Emergency Department, The First Affiliated Hospital, Jinan University, Guangzhou, China.
Department of Orthopaedic Surgery and Sports Medicine Center, The First Affiliated Hospital, Jinan University, Guangzhou, China.
Orthop Surg. 2022 Jun;14(6):1217-1228. doi: 10.1111/os.13274. Epub 2022 Apr 22.
To explore the effect of diabetes mellitus (DM) on implant osseointegration of titanium screws.
Sixty rats were randomly divided into a DM group and a control group (each group, n = 30). DM group rats were injected with 1% Streptozotocin solution at 65 mg/kg to establish a DM model. Titanium screws were implanted into the rats' distal femurs in both groups. The rats were sacrificed for micro-CT scanning, micro-indentation, biomechanical detection, confocal Raman microspectroscopy, and histological and histomorphometric analysis at 4, 8, and 12 weeks post-implantation, respectively. Messenger RNA (mRNA) expression and protein expression of the related growth factors around the implant were analyzed using real-time polymerase chain reaction and Western blots.
At 4, 8 and 12 weeks, micro-CT scanning, hematoxylin-eosin (HE) staining, Gieson's acid-magenta staining, and fluorescent labeled staining showed disorder in the bone tissue arrangement, a lack of new bone tissue, poor maturity and continuity, and poor trabecular bone parameters around the implant in the DM group. At 4, 8, and 12 weeks, the interfacial bone binding rate in the DM group was significantly lower (16.2% ± 4.8%, 25.7% ± 5.7%, 42.5% ± 5.8%, respectively) than that in the control group (23.6% ± 5.2%, 40.8% ± 6.3%, 64.2% ± 7.3%, respectively; P < 0.05). At 8 and 12 weeks, the elastic modulus (17.0 ± 1.8 and 15.1 ± 1.5 GPa, respectively) and trabecular bone hardness (571 ± 39 and 401 ± 37 MPa, respectively) in the DM group were significantly lower than the elastic modulus (23.4 ± 2.3 and 23.8 ± 1.8 GPa, respectively) and trabecular bone hardness (711 ± 45 and 719 ± 46 MPa, respectively) in the control group (P < 0.05). The maximum load required for the prosthesis pull-out experiment in the DM group at 4, 8, and 12 weeks (55.14 ± 6.74 N, 73.34 ± 8.43 N, and 83.45 ± 8.32 N, respectively) was significantly lower than that in the control group (77.45 ± 7.48 N, 93.28 ± 8.29 N, and 123.62 ± 9.43 N, respectively, P < 0.05). At 8 and 12 weeks, the mineral-to-collagen ratio in the DM group (6.56 % ± 1.35% and 4.45%± 1.25%, respectively) was significantly higher than that in the control group (5.31% ± 1.42% and 3.62% ± 1.33%, respectively, P < 0.05). At 12 weeks, mRNA and protein expression levels of bone morphogenetic protein 2, transforming growth factor-β1, vascular endothelial growth factor, osteopontin, osteocalcin, and runt-related transcription factor 2 in the DM group were significantly lower than that in the control group.
DM can negatively affect bone osseointegration, manifesting as disorder in bone tissue arrangement around the implant, a lack of new bone tissue, poor maturity and continuity, poor trabecular bone parameters and lower expression of the related growth factors.
探讨糖尿病（DM）对钛螺钉种植体骨整合的影响。
将 60 只大鼠随机分为 DM 组和对照组（每组 n=30）。DM 组大鼠以 65mg/kg 的 1%链脲佐菌素溶液注射建立 DM 模型。两组大鼠均在其股骨远端植入钛螺钉。分别于植入后 4、8 和 12 周时进行微 CT 扫描、微压痕、生物力学检测、共聚焦拉曼微光谱分析及组织学和组织形态计量学分析。采用实时聚合酶链反应和 Western blot 分析种植体周围相关生长因子的信使 RNA（mRNA）表达和蛋白表达。
在 4、8 和 12 周时，DM 组的微 CT 扫描、苏木精-伊红（HE）染色、Gieson 酸-品红染色和荧光标记染色显示，其骨组织排列紊乱，缺乏新骨组织，成熟度和连续性差，种植体周围的小梁骨参数较差。在 4、8 和 12 周时，DM 组的界面骨结合率（分别为 16.2%±4.8%、25.7%±5.7%和 42.5%±5.8%）明显低于对照组（分别为 23.6%±5.2%、40.8%±6.3%和 64.2%±7.3%；P<0.05）。在 8 和 12 周时，DM 组的弹性模量（分别为 17.0±1.8 和 15.1±1.5 GPa）和小梁骨硬度（分别为 571±39 和 401±37 MPa）明显低于对照组（分别为 23.4±2.3 和 23.8±1.8 GPa 和 711±45 和 719±46 MPa；P<0.05）。在 4、8 和 12 周时，DM 组的假体拔出实验所需的最大负荷（分别为 55.14±6.74 N、73.34±8.43 N 和 83.45±8.32 N）明显低于对照组（分别为 77.45±7.48 N、93.28±8.29 N 和 123.62±9.43 N；P<0.05）。在 8 和 12 周时，DM 组的矿化-胶原比（分别为 6.56%±1.35%和 4.45%±1.25%）明显高于对照组（分别为 5.31%±1.42%和 3.62%±1.33%；P<0.05）。在 12 周时，DM 组骨形态发生蛋白 2、转化生长因子-β1、血管内皮生长因子、骨桥蛋白、骨钙素和 runt 相关转录因子 2 的 mRNA 和蛋白表达水平明显低于对照组。
DM 可对骨整合产生负面影响，表现为种植体周围骨组织排列紊乱，缺乏新骨组织，成熟度和连续性差，小梁骨参数差，相关生长因子表达水平降低。
