北京生物医学工程

放散式冲击波治疗双侧卵巢切除大鼠晚期骨质疏松症的实验研究

Effect of radial extracorporeal shock wave therapy on ovariectomy-induced advanced osteoporosis in rats

作者：杰永生郭安忆綦惠郑蕊梁震景金珠刘亚军

单位：京市创伤骨科研究所（北京 100035）；北京积水潭医院骨科冲击波诊疗中心（北京 100035） <p>通信作者：刘亚军。E-mail：drliuyajun@163.com</p> <p> </p>

分类号： R318.01

出版年·卷·期（页码）：2022·41·3（275-279）

摘要：

目的探讨放散式冲击波在治疗晚期骨质疏松症（osteoporosis，OP）中的角色，为临床应用奠定实验基础。方法将大鼠随机分成3组：Sham组，仅暴露卵巢，不进行切除；OP组，采用双侧卵巢切除术建立大鼠OP模型，不进行治疗；OP+冲击波治疗组，采用双侧卵巢切除术建立大鼠OP模型，术后6个月左侧股骨颈给予放散式冲击波治疗。治疗结束，采用HE染色、抗酒石酸碱性磷酸酶（tartrate-resistant acid phosphatase，TRAP）化学染色以及micro-CT观察各组股骨近端组织结构。进一步对micro-CT的结果进行定量分析，比较骨密度（bone mineral density，BMD），骨体积分数（BV/TV），骨小梁数量（Tb.N），骨小梁厚度（Tb.Th），骨小梁分离度（Tb.Sp）等指标在各组之间的差异。对各组血清学骨钙素（osteocalcin，OCN）和I型胶原 C 端肽（C-terminal telopeptide of type I collagen，CTX-I）采用酶联免疫吸附试验（enzyme-linked immunosorbent assay，ELISA）进行检测和比较。应用生物力学机对腰椎椎体的抗压性能进行检测。结果与Sham组相比，OP组骨小梁数量降低，结构变细，TRAP化学染色阳性的破骨细胞数显著增多（P<0.05），冲击波治疗未明显改变这种情况。OP组以及OP+冲击波治疗组BMD均显著低于Sham组（P<0.05），但各组之间BV/TV，Tb.N，Tb.Th，Tb.Sp，以及血清学数据并未有显著差异。力学检测结果显示，OP组以及OP+冲击波治疗组的抗压性能均显著低于Sham组（P<0.05）。结论晚期OP放散式冲击波治疗后，股骨颈的微结构、L3和L4椎体的抗压性能以及血清学指标未有明显改善，很可能需要与其他方式联合应用才能达到一定的治疗效果。

Objective To explore the role of radial extracorporeal shock wave therapy (rESWT) in the treatment of advanced osteoporosis (OP) in rats. Methods Female SD rats were anesthetized and randomly divided into three groups: Sham group, in which ovaries were exposed bilaterally but without other operation; OP group, and OP+rESWT group, in which bilateral ovariectomy were performed, and the rats of OP+rESWT group were treated with rESWT to the left femur necks after six months of ovariectomy. After treatment, the rats were euthanized, blood were gathered, and the left femurs, and the lumbar vertebrae 3-4 were dissected. The left femurs were submitted to HE staining and tartrate-resistant acid phosphatase (TRAP) staining. Micro-CT examination were applied to test the tissue structure in each group, and the bone mineral density (BMD), bone volume fraction (BV/TV), trabecular number (Tb.N), trabecular thickness (Tb.Th), trabecular separation (Tb.Sp) were compared among the three groups. The levels of osteocalcin (OCN) and C-terminal telopeptide of type I collagen (CTX-I) in the serum were detected through enzyme-linked immunosorbent assay (ELISA). The lumbar vertebrae 3-4 were submitted to biomechanical test. Results Compared with Sham group, the number of bone trabecular bone decreased, and the number of TRAP positive osteoclasts increased significantly (P < 0.05) in OP group. But after treatment with rESWT, the data in OP+rESWT group were not promoted. BMD in OP group and OP+rESWT group were significantly lower than that in Sham group (P < 0.05). BV/TV, Tb.N, Tb.Th, Tb.Sp and the serum levels of OCN and CTX-I in OP+rESWT group were not changed significantly compared with OP group. What’s more, the duration strength of the lumbar vertebrae in OP group and OP+rESWT group were obviously reduced compared with that of the Sham group. Conclusions For advanced OP, the effects of rESWT on the local trabecular bone of the femoral neck is limited, since the osteoporotic condition of the whole body is still not changed. Other treatment methods should also be used at the same time, which may have better results.

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