不同时间冲击波干预对骨不连家兔成骨细胞VEGF的影响

Effect of extracorporeal shock wave of different treatment time on vascular endothelial growth factor of osteoblast in bone nonunion rabbits

目的：观察不同时间冲击波干预兔骨不连模型后成骨细胞中VEGF的表达，初步探讨体外冲击波疗法（ESWT）的最佳干预时间。方法将46只造模成功的雄性新西兰白兔随机分为：A组不行冲击波干预（对照组），分别于术后2、4、8、12周行冲击波干预治疗为B、C、D、E组（实验组）。干预后拍X线片、组织学观察、免疫组化检测。结果（1）X线测量A、B、C、D、E组治疗前后骨不连间隙分别缩小（0.0061±0.0105）mm、（0.4599±0.0550）mm、（0.4229±0.0697）mm、（0.3732±0.0933）mm、（0.2644±0.1513）mm，经配对t检验，治疗前后骨不连间隙改变A组差异无显著性（P＞0.05），而B、C、D、E组改变显著（P＜0.05）。（2）组织学观察，干预后4周和6周时实验组由B到E组成骨细胞、成纤维细胞、间充质细胞及毛细血管内皮细胞增生活跃程度均有逐渐减弱趋势。（3）免疫组化方法显示，治疗组成骨细胞中VEGF含量明显高于对照组，有显著性差异（P＜0.05）；且同一时间段E组VEGF含量较B、C、D组低，差异有显著性（P＜0.05）。结论 ESWT早期干预能影响成骨细胞中VEGF的表达，于术后2-8周之间开始治疗最为合理。

Objective To observe the effect of extracorporeal shock wave （ESW） of different period on vascular endothelial growth factor （VEGF） of osteoblast in bone nonunion rabbits, so as to find out the best intervention time for ESWT. Methods 46 male New Zealand bone nonunion rabbits were divided into 5 groups randomly：the group A without treatment （the control group）;while the group B, C, D and E were treated by ESW at 2nd, 4th, 8th and 12th week after the operation （ the experimental group）. Then X-ray photos were taken and the bone defection’s bony callus organization specimen were taken to do histology-checking and immunohistochemistry-checking. Results The length of the bone nonunion clearance reduced：group A （0.006 1±0.010 5）mm, group B（0.459 9±0.055 0）mm, group C （0.422 9±0.069 7）mm, group D （0.373 2±0.093 3）mm and group E （0.264 4±0.151 3）mm. By paired t test, there was no significant difference （P〉0.05） in group A, while there were significantly （P〈0.05） in the group B, C, D and E. Histology-checking and immunohistochemistry-checking showed that bone nonunion healing appeared a weakening trend from group B to group E both after 4 and 6 weeks by ESW intervention, and B, C, D groups had significant differences from the group E （P〈0.05）. Conclusion Early intervention with ESW can affect the expression of VEGF in osteoblasts and the best treatment time is 2-8 weeks after the operation.