刘宏建，陈勇，杜靖远，梁惠民，刘昌胜，汪岚.复合rhBMP-2的注射型磷酸钙人工骨在椎体成形术中的应用及生物力学评价[J].中华物理医学与康复杂志,2004,(7):
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| 复合rhBMP-2的注射型磷酸钙人工骨在椎体成形术中的应用及生物力学评价 |
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| DOI： |
| 中文关键词: 骨质疏松症 生物力学 椎体成形术 充填材料 聚甲基丙烯酸甲酯 磷酸钙人工骨 重组人类骨形态发生蛋白-2 |
| 英文关键词: Osteoporosis Biomechanics Vertebroplasty PMMA CPC rhBMP-2 rhBMP-2/CPC |
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| 中文摘要: |
| 目的通过将复合有重组人类骨形态发生蛋白-2（rhBMP-2）的注射型磷酸钙人工骨（rhBMP-2/CPC）应用于体外经皮椎体成形术（PVP）实验中，观察并评价其生物力学性能，以探寻rhBMP-2/CPC能否有效替代聚甲基丙烯酸甲酯（PMMA）而应用于PVP手术。 方法选取6具尸体脊柱标本（T8～L5）并测试骨密度，然后将其游离成60个椎体并随机分为4组：I组为空白对照组(n=30)；II组为PMMA组(n=10)；III组为CPC组(n=10)；IV组为rhBMP-2/CPC组(n=10)。在“C”形臂X线机导引下，II～IV组椎体经双侧椎弓根分别充填PMMA、CPC及rhBMP-2/CPC；在万能材料实验机上将所有椎体压缩至原始高度的50%，测得最大载荷及刚度；随后将I组再进一步划分为IA、IB及IC组，分别充填PMMA、CPC及rhBMP-2/CPC，按前述加载方法再次压缩至充填后椎体高度的50％。 结果实验开始前，各组椎体BMD为（0.310～0.689）g/cm2,高度为（1.64～3.09）cm(组间比较，均P>0.05)。IA、IB及IC组充填后椎体前缘高度分别增加（0.16±0.05）cm，（0.18±0.07）cm和（0.21±0.09）cm，与充填前比较，差异无显著性意义（均P>0.05）。材料充填量方面：IA组是（2.8±0.7）ml，IB组是（2.3±0.3）ml，IC组是（2.4±0.3）ml，II组是（3.2±2.6）ml，III组是（3.1±1.9）ml，IV组是（2.9±1.4）ml，各组间差异均无显著性意义。平均最大载荷方面: I～IV组椎体最大载荷间差异均有显著性意义，IA与IB、IC及I组间差异也有显著性意义，而IB、IC与I组间差异均无显著性意义。刚度方面：I～IV组间差异均有显著性意义，IA组与IB、IC及I组间差异也有显著性意义，IC组与I组间差异有显著性意义，而IB组与I组间差异则无显著性意义。 结论CPC 和rhBMP-2/CPC均可以有效恢复骨质疏松椎体的力学性能，有望成为PVP手术中充填材料PMMA的替代品。 |
| 英文摘要: |
| Objective To evaluate the biomechanical performance of the injectable calcium phosphate cement (CPC) recombined human bone morphogenetic protein-2（rhBMP-2/CPC） in an in vitro vertebroplasty model. MethodsA total of 60 vertebral bodies(VBs) obtained from 6 cadaveric thoracolumbar spine (T8～L5) were used.After the bone mineral density (BMD) of each VB was measured using a dual energy X-ray absorptiometry (DEXA), the VBs were assigned into 4 groups, intact control group (group I), polymethylmethacrylate (PMMA) injection group(group II)，CPC injection group (group III) and rhBMP-2/CPC injection group(group IV). The VBs were then fixed on a material testing system and compressed to 50% of their original heights, respectively. After fracture，the VBs in group I were further divided into 3 subgroups and injected with PMMA(group IA),CPC(group IB) or rhBMP-2/CPC(group IC),respectively. The VB height was measured again after cement injection to evaluate the magnitude of the regained height, and these VBs were compressed to 50% of the post-injection height. Force and displacement data were recorded and used to determine the maximum load and stiffness. ResultsBMDs of all tested groups ranged from 0.310 to 0.689 g/cm2（P>0.05）, VBs height ranged from 1.64 to 3.09 cm（P>0.05）. For groups II,III,IV,IA,IB and IC，3.2±2.6ml，3.1±1.9ml，2.9±1.4ml，2.8±0.7ml，2.3±0.3ml and 2.4±0.3 ml of cement were injected on average(P>0.05)，respectively. No significant difference was revealed in the mean VB height regained by injection of PMMA. The maximum load of groups II, III, IV and IA were greater than that of group I(P<0.05)，no significant difference was found among groups IC，IB and I. Stiffness of groups II， III， IV and IA were greater than that of group I（P<0.05）,and the stiffness of group I was greater than that of group IC(P<0.05)，while no significant difference was found between groups I and IB(P>0.05). ConclusionCPC and rhBMP-2/CPC can improve the biomechanical strength of the VB, and could be used as the substitute of the PMMA in the percutaneous vertebroplasty operation. |
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