小尾寒羊颈椎前路椎间盘切除融合优化模型的建立及评估
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1.北京大学第三医院;2.首都医科大学附属北京友谊医院;3.山东第一医科大学附属省立医院

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北京市科学技术委员会、中关村科技园区管理委员会项目


Establishment and evaluation of anterior cervical discectomy fusion optimization model in small tailed Han sheep model
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1.Peking University Third Hospital;2.Beijing Friendship Hospital Affiliated to Capital Medical University;3.Shandong Provincial Hospital Affiliated to Shandong First Medical University

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Beijing Municipal Science & Technology Commission, Administrative Commission of Zhongguancun Science Park

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    摘要:

    目的 颈椎间盘突出症(cervical disc herniation,CDH)是骨科常见疾病之一,随着对该疾病研究的深入及颈椎内植物的发展,建立颈椎融合动物模型成为不可或缺的部分,目前国内对颈椎融合动物模型建立及评估的研究报道较少,本实验以期为颈椎融合相关研究提供完备的动物模型和内植物性能的评估方案。方法 选择小尾寒羊,改良术式后行颈椎前路椎间盘切除融合术(anterior cervical discectomy fusion,ACDF),将聚醚醚酮(polyetheretherketone,PEEK)椎间融合器(interbody fusion cage, Cage)(对照组)、3D打印钛合金Cage(实验组1)及新方法钛合金Cage(实验组2)分别植入每只羊的不同颈椎节段(C2/3-C4/5),术后行血液学检测、组织病理学分析评估手术恢复情况及材料生物安全性,利用X光、CT、Micro-CT及定量分析、硬组织切片染色、生物力学试验评估内植物的骨长入及骨融合情况。结果 绵羊改良术式ACDF模型建立成功,血液学检测重要指标无显著性差异(P > 0.05),组织病理学分析显示均无炎症细胞浸润等病理改变,内植物生物安全性良好,X光及CT显示内固定位置及椎间融合情况良好,术后3个月及6个月Micro-CT及定量分析表明,与PEEK组相比,新方法钛合金Cage组及3D打印钛合金Cage组内部的骨体积/总体积、骨小梁数目显著性升高(P均< 0.01),骨小梁间距显著性降低(P均< 0.01),且新方法钛合金Cage组骨质长入更多(P < 0.01),硬组织切片染色表明新方法钛合金Cage组及3D打印钛合金Cage组孔隙内有明显骨质长入且较为密实,结合较PEEK Cage组略好,生物力学试验显示,与PEEK Cage组相比,新方法钛合金Cage及3D打印钛合金Cage在一定程度上降低了颈椎屈伸、侧弯、扭转运动范围(P均< 0.05),同时增强了颈椎的稳定性,且新方法钛合金Cage更有优势(P均< 0.05)。结论 建立绵羊改良术式ACDF模型后,利用合理有效的评估方法,证明了该模型的合理性及有效性,同时说明3种材料的Cage均显示出良好的生物安全性,新方法钛合金Cage及3D打印钛合金Cage较PEEK Cage的骨长入及骨融合性能更强,可增强颈椎的稳定性,且新方法钛合金Cage更有优势。

    Abstract:

    Objective Cervical disc herniation (CDH) is one of the common orthopaedic diseases. With the in-depth study of it and the development of cervical implants, the establishment of cervical fusion animal models has become an indispensable part. At present, there are few reported researches about the establishment and evaluation of cervical fusion animal models in China. The aim of this study is to provide a good animal model and evaluation scheme of implants for cervical spine-related research. Methods Small tailed Han sheep were chosen for anterior cervical discectomy fusion (ACDF) after modified operation and polyetheretherketone (PEEK) interbody fusion cage (Cage) (control group), 3D-printed Ti6Al4V Cage (experimental group 1) and new method Ti6Al4V Cage (experimental group 2) were implanted in different cervical segments (C2/3-C4/5) of each sheep respectively. After surgery, hematology and histopathological analysis were performed to evaluate the recovery of sheep and the biosafety of the materials. X-ray, CT, Micro-CT and quantitative analysis, hard tissue section staining and biomechanical tests were executed to assess the conditions of bone in-growth and bone fusion. Results The modified ACDF ovine model was established successfully. There was no significant difference in the important indexes of hematology (P< 0.05), and histopathological analysis showed there were no pathological changes such as inflammatory cell infiltration. The implants had a good biosafety..Furthermore, X-ray and CT showed the position of internal fixation and the interbody fusion were good. The results of Micro-CT and quantitative analysis at 3 and 6 months after operation showed that compared with PEEK Cage group, the bone volume/total volume and trabecular number in the new method Ti6Al4V Cage group and 3D-printed Ti6Al4V Cage group were significantly increased (all P < 0.01), while the trabecular spacing decreased significantly (all P < 0.01). Moreover, the new method Ti6Al4V Cage group had more bone growth (P < 0.01). Hard tissue section staining demonstrated that the pores of the new method Ti6Al4V Cage and 3D-printed Ti6Al4V Cage had obvious bone growth and were relatively dense, and the combination was slightly better than that of PEEK Cage. Biomechanical evaluation indicated that compared with PEEK Cage, the new method Ti6Al4V Cage and 3D-printed Ti6Al4V Cage reduced the range of cervical flexion-extention , lateral bending and axial rotation to a certain extent (all P < 0.05), at the same time enhanced the stability of cervical vertebra, and the new method Ti6Al4V Cage was more advantageous (all P < 0.05). Conclusions After the establishment of the modified ACDF ovine model, reasonable and effective assessment methods were used to demonstrate the rationality and effectiveness of the model, and good biosecurity of the Cages of the three materials. Compared with PEEK Cage, the new method Ti6Al4V Cage and 3D-printed Ti6Al4V Cage had better performance in bone growth and bone fusion, which could enhance the stability of cervical vertebrae, and the new method Ti6Al4V Cage had more advantages.

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  • 收稿日期:2023-08-04
  • 最后修改日期:2023-11-14
  • 录用日期:2023-11-14
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