卵巢，假手术组大鼠仅切除双侧卵巢附近的脂肪组织。术后3个月，在三组大鼠胫骨近中干骺端分别植入纯钛光滑柱状种植体。手术后第一天，中药组大鼠用补肾方剂－—抗骨松冲剂灌胃。用量：按0.32g生药/100g体重比例配制抗骨松冲剂溶液，每只大鼠取稀释药液2ml灌胃，1/日。其它两组灌服等量生理盐水。于种植术后1个月、2个月、3个月时，取出带种植体的胫骨，取下的标本立即放入10%甲醛缓冲溶液固定、经过8%甲酸溶液脱钙、梯度酒精脱水后，制作HE染色的组织学切片，做光镜及骨组织的形态计量学观察。结果：1.卵巢切除术后3个月，分别用双能X线骨密度测量仪(美国LUNAR公司生产)测量三组大鼠的全身骨密度（BMD）。卵巢切除组和中药组大鼠的全身骨密度（BMD）均明显低于假手<WP=4>术组大鼠（P﹤0.01）,卵巢切除组和中药组大鼠的全身骨密度（BMD）无显著性差异(P﹥0.05)。同时，分别称量三组动物的体重，卵巢切除组和中药组大鼠的体重均明显高于假手术组大鼠（P﹤0.01），卵巢切除组和中药组大鼠的体重则无显著性差异(P﹥0.05)。说明用去势法已成功建立骨质疏松动物模型。2.种植术后1个月，组织学观察，假手术组：结合骨板较薄，连续性较好，在皮质骨区主要为编织骨，骨松质区骨小梁较密集，成骨细胞较少，破骨细胞少见；卵巢切除组：结合骨板较薄，连续性差，有的间隙部位为胶原纤维束所替代，骨松质区骨小梁稀疏，破骨细胞均较多见；中药组：可见结合骨板连续性较好，较薄，骨松质区骨小梁密集，成骨细胞较多。种植术后2个月，组织学观察，假手术组：结合骨板较厚，可见有成熟的哈佛氏系统，破骨细胞少见；卵巢切除组：结合骨板较薄，有一定的连续性。骨小梁稀疏粗细不均，排列紊乱；中药组：结合骨板较厚，可见改建中或趋于改建完成的骨单位，结合骨板与和骨小梁周围可见大量的柱状成骨细胞，排列整齐。种植术后3个月，组织学观察，假手术组：结合骨板较厚。松质区骨小梁密集，沿骨小梁排列的成骨细胞多为扁平柱状，破骨细胞少见；卵巢切除组：结合骨板较薄，松质骨区骨小梁稀疏，成骨细胞和破骨细胞均少见；中药 组：类似于假手术组的镜下形态；但成骨细胞较多。3.骨计量学观察：种植术后1个月，假手术组的成骨细胞个数和破骨细胞个数均明显小于卵巢切除组（P<0.01），假手术组的结合骨板宽度、骨小梁宽度和松质骨区骨量均明显大于卵巢切除<WP=5>组（P<0.01）；假手术组的成骨细胞个数、结合骨板宽度、骨小梁宽度和松质骨区骨量均明显大于中药组（P<0.01），中药组的骨小梁宽度、结合骨板宽度、成骨细胞个数均明显大于卵巢切除组（P<0.01）。种植术后2个月，假手术组的结合骨板宽度、骨小梁宽度和松质骨区骨量均明显大于卵巢切除组（P<0.01）；假手术组的松质骨区骨量、破骨细胞个数、骨小梁宽度和中药组之间无显著性差异（P＞0.05），假手术组的结合骨板宽度明显大于中药组 (P<0.01)；中药组的结合骨板宽度、骨小梁宽度、松质骨区骨量以及成骨细胞个数均明显大于卵巢切除组（P<0.01）。种植术后3个月，假手术组的结合骨板宽度、骨小梁宽度、松质骨区骨量均明显大于卵巢切除组（P<0.01）；假手术组的松质骨区骨量、结合骨板宽度、骨小梁宽度、破骨细胞个数和中药组之间无显著性差异（P＞0.05），假手术组的成骨细胞个数明显小于中药组（P<0.01）；中药组的结合骨板宽度、骨小梁宽度、松质骨区骨量以及成骨细胞个数均明显大于卵巢切除组（P<0.01）。结论：1.切除大鼠双侧卵巢建立的骨质疏松模型，与绝经女性所形成的骨质疏松同属于高转换型骨质疏松，从产生原因和病理表现有一定相似性。用以研究补肾方剂对骨质疏松纯钛种植体愈合的影响，有一定的科学性。2.骨质疏松可使种植体结合骨板宽度，种植体周围的松质骨区骨量明显降低，影响种植体的骨结合质量。3.补肾方剂可以使骨质疏松大鼠的种植体结合骨板宽度，种植体周围的松质骨区骨量明显增加，有促进种植体骨结合的作用。4.骨组织形态计量学是研究种植体骨结合时骨组织变化的有<WP=6>效手段。5.补肾方剂能促进种植术后血肿的机化和吸收，增加成骨细胞数量，促进骨改建，从而提高骨结合的质量。更多还原

【Abstract】 Objective: To study the influence of tonifying kidney recipes on osseintegration around Titanium Implants and investigate the mechanism of the effect of tonifying kidney recipes on osseointegration of the Titanium Implants by established animal model of osteoporosis rats.Methods: Fifty-four female SD rats (8-month-old) were randomly divided into three groups, 18 rats in each group, They included a sham-operated group (Sham group), an ovariectomized group (OVX group) and a tonifying kidney recipes therapy group (TKR group), After 3 months, the animal models of osteoporosis were established, pour titanium smooth columnar implants were placed in the proximal metaphyses of left tibiae of the rats. One day after the implant surgery, tonifying kidney recipes was given orally at the dose of 0.32g/100g/day in the TKR group and normal saline was given to the rats of the other two groups. At 1st、2nd、3rd months after surgery the rats were killed respectively and the implanted tibiae were got , the tissue samples were fixed with 10% Formaldehyde soaked and 8% formic acid was used to dissolve the calcium for 10 days. After rinsed 24 hours with water, the tissue samples were embedded in paraffin and were sectioned with a thickness of 5μm. The sections<WP=8>were stained with HE for histological examination and bone histomor- phometric parameters were measured to quantify the changes of new bone around titanium implants and to observe the changes of implant-bone interface.Results: 1.At the 3rd months after ovarictomy surgery, the weight of rats increased significantly in ovariectomized group compared with sham group(P<0.01), the weight of rats increased significantly in TKR group(P<0.01); while there were no significant changes of weight between the OVX group and the TKR group(P＞0.05). Meanwhile, the changes of bone mineral density (BMD) of the three groups were measured by densitometry. The BMD of the rats in Sham group increased significantly compared with OVX group (P<0.01);the BMD of the rats in sham group increased significantly compared with TKR group, but there were no significant changes of the BMD of the rats between OVX group and TKR group (P＞0.05).The results showed that the animal models of osteoporosis rats were established by ovarictomy.2.The results observed by light microscopy showed as follows:At the 1st month after implant surgery, in the sham group, the new bone in cortical bone area was mainly formed by woven bone which was in direct contact with implants in cancellous bone area, the combinded bone lamella was thicker, the density of trabecular bone was greater; the OVX group, the combinded bone lamella was thin and was not contacted with implants somewhere, there were a lots of<WP=9>osteoblasts(OB) and osteoclasts(CB). Haversion system in cortical bone area was immature; the TKR group, the interface bone lamella were thicker than OVX group, the contact of new bone around implant and the osteoid perimeter were greater than OVX- group, trabeculars were concentrated, there were a lots of osteoblast with larger cell nucleolus, osteoclast were sparsity. At the 2nd month after implant surgery, the Sham group combinded bone lamella was thicker and the surface of it was smooth, the density of trabecular bone were greater than that of 1st months after implant surgery; the OVX group, combinded bone lamella was thin, a lots of osteoblast and osteoclast could been saw; the TKR group, combinded bone lamella was thicker, osteoblasts were massive, and osteoclast were sparsity.At the 3rd month after implant surgery, The woven bone was substituted by lamellalike new bone in cortical bone area in the three group, the density of trabecular bone and contact of new bone around implants in Sham group and TKR group were greater compared with OVX group. 3.The results of bone histomorphometry were as follows:At the 1st month after implant surgery, Trabercular Area (Tb·Ar%), Trabercular Width (Tb·Wi), Combinded Bone Lamella Width (CBLW) in Sham group were significantly increased compared with O更多还原