降钙素防治骨质疏松模型兔的人工假体无菌性松动的实验研究

目的]探讨降钙素对已行人工假体植入骨质疏松模型免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（6U／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（ROI）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。

Prevention and treatment of the aseptic loosening of prosthesis for the rabbits of osteoporosis by the salmon calcitonin: an experimental study

Objective]To investigate the prevention and treatment of the aseptic loosening of prosthesis for the rabbits of osteoporosis by the salmon calcitonin.Method]Thirty osteoporosis female rabbits which had been set up the models of the arthroplasty were divided into two groups randomly;one received salmon calcitonin,and the other placebo as control for 6 months.The BMD of the region of interested(ROI)around the prosthesis was detected before the operation and after 4,8,12 and 24 weeks of the operation;the BALP,BGP and TRAP-Sb in reflecting bone metabolism were observed before operation and after 4,12,24 weeks of operation.All rabbits were sacrificed after 24 weeks of implantation.Specimens of right femur were sectioned to be studied by biomechanical test and histomorphometry.Result]The BMD of ROI for the experimental group increased by 5%,however that of the control decreased by 6%.Among the bone metabolism,the BALP,BGP and TRAP-5b showed lower,specially the TRAP-5b(P<0.01)compared with the control.The pull-out strength of the experimental group was 1.5 times than that of the control and the torsion strength was 2 times,while there was a significant difference(P<0.01)on this aspects.The result of histomorphometry showed the bone loss decreased and the mini-structure of bone(%Tb.Ar,Tb.N,Tb.Sp)became better;the remodel of trabcular(OS/BS,MAR,BFR/TV,%L.Pm)increased obviously and the bone resorption(Oc.No/Tb.Pm,ES/BS)decreased,and there were a significance on all the aspects between the two groups(P<0.01 or P<0.05).Conclusion]The therapy of salmon calcitonin can decrease the bone loss and the bone resorption around the prosthesis,increase the BMD of ROI,accelerate the formation of bone and the good change of the bone mini-structure,and change the quality of bone with the better aspects of bone biomechanical test and the stabilities of prosthesis.The salmon calcitonin can inhibit aseptic loosening of prosthesis in rabbits and it chould be a good drug for the prevention and treatment of aseptic loosening prothesis for the rabbits of osteoporosis.