99Tc．MDP联合“骨康灵”治疗兔骨质疏松的生物力学研究

The biomechanics study of rabbit osteoporosis models treated by 99 Tc-MDP combined with GuKang-Ling

目的探讨99Tc．MDP联合中药“骨康灵”治疗骨质疏松兔模型在治疗前后的骨生物力学变化。方法制作兔骨质疏松动物模型（C组）与对照组（A组），以证实骨质疏松模型建立。设正常对照组（B组）和骨质疏松对照组（D组），用于在实验结束时对照；同时设99Tc—MDP治疗组（E组）、“骨康灵”治疗组（F组）和99Tc—MDP联合“骨康灵”治疗组（G组），治疗时间16周。疗效评判指标或方法：骨生物力学、细胞病理学、骨形态计量、骨密度、X线、CT、核素骨显像和血清骨碱性磷酸酶（BALP）、骨钙素（BGP）测定。疗效分为显效、有效和无效。采用SPSS13．0软件，多组比较行方差分析，2组间比较采用t检验。结果实验兔连续6周肌内注射地塞米松（按体质量2mg／kg），A组病理细胞学切片无骨小梁破坏；12组实验兔病理切片见骨小梁排列稀疏、断裂，存在较明显的骨破坏现象，C组的骨生物力学[左股骨头为（265．914±52．773）N，第4腰椎L4为（369．671±94．919）N]、骨密度[左股骨头（0．238±0．016）g／cm^2，L。（0．236±0．016）g／cm^2]、骨形态计量[（66．230±10．848）％]较A组[各指标依次为（405．343±55．410）N，（750．870±53．718）N，（0．294±0．017）g／c-，（0．3024-0．023）∥cm^2，（131．500±21．846）％]明显降低（t均≥4．550，P均〈0。01）。核素骨显像示c组各大关节放射性摄取较A组明显增强，椎体显示不清；BALP、BGP与A组相比差异有统计学意义［分别为（45．000±7．303）比（12．485±1．512）U／L，（0．168±0．018）比（0．115±0．017）斗g／L，￡=4．126，5．476，P均〈0．01]，证实兔骨质疏松模型成功建立。E组、F组、G组经16周治疗后，病理切片显示：E组、G组表现为骨组织结构和骨小梁明显得到修复，骨小梁增粗；F组修复较差。E组、G组骨生物力学指标[左股骨头分别为（386．457±77．077）N和（432．771±17．525）N，L4分别为（649．550±126．859）N和（655．443±76．555）N]明显改善，骨显像表现与B组基本相似，而F组放射性摄取略低于D组。治疗后各组骨生物力学、骨形态计量、骨密度和血清BALP、BGP结果差异有统计学意义（F值8．556—31．608，P均〈0．01），G组的骨生物力学略强于E组（f=2．625，P〈0．05）。疗效评判G组和E组均为显效，F组为有效。结论99Tc-MDP联合“骨康灵”治疗兔骨质疏松在骨生物力学改善方面较明显，在提高骨抗外力的骨强度中可能有潜在的优势。

Objective To study the bone biomechanics of the rabbit osteoporosis models induced by dexamethasone sodium phosphate injection （DX） using a combined treatment modality of 99Tc-MDP and GuKangLing. Methods Rabbits were intramuscularly injected with DX （2 mg/kg） twice a week for 6 weeks. The animal osteoporosis model group （Group C） and normal group （Group A） were compared to confirm the model was available. Another control group （Group B）, the osteoporosis control group （Group D） were set for the comparison at the end of the experiment. The 99Tc-MDP therapy group （Group E）, GuKangLing therapy group （Group F） and 99Tc-MDP plus GuKangLing therapy group （Group G） were included inthe study. The treatment lasted for 16 weeks. The bone biomechanics, cytopathology bone histomorphology, bone mineral density （BMD）, X-ray, CT, bone scintigraphy and serum bone alkaline phosphatase （BALl）） and P （bone gla protein） were chosen as the markers or methods to evaluate the treatment results（ excellent, effective and invalid）. The analysis of variance （ANOVA） and t-test were used for group comparison analy- sis. Results Cytopathology result indicated that there was no bone trabecula destruction in Group A. How- ever, there was distinct bone destruction in Group C. The bone biomechanics （left femur head （265. 914 ±52.773） N, L4（369.671±94.919） N）, BMD（left femur （0.238±0.016） g/cm2, L4（0.236±0.016） g/eraz） and bone histomorphology （ （66. 230± 10. 848）% ） in Group C reduced clearly as compared with Group A （（405.343±55.410） N, （750.870±53.718） N, （0.294±0.017） g/era2, （0.302±0.023） g/em2, （ 131. 500± 21. 846） % ） （ t ≥4. 550, all P 〈 0.01 ）. Radionuelidc bone scan also showed that the uptake of tracers was higher by the main arthrosis in Group C than that in Group A. Vertebra was not clearly visual- ized on bone scan image. There were significant differences between Group A and Group C in serum BALP and P （（45. 000 _＋7. 303） vs （12.485 ~ 1.512） U/L, （0. 168 _＋0.018） vs （0. 115 ＋0.017） txg/L,t = 4. 126, 5. 476, both P 〈 0.01 ）, which indicated that the animal osteoporosis model was available. The pathological results showed an improved recovery of bone structure and trabecular in Groups E and G, but a worse recovery in Group F. Biomechanies result in Groups E and G （left femur head （386. 457 ±77. 077） N and （432. 771 ± 17. 525 ） N, L4 （649. 550 ± 126. 859） N and （655. 443 ±76. 555 ） N） improved apparently, which were similar to Group B. The radiotraeer uptake in Group F was lower than that in group D. The bone biomechanics, bone histomorphology,BMD, serum BALP and P after the treatment showed significant differences in Groups E, F and G （F= 8. 556 - 31. 608, all P 〈0.01 ） , and the bone biomeehanics result in Group G was a little better than that in Group E （ t = 2. 625, P 〈 0.05 ）. The results of Group G and E were considered as excellent, and Group F was considered as effective. Conclusions The treatment of 99Tc-MDP combined with GuKangLing could improve the bone biomeehanies of rabbit osteoporosis models and may be a potential method to increase the bone strength for resisting external force.