北京生物醫(yī)學(xué)工程

放散式?jīng)_擊波治療雙側(cè)卵巢切除大鼠晚期骨質(zhì)疏松癥的實(shí)驗(yàn)研究

Effect of radial extracorporeal shock wave therapy on ovariectomy-induced advanced osteoporosis in rats

作者：杰永生郭安憶綦惠鄭蕊梁震景金珠劉亞軍

單位：京市創(chuàng)傷骨科研究所（北京 100035）；北京積水潭醫(yī)院骨科沖擊波診療中心（北京 100035） <p>通信作者：劉亞軍。E-mail：[email protected]</p> <p> </p>

關(guān)鍵詞：晚期骨質(zhì)疏松癥；放散式?jīng)_擊波；骨密度；骨小梁

分類號(hào)： R318.01

出版年·卷·期（頁(yè)碼）：2022·41·3（275-279）

摘要：

目的探討放散式?jīng)_擊波在治療晚期骨質(zhì)疏松癥（osteoporosis，OP）中的角色，為臨床應(yīng)用奠定實(shí)驗(yàn)基礎(chǔ)。方法將大鼠隨機(jī)分成3組：Sham組，僅暴露卵巢，不進(jìn)行切除；OP組，采用雙側(cè)卵巢切除術(shù)建立大鼠OP模型，不進(jìn)行治療；OP+沖擊波治療組，采用雙側(cè)卵巢切除術(shù)建立大鼠OP模型，術(shù)后6個(gè)月左側(cè)股骨頸給予放散式?jīng)_擊波治療。治療結(jié)束，采用HE染色、抗酒石酸堿性磷酸酶（tartrate-resistant acid phosphatase，TRAP）化學(xué)染色以及micro-CT觀察各組股骨近端組織結(jié)構(gòu)。進(jìn)一步對(duì)micro-CT的結(jié)果進(jìn)行定量分析，比較骨密度（bone mineral density，BMD），骨體積分?jǐn)?shù)（BV/TV），骨小梁數(shù)量（Tb.N），骨小梁厚度（Tb.Th），骨小梁分離度（Tb.Sp）等指標(biāo)在各組之間的差異。對(duì)各組血清學(xué)骨鈣素（osteocalcin，OCN）和I型膠原 C 端肽（C-terminal telopeptide of type I collagen，CTX-I）采用酶聯(lián)免疫吸附試驗(yàn)（enzyme-linked immunosorbent assay，ELISA）進(jìn)行檢測(cè)和比較。應(yīng)用生物力學(xué)機(jī)對(duì)腰椎椎體的抗壓性能進(jìn)行檢測(cè)。結(jié)果與Sham組相比，OP組骨小梁數(shù)量降低，結(jié)構(gòu)變細(xì)，TRAP化學(xué)染色陽(yáng)性的破骨細(xì)胞數(shù)顯著增多（P<0.05），沖擊波治療未明顯改變這種情況。OP組以及OP+沖擊波治療組BMD均顯著低于Sham組（P<0.05），但各組之間BV/TV，Tb.N，Tb.Th，Tb.Sp，以及血清學(xué)數(shù)據(jù)并未有顯著差異。力學(xué)檢測(cè)結(jié)果顯示，OP組以及OP+沖擊波治療組的抗壓性能均顯著低于Sham組（P<0.05）。結(jié)論晚期OP放散式?jīng)_擊波治療后，股骨頸的微結(jié)構(gòu)、L3和L4椎體的抗壓性能以及血清學(xué)指標(biāo)未有明顯改善，很可能需要與其他方式聯(lián)合應(yīng)用才能達(dá)到一定的治療效果。

Objective To explore the role of radial extracorporeal shock wave therapy (rESWT) in the treatment of advanced osteoporosis (OP) in rats. Methods Female SD rats were anesthetized and randomly divided into three groups: Sham group, in which ovaries were exposed bilaterally but without other operation; OP group, and OP+rESWT group, in which bilateral ovariectomy were performed, and the rats of OP+rESWT group were treated with rESWT to the left femur necks after six months of ovariectomy. After treatment, the rats were euthanized, blood were gathered, and the left femurs, and the lumbar vertebrae 3-4 were dissected. The left femurs were submitted to HE staining and tartrate-resistant acid phosphatase (TRAP) staining. Micro-CT examination were applied to test the tissue structure in each group, and the bone mineral density (BMD), bone volume fraction (BV/TV), trabecular number (Tb.N), trabecular thickness (Tb.Th), trabecular separation (Tb.Sp) were compared among the three groups. The levels of osteocalcin (OCN) and C-terminal telopeptide of type I collagen (CTX-I) in the serum were detected through enzyme-linked immunosorbent assay (ELISA). The lumbar vertebrae 3-4 were submitted to biomechanical test. Results Compared with Sham group, the number of bone trabecular bone decreased, and the number of TRAP positive osteoclasts increased significantly (P < 0.05) in OP group. But after treatment with rESWT, the data in OP+rESWT group were not promoted. BMD in OP group and OP+rESWT group were significantly lower than that in Sham group (P < 0.05). BV/TV, Tb.N, Tb.Th, Tb.Sp and the serum levels of OCN and CTX-I in OP+rESWT group were not changed significantly compared with OP group. What’s more, the duration strength of the lumbar vertebrae in OP group and OP+rESWT group were obviously reduced compared with that of the Sham group. Conclusions For advanced OP, the effects of rESWT on the local trabecular bone of the femoral neck is limited, since the osteoporotic condition of the whole body is still not changed. Other treatment methods should also be used at the same time, which may have better results.

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