氨基己酸和氨甲环酸对动物模型腰椎融合的影响。

The effects of Amicar and TXA on lumbar spine fusion in an animal model.

作者信息

Cuellar Jason M, Yoo Andrew, Tovar Nick, Coelho Paulo G, Jimbo Ryo, Vandeweghe Stefan, Kirsch Thorsten, Quirno Martin, Errico Thomas J

机构信息

*Department of Orthopaedic Surgery, NYU Hospital for Joint Diseases, New York, NY †NYU College of Dentistry, New York, NY ‡Department of Prosthodontics Faculty of Odontology, Malmo University, Malmo, Sweden; and §Department of Periodontology and Oral Implantology and Medicine and Health Sciences, University of Ghent, Ghent, Belgium.

出版信息

Spine (Phila Pa 1976). 2014 Sep 1;39(19):E1132-7. doi: 10.1097/BRS.0000000000000488.

DOI:10.1097/BRS.0000000000000488

PMID:24979407

Abstract

STUDY DESIGN

Animal model.

OBJECTIVE

To determine whether aminocaproic acid (Amicar) and tranexamic acid (TXA) inhibit spine fusion volume.

SUMMARY OF BACKGROUND DATA

Amicar and TXA are antifibrinolytics used to reduce perioperative bleeding. Prior in vitro data showed that antifibrinolytics reduce osteoblast bone mineralization. This study tested whether antifibrinolytics Amicar and TXA inhibit spine fusion.

METHODS

Posterolateral L4-L6 fusion was performed in 50 mice, randomized into groups of 10, which received the following treatment before and after surgery: (1) saline; (2) TXA 100 mg/kg; (3) TXA 1000 mg/kg; (4) Amicar 100 mg/kg; and (5) Amicar 1000 mg/kg. High-resolution plane radiography was performed after 5 weeks and micro-CT (computed tomography) was performed at the end of the 12-week study. Radiographs were graded using the Lenke scale. Micro-CT was used to quantify fusion mass bone volume. One-way analysis of variance by ranks with Kruskal-Wallis testing was used to compare the radiographical scores. One-way analysis of variance with least significant difference post hoc testing was used to compare the micro-CT bone volume.

RESULTS

The average±standard deviation bone volume/total volume (%) measured in the saline, TXA 100 mg/kg, TXA 1000 mg/kg, Amicar 100 mg/kg, and Amicar 1000 mg/kg groups were 10.8±2.3%, 9.7±2.2%, 13.4±3.2%, 15.5±5.2%, and 17.9±3.5%, respectively. There was a significant difference in the Amicar 100 mg/kg (P<0.05) and Amicar 1000 mg/kg (P<0.001) groups compared with the saline group. There was greater bone volume in the Amicar groups compared with the TXA group (P<0.001). There was more bone volume in the TXA 1000 mg/kg group compared with TXA 100 mg/kg (P<0.05) but the bone volume in neither of the TXA groups was different to saline (P=0.49). There were no between-group differences observed using plane radiographical scoring.

CONCLUSION

Amicar significantly "enhanced" the fusion bone mass in a dose-dependent manner, whereas TXA did not have a significant effect on fusion compared with saline control.These data are in contrast to prior in vitro data that antifibrinolytics inhibit osteoblast bone mineralization.

LEVEL OF EVIDENCE

N/A.

摘要

研究设计

动物模型。

目的

确定氨基己酸（氨甲环酸）和氨甲环酸（TXA）是否会抑制脊柱融合体积。

背景数据总结

氨甲环酸和TXA是用于减少围手术期出血的抗纤溶药物。先前的体外数据表明，抗纤溶药物会降低成骨细胞的骨矿化。本研究测试了抗纤溶药物氨甲环酸和TXA是否会抑制脊柱融合。

方法

对50只小鼠进行L4-L6后外侧融合术，随机分为10只一组，在手术前后接受以下治疗：（1）生理盐水；（2）100mg/kg TXA；（3）1000mg/kg TXA；（4）100mg/kg氨甲环酸；（5）1000mg/kg氨甲环酸。5周后进行高分辨率平面X线摄影，并在12周研究结束时进行微型计算机断层扫描（micro-CT）。使用Lenke量表对X线片进行分级。微型计算机断层扫描用于量化融合块骨体积。采用Kruskal-Wallis检验的秩和单向方差分析来比较X线评分。采用最小显著差异事后检验的单向方差分析来比较微型计算机断层扫描骨体积。

结果

生理盐水组、100mg/kg TXA组、1000mg/kg TXA组、100mg/kg氨甲环酸组和1000mg/kg氨甲环酸组测得的平均±标准差骨体积/总体积（%）分别为10.8±2.3%、9.7±2.2%、13.4±s3.2%、15.5±5.2%和17.9±3.5%。与生理盐水组相比，100mg/kg氨甲环酸组（P<0.05）和1000mg/kg氨甲环酸组（P<0.001）有显著差异。与TXA组相比，氨甲环酸组的骨体积更大（P<0.001）。1000mg/kg TXA组的骨体积比100mg/kg TXA组更多（P<0.05），但两个TXA组的骨体积与生理盐水组相比均无差异（P=0.49）。使用平面X线评分未观察到组间差异。