Institute of Biophysics Carlos Chagas Filho, Federal University of Rio de Janeiro, Carlos Chagas Filho Avenue, 373, Bloco G, Sala G1-003, 1st Floor, Cidade Universitária, Ilha do Fundão, Rio de Janeiro, Centro de Ciências da Saúde, RJ, CEP 21941-902, Brazil.
Institute of Biophysics Carlos Chagas Filho, Federal University of Rio de Janeiro, Carlos Chagas Filho Avenue, 373, Bloco G, Sala G1-003, 1st Floor, Cidade Universitária, Ilha do Fundão, Rio de Janeiro, Centro de Ciências da Saúde, RJ, CEP 21941-902, Brazil.
J Craniomaxillofac Surg. 2018 Sep;46(9):1576-1585. doi: 10.1016/j.jcms.2018.04.016. Epub 2018 Apr 19.
Among the systemic conditions that impact negatively on the planning and execution of surgical procedures, diabetes mellitus (DM) is the primary clinical condition responsible for complications. This study investigated bone formation in critical defects surgically filled with hydroxyapatite (HA) in diabetic rats. A descriptive, randomized sample and blinded analysis were conducted to test bone regeneration in critical bone defects surgically performed in rat calvaria. Twenty adult male Wistar rats were randomly divided into two groups: control, normoglycemic animals (CG); and test, streptozotocin-induced hyperglycemic animals (TG). A circular bone defect was filled with HA and maintained subperiosteally. The clinical parameters evaluated were body weight, water and food intake, fasting blood glucose, and bone alkaline phosphatase. Bone-grafted area samples were submitted for histomorphometric and stereological analysis. The TG showed a significantly higher rate of new bone formation compared with the CG, sacrificed 15 days after surgery (p < 0.0001). However, at the end of the study, there was no significant difference in the amount of bone formed between groups (p = 0.077). In parallel, with the increase in osteoblastic activity observed in the TG by the measurement of systemic bone alkaline phosphatase (p = 0.016), the analysis of polarized microscopy and stereology demonstrated a lower level collagen maturation and mineralization in the TG. Quantitatively, the TG showed significantly better results for bone gain in the first 15 days. Qualitative assessments, however, showed fewer collagen fibers and bone maturation in the TG compared with the CG both at 15 and 45 days. Therefore, the postoperative evaluation of bone grafts with HA in hyperglycemic situations should consider the systemic and local effects of this condition on the quality of bone repair, rather than identifying the filling or stability of the grafted area after the process. We conclude that clinically detectable bone repair in diabetic animal models submitted to hydroxyapatite grafts may be satisfactory in the early stages. However, hyperglycemia compromises the quality of the newly formed bone and the collagen cross-linking involved in this process.
在影响手术计划和执行的系统性疾病中，糖尿病（DM）是导致并发症的主要临床疾病。本研究调查了在糖尿病大鼠中用羟磷灰石（HA）填充的临界缺损中的骨形成。采用描述性、随机样本和盲法分析，测试了在大鼠颅骨中手术进行的临界骨缺损中的骨再生。将 20 只成年雄性 Wistar 大鼠随机分为两组：对照组，正常血糖动物（CG）；实验组，链脲佐菌素诱导的高血糖动物（TG）。用 HA 填充圆形骨缺损，并保持在骨膜下。评估的临床参数包括体重、水和食物摄入量、空腹血糖和骨碱性磷酸酶。对移植骨区域的样本进行组织形态计量学和体视学分析。与 CG 相比，TG 在手术后 15 天的新骨形成率明显更高（p<0.0001）。然而，在研究结束时，两组之间形成的骨量没有显著差异（p=0.077）。同时，通过测量系统骨碱性磷酸酶，TG 中观察到成骨细胞活性增加（p=0.016），偏振显微镜和体视学分析表明 TG 中胶原成熟和矿化程度较低。定量分析显示，TG 在最初 15 天内的骨增益效果更好。然而，定性评估显示，与 CG 相比，TG 在第 15 天和第 45 天均显示出较少的胶原纤维和骨成熟。因此，在高血糖情况下，用 HA 进行骨移植的术后评估应考虑到这种情况对骨修复质量的全身和局部影响，而不仅仅是在手术过程后识别移植区域的填充或稳定性。我们得出结论，在接受羟磷灰石移植的糖尿病动物模型中，临床上可检测到的骨修复在早期可能是令人满意的。然而，高血糖会损害新形成的骨的质量和参与该过程的胶原交联。
