【摘要】 背景:近年来一些椎体成形术的并发症逐渐凸显。考虑到骨水泥的热效应、单体毒性及占位填充等因素,对椎体邻近结构又会产生什么样的结果呢,尤其是对于紧邻椎体的结构——椎间盘会有什么影响呢?针对这一情况鲜有报道。目的:通过对兔骨质疏松模型椎体注入不同剂量骨水泥观察其对邻近椎间盘的影响。方法:30只5月龄雌性大白兔均通过去势联合糖皮质激素注射建立骨质疏松模型,随机分为5组。假手术组L5椎体实施穿刺假手术,碘海醇组L5椎体穿刺后注入碘海醇0.2 m L,低、中、高剂量骨水泥组L5椎体分别注入骨水泥0.1,0.2,0.3 m L,之后继续饲养12周。12周后处死所有兔,完整取出L4-5椎间盘并分成2部分,一部分行TUNEL染色观察细胞凋亡并计算凋亡指数,一部分行real time PCR观察白细胞介素1、Ⅱ型胶原蛋白、基质金属蛋白酶7 m RNA相对表达量。结果与结论:(1)低、中、高剂量骨水泥组细胞凋亡指数与假手术组和碘海醇组比较差异均有显著性意义,低、中、高剂量骨水泥组间相互比较差异无显著性意义;(2)高剂量骨水泥组白细胞介素1 m RNA相对表达量同假手术组比较差异有显著性意义;在Ⅱ型胶原蛋白与基质金属蛋白酶7 m RNA相对表达量上,低、中、高剂量骨水泥组与假手术组和碘海醇组比较差异均有显著性意义,高剂量骨水泥组与低、中剂量骨水泥组比较差异有显著性意义;(3)结果提示,兔骨质疏松模型实施椎体成形术后,椎体内骨水泥确可对邻近椎间盘造成影响;而这一影响并没有严格呈现出剂量依赖关系,在达到大剂量时可表现出显著的退变加剧。更多还原

【Abstract】 BACKGROUND: With the development of clinical practices, some complications of vertebroplasty are gradually highlighted. Considering the thermal reaction, toxicity and space-occupying filling of bone cement, vertebroplasty with bone cement injection is likely to cause some impacts on the surrounding vertebrae, especially the adjacent ones. However, little is reported on the effect of different volumes of bone cement on degeneration of the adjacent vertebrae. OBJECTIVE: To determine the effects of different bone cement volumes in percutaneous vertebroplasty on adjacent intervertebral discs in a rabbit model of osteoporosis. METHODS: Thirty 5-month-old New Zealand rabbits were randomly assigned into five groups: sham, iohexol, low-dose bone cement, middle-dose bone cement and high-dose bone cement groups. Osteoporosis models were established by ovariectomy combined with glucocorticoid injection. After modeling, sham puncture at the fifth lumbar vertebrae was done in the sham group, and true puncture at the fifth lumber vertebra was done in the iohexol group followed by injection with 0.2 m L of iohexol. Different volumes of bone cement(0.1, 0.2, 0.3 m L) were injected in the low-, middle-and high-dose bone cement groups, respectively. After 12 weeks, rabbits in these three groups were killed to take the intact L4-5 segments that were divided into two parts: one for TUNEL staining to observe cell apoptosis and to calculate apoptotic index, and the other for real-time PCR detection of relative expression of interleukin-1, type II collagen and matrix metalloproteinase-7. RESULTS AND CONCLUSION: The cell apoptosis index in the low-, middle-and high-dose bone cement groups were significantly different from that in the sham and iohexol groups, but there was no significant difference among three bone cement groups. The relative expression of interleukin-1 m RNA showed a significant difference between the high-dose group and sham group. The relative expression of type II collagen and matrix metalloproteinase-7 in the three bone cement groups was significantly different from that in the sham and iohexol groups, and the expression in the high-dose bone cement group was also significantly different from that in the low-and middle-dose bone cement groups. To conclude, after percutaneous vertebroplasty, injected bone cement certainly impacts the adjacent vertebrae in the rabbit model of osteoporosis, but not in a dose-dependent manner. Moreover, a dramatic aggravation of degeneration of the adjacent vertebrae is developed when high-dose bone cement is injected.更多还原