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甲状旁腺激素(1-34)对种植体固定的刺激作用——聚甲基丙烯酸甲酯骨水泥与不锈钢的组织形态计量学比较

Stimulation of implant fixation by parathyroid hormone (1-34)-A histomorphometric comparison of PMMA cement and stainless steel.

作者信息

Skripitz Ralf, Böhling Silvia, Rüther Wolfgang, Aspenberg Per

机构信息

Orthopaedic Department, University Hospital Eppendorf, Hamburg, Germany.

出版信息

J Orthop Res. 2005 Nov;23(6):1266-70. doi: 10.1016/j.orthres.2005.04.006.1100230605. Epub 2005 Jun 16.

Abstract

Whereas continuous exposure to PTH results in bone resorption, PTH administration at intermittent doses results in bone formation by increasing osteoblast number and activity. PTH leads to faster fracture repair and better fixation of orthopaedic implants in animal models. The present study evaluates if PTH is able to increase the contact surface between bone and implant and whether the effect of PTH is dependent on implant material characteristics. The implants were made as rods, either of stainless steel or Palacos R bone-cement. The steel rods had a surface roughness of R(a) 0.1 microm and the cement rods R(a) 2.2 microm. In 40 adult male rats, one cement rod was inserted in the left tibia and one steel rod in the right tibia. After implantation, the rats were divided into groups by random. One group was injected three times a week with human PTH (1-34) at a dose of 60 microg/kg BW/injection. The second group was injected with the vehicle only. Both groups were then divided into groups for 2 and 4 weeks time till tibial harvest. The tibial segments around the hole of the rods were then prepared by standard histological techniques. The linear tissue surfaces, that had been in contact with the surface of the rod, were analyzed in a blind fashion. PTH increased the bone contact fraction compared with the vehicle in the steel group from 7.4 (SD 7.6) to 21.1 (SD 10.7) % after 2 weeks and from 9.8 (SD 8.1) to 47.1 (SD 13.3) % after 4 weeks. In the cement group PTH increased the contact index again compared with the vehicle from 7.8 (SD 10.2) to 53.6 (SD 26.3) % already after 2 weeks and from 14.3 (SD 15) to 65.6 (SD 15.7) % after 4 weeks. The bone trabeculae adjacent to the implant had become fewer and thicker after the treatment with PTH (1-34), with an increase of the bone mass in the area next to the bone-implant-interface. The earlier onset of PTH effects in the rougher cement group suggests that intermittent PTH treatment might lead to an increased micro-interlock between implant and bone, and might therefore be considered as a possible drug to enhance incorporation of orthopedic implants.

摘要

持续暴露于甲状旁腺激素(PTH)会导致骨吸收,而间歇性给予PTH则会通过增加成骨细胞数量和活性来促进骨形成。在动物模型中,PTH能使骨折愈合更快,骨科植入物固定得更好。本研究旨在评估PTH是否能够增加骨与植入物之间的接触面积,以及PTH的作用是否依赖于植入材料的特性。植入物制成棒状,材料为不锈钢或Palacos R骨水泥。不锈钢棒的表面粗糙度为R(a) 0.1微米,骨水泥棒的表面粗糙度为R(a) 2.2微米。在40只成年雄性大鼠中,将一根骨水泥棒插入左胫骨,一根不锈钢棒插入右胫骨。植入后,将大鼠随机分组。一组每周注射三次人PTH(1-34),剂量为60微克/千克体重/次。第二组仅注射赋形剂。然后将两组再按2周和4周的时间分组,直至收获胫骨。接着用标准组织学技术制备棒孔周围的胫骨节段。以盲法分析与棒表面接触的线性组织表面。与赋形剂组相比,PTH使不锈钢组2周后骨接触率从7.4(标准差7.6)%提高到21.1(标准差10.7)%,4周后从9.8(标准差8.1)%提高到47.1(标准差13.3)%。在骨水泥组,与赋形剂组相比,PTH使接触指数在2周后就从7.8(标准差10.2)%提高到53.6(标准差26.3)%,4周后从14.3(标准差15)%提高到65.6(标准差15.7)%。用PTH(1-34)治疗后,与植入物相邻的骨小梁数量减少且变厚,骨-植入物界面附近区域的骨量增加。PTH在表面更粗糙的骨水泥组中起效更早,这表明间歇性PTH治疗可能会增加植入物与骨之间的微锁合,因此可能被视为一种促进骨科植入物融合的潜在药物。

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