Grötz K A, al-Nawas B, Piepkorn B, Reichert T E, Duschner H, Wagner W
Universitätsklinik für Mund-, Kiefer- und Gesichtschirurgie, Johannes-Gutenberg-Universität Mainz.
Mund Kiefer Gesichtschir. 1999 May;3(3):140-5. doi: 10.1007/s100060050118.
Early radiation effects on human bone may lead to osteoradionecrosis (ORN). Direct bone cellular lesions [28] as well as fibrous degeneration of blood vessels [21] are considered to be pathologically relevant. Only few data on initial subclinical radiation effects are available. Patients were grouped according to the dose of radiation and clinical findings. Group 1: sound human bone of lower jaw, mostly collected during orthodontic surgery (n = 10 patients); group 2: specimens of lower jaw from patients with ORN (n = 12 patients); group 3: specimens of lower jaw from patients with head and neck cancer who were preoperatively treated with 36 Gy radiation; group 4: specimens of lower jaw from patients with head and neck cancer (n = 9) who were treated with 60-70 Gy radiation. Specimens were studied by confocal laser scanning microscopy (CLSM), by conventional light microscopy (DL) and by fluorescence darkfield microscopy (DFM) after bisbenzimide staining (H 33258) of the viable cellular nuclei. For the correlating study of identical areas in CLSM and DL the specimens were prepared according to the sawing and grinding technique [8]. All the radiated bony specimens, regardless of the dose of radiation, showed areas of extensive or total loss of vitality of the osteocytes. This finding was also evident after 36 Gy and a short interval between radiation and sample collection (group 3). Additionally, in CLSM micromorphologic lesions of the lamellate structure were seen. With these results we can confirm the loss of vitality of the osteocytes as an initial radiation effect as described earlier [10, 23, 28]. In addition to these findings, alteration of the lamellate microstructure was found in the early phase after radiation. The functional and mechanical significance of these findings should be the subject of further studies.
早期辐射对人体骨骼的影响可能会导致放射性骨坏死（ORN）。直接的骨细胞损伤[28]以及血管的纤维变性[21]被认为具有病理学相关性。关于初始亚临床辐射效应的可用数据很少。患者根据辐射剂量和临床发现进行分组。第1组：下颌健康人骨，大多在正畸手术期间采集（n = 10例患者）；第2组：ORN患者的下颌骨标本（n = 12例患者）；第3组：术前接受36 Gy辐射的头颈癌患者的下颌骨标本；第4组：接受60 - 70 Gy辐射的头颈癌患者的下颌骨标本（n = 9）。标本通过共聚焦激光扫描显微镜（CLSM）、传统光学显微镜（DL）以及对活细胞核进行双苯甲酰亚胺染色（H 33258）后的荧光暗视野显微镜（DFM）进行研究。为了在CLSM和DL中对相同区域进行相关研究，标本根据锯切和研磨技术[8]制备。所有接受辐射的骨标本，无论辐射剂量如何，均显示出骨细胞活力广泛或完全丧失的区域。这一发现在36 Gy辐射后以及辐射与样本采集之间间隔较短时（第3组）也很明显。此外，在CLSM中可见板层结构的微观形态学损伤。根据这些结果，我们可以确认骨细胞活力丧失是如先前所述的[10, 23, 28]初始辐射效应。除了这些发现外，在辐射后的早期阶段还发现了板层微结构的改变。这些发现的功能和力学意义应作为进一步研究的主题。
