李锋;方忠;熊伟;李光辉;

• 1:华中科技大学同济医学院附属同济医院骨科
• 2:华中科技大学同济医学院附属同济医院骨科
• 3:华中科技大学同济医学院附属同济医院骨科
• 4:华中科技大学同济医学院附属同济医院骨科 武汉430030

摘要(Abstract)：

[目的]探讨降钙素对已行人工假体植入骨质疏松模型兔的假体无菌性松动防治作用的实验研究。[方法]将30只假体植入模型的骨质疏松症兔随机分成实验组和对照组,各15只。实验组给予鲑鱼降钙素治疗(6 U/kg,肌注,隔日1次),而对照组给予等量的生理盐水肌注,持续治疗半年。两组均分别于术前、术后4、8、12和24周检测假体周围感应区(RO I)骨密度(BMD);于术前及术后4、12、24周行血清骨代谢指标检测:骨特异性碱性磷酸酶(BALP)、骨钙素(BGP)、抗酒石酸酸性磷酸酶-5b(TRAP-5b);所有动物于术后24周处死,分别行假体拔出实验与扭转实验测定和假体周围骨组织形态计量学分析。[结果]术后24周,实验组假体周围局部感兴趣区BMD增加近5%,而对照组假体周围局部感兴趣区BMD下降了6%,两组比较有显著性差异(P<0.01);骨代谢指标中,术后24周实验组的BALP、BGP稍有下降,但组内无显著性差异(P>0.05),而TRAP-5b有明显下降(P<0.05),这些指标与对照组比较差异显著(P<0.05或P<0.01);生物力学检测显示,实验组的假体拔出实验较对照组提高了约50%,扭转实验提高近1倍,且两组比较差异显著(P<0.01);骨组织形态计量学显示,实验组中反映骨吸收的Oc.No/Tb.Pm、ES/BS明显减少;反映骨量和微结构的%Tb.Ar、Tb.N明显增多,而Tb.Sp明显变窄:反映骨形成与骨矿化的OS/BS、MAR、BFR/TV及%L.Pm也均明显增多;这些指标与对照组比较差异显著(P<0.01或P<0.05)。[结论]鲑鱼降钙素能明显减少人工假体周围骨量的丢失和抑制骨溶解;并加快假体周围的骨形成,提高骨密度,促进生理性骨矿化;还能改善骨质量,促进骨微结构改变,提高骨的生物力学特性并增加假体四周的支撑力。其对骨质疏松症兔的假体松动有明显的预防和治疗作用。这对临床预防和治疗人工关节的无菌性松动有很好的指导意义。

关键词(KeyWords)： 降钙素;骨质疏松;假体;无菌性松动

Abstract:

Keywords:

基金项目(Foundation):

作者(Author): 李锋;方忠;熊伟;李光辉;

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参考文献(References)：

• [1]Tipper JL,Ingham E,Halley JL,et al.Quantitative analysis of polyeth-ylene wear debris,wear rate and head damage in retrieved Charn leyh ip prostheses[J].JMater SciMaterM ed,2000,11:117-124.
• [2]朱宪彝,主编.临床内分泌学[M].天津:天津科学技术出版社,1993,316-321.
• [3]于明香,王洪复.降钙素对破骨细胞骨吸收抑制作用的机理[J].中华内分泌与代谢杂志,1997,13:119-122.
• [4]Rodan GA,Martin TJ.Therapeutic approaches to bone d iseases[J].Science,2000,289:1508-1514.
• [5]Vaananen HK,Zhao H,Mu lariM,et al.The cell b iology of osteoclastfunction[J].J Cell Sci,2000,113:377-381.
• [6]Staurt L,S ilverman.Calciton in[J].Am JM ed Sci,1997,313:13-16.
• [7]Petersen MM,Lauritzen JB,Schwarz P,et al.E ffect of nasal calciton inon post-traumatic osteopen ia follow ing ankle fracture,a random izeddoub le-b lind placebo-controlled study in 24 patients[J].Acta O rthopSeend,1998,69:347-350.
• [8]W allach S,Rousseau G,Martin L.E ffects of calciton in on an imal andin vitro models of skeletalm etabolism[J].Bone,1999,25:509-516.
• [9]Farley JR,W ergedal JE,Hall SL,et al.Calciton in has d irect effects on3[H]-thymidine incorporation and alkaline phosphatase activity in hu-man osteoblast-line cells[J].Calcif Tissue Int,1991,48:297-301.
• [10]Kobayashi T,Sugimoto T,Saijoh K,et al.Calcitonin directly acts onmouse osteoblastic MC3T3-E1 cells to stimulate mRNA expression ofc-los,insulin-like growth factor-Ⅰand osteoblastic phenotypes(typeⅠcollagen and osteocalcin)[J].Biophys Res Commun,1994,199:876-880.
• [11]Drissi H,Holt M,Marie PJ,et al.Expression of the CT/CGRP geneand its regulation by dibutyryl cyclic adenosine monophosphate in hu-man osteoblastic cells[J].J Bone Miner Res,1997,12:1805-1814.
• [12]Giardion R.Effects of synthetic salmon calcitonin and alendronate onbone quality in ovariectomuzed rats[J].Minerva Med,1997,88:469-477.
• [13]朱建民,方浩,陈新刚,等.降钙素对体外培养成骨细胞的影响[J].中国骨质疏松杂志,2001,7:147-148.
• [14]詹志伟,孟迅吾.降钙素与原发性骨质疏松症[J].国外医学内分泌学分册,1996,16:67-71.
• [15]Charles H,Chestnut H,et al.A randomized trial of nasal spray salmoncalcitonin in postmenopausal wmen with established osteoporosis:theprevent recurrence of osteoporotic fractures study[J].Am J Med,2000,109:267-276.
• [16]Plotkin LI,Weinstein RS,Parfitt AM,et al.Prevention of osteocyte andosteoblast apoptosis by bisphosphonates and calcitonin[J].J Clin In-vest,1999,104:1363-1374.
• [17]Geusens P,Boonen S,Nijs J,el al.Effect of salmon calcitonin on femo-ral bone quality in adult ovarieclomized ewes[J].Calcif Tissue Int,1996,59:315-320.
• [18]Chesnut C.“Effect of intranasal calcitonin on bone quality,results ofthe QUESTstudy”,abstract book from the 4thEuropean congress onclinical aspects of Osteoporosis[J].November,2003.
• [19]Rico H,Revilla M,Herandez ER,et al.Total and regional bone miner-al content and fracture rate in postmenopausal osteoporosis treated withsalmon calcitonin:a prospective study[J].Calcif Tissue Int,1995,56:181-189.