大黄素治疗对去卵巢大鼠骨量流失的保护作用机制研究

目的探讨大黄素(emodin,DHS)对去卵巢大鼠骨量流失的影响,并探索可能的机制。方法通过双侧去卵巢建立骨质疏松大鼠模型;随后随机分为假手术组(Sham)、去卵巢组(OVX)以及大黄素组(DHS),每组10只;其中DHS组大鼠接受大黄素[90 mg/(kg·d)]治疗12周;待治疗结束后使用Micro-CT、HE染色切片、骨代谢指标、以及蛋白质印迹观察治疗效果以及可能的机制。结果治疗12周后,与OVX组相比,Micro-CT和HE染色切片结果显示DHS组的大鼠骨小梁数量和骨密度得到明显改善。DHS组大鼠BMD、TV/BV、Tb.N、Tb.Th和Tb.Sp较OVX组明显改善(P<0.05)。与OVX组相比,DHS组的BALP水平明显升高(P<0.05);而TRACP-5b和β-CTX水平显著降低(P<0.05)。和OVX组比较,DHS组OPG表达水平上调(P<0.05),而RANKL和β2AR表达水平下调(P<0.05)。结论大黄素可以通过降低β2AR表达和激活OPG/RANKL信号通路介导对去卵巢大鼠骨量流失的保护作用。     

骨质疏松症大鼠模型生物力学性能和OPG/RANKL/RANK信号通路研究

摘要：目的 研究针刺对骨质疏松症（osteoporosis，OP）模型大鼠生物力学性能和骨保护素（OPG）/核因子-κB受体活化因子（RANKL） /核因子-κB受体活化因子受体（RANK）信号通路的影响，探讨针刺防治OP的作用机制。方法 选取50只雌性SD大鼠，通过摘除卵巢建立OP大鼠模型，分为假手术组、模型组、针刺低剂量组、针刺高剂量组、阿仑膦酸钠组，每组10只。成功建立模型并对大鼠进行适应性喂养2个月后，连续灌胃给药12周，再进行腹主动脉取血并处死大鼠。通过双能X射线仪测定各组大鼠右侧下肢股骨骨矿含量；用酶联免疫吸附法测定法检测血清钙（Ca2+）、磷（P）和OPG、RANKL、RANK的水平；采用AG-IX万能实验机检测股骨的生物力学性能；采用蛋白质印迹法检测骨组织OPG、RANKL、RANK蛋白的表达。结果 与假手术组比较，模型组大鼠骨组织中骨矿含量、血清Ca2+、P、OPG的表达、股骨组织中OPG蛋白含量和股骨最大载荷、刚度及弹性模量均明显降低（P＜0.01）；血清RANKL和RANK的表达及股骨组织中RANKL、RANK蛋白含量明显升高（P＜0.01）。与模型组比较，针刺低剂量组和针刺高剂量组以及阿仑膦酸钠组上述指标均有明显改善（P<0.05或P<0.01），且针刺的作用具有剂量依赖性（P<0.05或P<0.01）。结论 针刺具有明显的抗OP作用，可能与其改善骨组织生物力学特性以及调控OPG/RANKL/RANK通路有关。     

当归鸡血藤化裁方发挥类雌激素作用保护去卵巢大鼠骨量流失

目的 观察当归鸡血藤化裁方对去卵巢大鼠骨密度和骨量的影响并探讨相关的作用机制。方法 将30只3月龄雌性大鼠随机分为Sham组、OVX组以及OVX+T组，每组10只；适应性饲养两周后对Sham组行假手术，对OVX及OVX+T组行双侧卵巢去势手术，其中OVX+T组于术后两个月给予等效当归鸡血藤化裁方灌胃治疗；连续给药12周后，取各组大鼠血清及股骨组织分别进行骨密度检测、组织切片检测、蛋白印迹检测及血清指标检测。结果 X线及HE切片显示，OVX组骨密度及骨微参数均低于Sham组，OVX+T组骨密度及骨微参数高于OVX组(P＜0.05)。血清指标显示，OVX组的17β-E2水平低于Sham组，ALP、CTX-1、TRAcP-5b含量或活性高于Sham组；OVX+T组的17β-E2水平高于OVX组，ALP、CTX-1、TRAcP-5b含量或活性低于OVX组(P＜0.05)。蛋白印迹结果显示，OVX组的OPG、ERK表达水平低于Sham组，RANKL、RANK、RANKL/OPG的比率高于Sham组；OVX+T组的OPG、ERK表达水平高于OVX组，RANKL、RANK、RANKL/OPG的比率低于OVX组(P＜0.05)。结论 当归鸡血藤化裁方是通过类雌激素作用抑制骨的高转化率，并通过OPG/RANKL/RANK信号通路来促进骨形成并抑制骨吸收，从而来防治雌激素缺乏引起的骨质疏松症。在这一过程中可能有ERK信号通路的参与。     

益肾健骨膏对去卵巢骨质疏松大鼠骨代谢的影响

目的 探讨益肾健骨膏对去卵巢骨质疏松大鼠骨代谢的影响及可能机制。方法 50只雌性SD大鼠被随机分为假手术组、模型组、高剂量膏方组、低剂量膏方组、阳性药物组,每组10只。假手术组、模型组给予10 mL /（kg·d）生理盐水灌胃,低、高剂量膏方组分别给予2 g /（kg·d）、13 g/（kg·d）益肾健骨膏灌胃,阳性药物组灌服6.25 mg/（kg·w）阿仑膦酸钠维D3。治疗12周后检测大鼠腰椎骨密度和腰椎最大压缩载荷,通过Elisa检测血清骨代谢指标抗酒石酸酸性磷酸酶（TRACP）、骨保护素(OPG)、Ⅰ型前胶原氨基端原肽(PINP)、Ⅰ型胶原交联羧基端肽(CTX-Ⅰ),RT-PCR检测腰椎骨组织OPG、RANKL、RANK、TRAF6的 mRNA表达,RT-PCR及Western blot检测腰椎Notch1、Notch2、Jagged1、Jagged2的基因及蛋白表达。结果 益肾健骨膏治疗12周后,与模型组比较,高剂量膏方组大鼠腰椎骨密度、最大压缩载荷,血清PINP、OPG水平,骨组织Notch1、Notch2、Jagged1、Jagged2的mRNA和蛋白表达,OPG的mRNA表达显著升高（P<0.05）,而血清TRACP、CTX-Ⅰ水平,骨组织RANKL、RANK、TRAF6的mRNA表达显著降低（P<0.05）。结论 高剂量益肾健骨膏能改善去卵巢骨质疏松大鼠骨密度、骨强度及骨代谢,其作用机制可能与Notch通路及OPG/RANKL/RANK系统有关。     

金匮肾气丸对去势大鼠骨微结构及ALP、OPG、IL-6的影响

目的研究金匮肾气丸防治骨质疏松的机制,探讨"温补肾阳,以生髓壮骨"中医理论在绝经后骨质疏松中的应用。方法采用卵巢切除法复制绝经后骨质疏松大鼠模型,随机分为模型组、金匮肾气丸高、低剂量组、雌二醇组,同时设置假手术组作为对照组,各组分别给予相应的药物灌胃。给药3月后处死取材,计算子宫系数; HE染色观察子宫的病理变化; Micro-CT检测大鼠骨密度及骨微结构的变化;全自动生化分析仪检测各组大鼠血清中血糖、血脂及钙磷的变化; ELISA检测各组大鼠血清中ALP、IL-6及OPG表达的变化。结果与假手术组相比,模型组大鼠骨密度显著下降(P0.05),骨微结构破坏明显;与模型组相比,金匮肾气丸低剂量组大鼠骨密度得到了有效提高、骨微结构获得改善,血糖、血脂水平降低,血清中钙磷的含量明显提高,血清中ALP、IL-6含量降低,OPG含量升高。结论金匮肾气丸能够提高去卵巢大鼠的骨量,防治绝经后骨质疏松症,其作用机理可能与降低ALP、IL-6,提高OPG含量有关。     

橙皮苷对去卵巢骨质疏松症大鼠骨质流失和机制的影响

目的研究橙皮苷对去卵巢骨质疏松大鼠骨质流失和骨保护素(osteoprotegerin,OPG)/核因子kappa B配体的受体激活物(receptor activator of nuclear factor kappa B ligand,RANKL)/RANK通路的影响。方法将48只雌性Sprague-Dawley(SD)大鼠随机分为假手术组、去卵巢骨质疏松组、橙皮苷低剂量组、橙皮苷中剂量、橙皮苷高剂量组和雌激素组。检测骨组织骨体积分数(bone volume fraction,BV/TV)、骨小梁厚度(trabecular thickness,Tb.Th)、骨密度(bone mineral density,BMD)、骨小梁数量(trabecular number,Tb.N)、骨小梁分离度(trabecular separation,Tb.Sp),通过HE染色观察骨组织病理损伤,采用酶联免疫吸附法(enzyme linked immunosorbent assay,ELISA)检测人Ⅰ型胶原C端肽(C-terminal peptide collagen typeⅠ,CTX-Ⅰ)和血清骨钙素(bone glaprotein,BGP)的表达量。运用qRT-PCR和Western bolt分别检测骨组织OPG、RANKL、RANK的mRNA和蛋白表达。结果在橙皮苷治疗后,与去卵巢骨质疏松组相比,骨质疏松标志物BV/TV、BMD、Tb.Th和Tb.N水平升高,Tb.Sp水平降低;大鼠骨小梁数量明显增加,且骨小梁连接更为紧密;骨吸收标志物CTX-Ⅰ水平降低;骨形成标志物BGP水平升高。OPG mRNA相对表达量和蛋白的表达量升高,RANKL和RANK mRNA相对表达量和蛋白的表达量降低。结论橙皮苷能缓解去卵巢骨质疏松大鼠骨质流失并调节OPG/RANKL/RANK信号通路。     

二甲双胍对去卵巢大鼠骨质疏松症的影响及机制研究

目的 以雌二醇为对照,观察二甲双胍(metformin, MF)对去卵巢大鼠骨密度及骨矿含量的影响,并从细胞、分子水平探究MF可能的骨保护机制。方法 将60只雌性SD大鼠随机均分4组：假手术（SHAM）组、去卵巢（OVX）组、去卵巢+二甲双胍（OVX+MF）组和去卵巢+雌二醇(OVX+E2 )组。分组灌胃给药60 d后测量大鼠右侧胫骨骨密度和骨矿含量;分离培养各组大鼠骨髓间充质干细胞（BMSCs）并诱导其向成骨细胞分化,用MTT法测定细胞活性及增殖能力;测定各组碱性磷酸酶（ALP）活性、矿化结节数目、钙含量以及I型胶原（collagen type I）、骨钙素（OC）、骨保护素 (OPG)、NFκB受体的配体 (RANKL)、白细胞介素-6（IL-6）基因表达水平。结果 与OVX组相比,OVX+MF组和OVX+E2组成骨细胞的增殖能力与ALP活性明显增强,骨密度、骨矿含量以及钙沉积量显著增加(P均<0.05),且两组collagen type I、OC、OPG mRNA的表达水平显著升高,而RANKL、IL-6mRNA表达明显受到抑制;但OVX+MF组去卵巢大鼠成骨细胞的增殖能力、ALP活性、钙沉积量、collagen type I、OC、OPG mRNA表达水平低于OVX+E2组,RANKL、IL-6mRNA表达高于OVX+E2组（P均<0.05）;与SHAM组比较,OVX+MF组的collagen type I、OC、OPG mRNA的表达水平更高（P<0.05）。结论 二甲双胍可能通过OPG/RANKL/RANK信号通路促进BMSCs向成骨细胞分化,有效逆转去卵巢大鼠骨质疏松的状态,这种潜在的骨保护作用可能会改善糖尿病引起的骨质疏松。     

葛根素通过OPG/RANKL及Wnt/β-catenin信号通路介导对来曲唑引起骨流失的保护作用

目的观察葛根素对来曲唑治疗的老年雌性大鼠骨量和骨密度影响,并探索可能的机制。方法 30只24个月龄老年雌性SD大鼠随机分为3组:对照组(CON组);来曲唑组(LQC组):每周给予0.1 mg/kg来曲唑治疗;葛根素+来曲唑组(GGS+LQC组):每天给予50 mg/kg葛根素联合每周给予0.1 mg/kg来曲唑治疗,为期12周,待治疗结束后使用Micro-CT、Masson染色切片、血清学检测以及蛋白质印迹观察治疗效果以及可能的机制。结果治疗12周后,与LQC组相比,GGS+LQC组的大鼠骨小梁数量和骨密度得到明显改善。GGS+LQC组大鼠BMD、BV/TV、Tb.N、Tb.Th和Tb.Sp较CON组明显改善(P0.05)。治疗12周时,GGS+LQC组CTX-1和PINP水平较LQC组显著降低(P0.05),比较差异有统计学意义(P0.05)。和LQC组比较,GGS+LQC组的大鼠OPG/RANKL及Wnt/β-catenin信号通路被激活,OPG、Wnt3α、β-catenin水平显著上升,RANKL水平明显下降,比较差异有统计学意义(P0.05)。结论葛根素通过激活OPG/RANKL及Wnt/β-catenin信号通路逆转来曲唑对老年雌性大鼠骨骼有害作用。     

牛蒡苷元通过OPG/RANKL信号通路介导对去卵巢大鼠骨量流失的保护作用

目的探讨牛蒡苷元(AGN)对去卵巢大鼠骨强度和骨量的影响,并探索可能的机制。方法本研究中通过双侧去卵巢建立骨质疏松大鼠模型;随后随机分为假手术组(Sham)、去卵巢组(OVX)以及牛蒡苷元组(AGN),每组10只;其中牛蒡苷元组大鼠接受牛蒡苷元[40 mg/(kg.d)]治疗12周;待治疗结束后使用Micro-CT、Masson染色切片、骨代谢指标、骨生物力学检测以及蛋白质印迹观察治疗效果以及可能的机制。结果治疗12周后,与OVX组相比,Micro-CT和Masson染色切片结果显示AGN组的大鼠骨小梁数量和骨密度得到明显改善。AGN组大鼠BMD、TV/BV、Tb.N、Tb.Th和Tb.Sp较OVX组明显改善(P0.05)。治疗12周时,AGN组极限载荷和刚度较OVX组显著增加(P0.05),而AGN组骨代谢指标AKP和TRACP水平显著降低(P0.05),差异有统计学意义(P0.05)。和OVX组比较,AGN组OPG表达水平明显上调,而RANKL表达水平显著下调,差异有统计学意义(P0.05)。表明AGN组的大鼠OPG/RANKL信号通路被激活。结论牛蒡苷元可以通过OPG/RANKL信号通路介导对去卵巢大鼠骨骼的保护作用。     

骨碎补通过骨髓间充质干细胞调节RANKL/OPG抑制破骨细胞的实验研究

目的　研究骨碎补对绝经后骨质疏松大鼠骨髓间充质干细胞(bone marrow stromal cells,BMSCs)RANKL/OPG及破骨细胞分化成熟的影响并探查其可能的作用机制。方法 实验大鼠去双侧卵巢造模,分为实验组（OVXDF,造模+骨碎补水煎液灌胃）、模型组（OVX,造模+0.9%生理盐水灌胃）、假手术组（SHAM,假手术+0.9%生理盐水灌胃）,造模成功后提取BMSCs,将BMSCs和骨髓单核细胞共培养于Transwell小室的上室和下室,分为实验组+破骨细胞（OVXDF+OC）、模型组+破骨细胞（OVX+OC）、假手术组+破骨细胞（SHAM+OC）。下室加入破骨细胞诱导剂,倒置相差显微镜观察破骨细胞的分化成熟情况并计数,酶联免疫吸附剂测定（ELISA）检测下室培养液中骨保护素(osteoprotegerin,OPG)、RANKL的含量,并计算RANKL/OPG,实时荧光定量PCR和蛋白质印迹法(Western blot)检测BMSCs中Wnt10b、β-catenin、RANKL、OPG mRAN及蛋白表达并计算RANKL/OPG。结果 在共培养系统中,与去卵巢灌胃大鼠BMSCs共培养的破骨细胞（OVXDF+OC）数量较单纯模型组+破骨细胞（OVX+OC）明显减少（P＜0.05）。下室培养液OPG含量及共培养BMSCs中Wnt10b、β-catenin、OPG mRAN及蛋白表达模型组+破骨细胞（OVX+OC）最低,RANKL及RANKL/OPG最高,经骨碎补灌胃后（OVXDF+OC）培养液中OPG含量及BMSCs细胞中Wnt10b、β-catenin、OPG mRAN及蛋白表达明显升高,培养液及BMSCs细胞中RANKL及RANKL/OPG明显降低（P＜0.05）。结论 骨碎补可调节BMSCs细胞OPG、RANKL的表达,激活OPG/RANKL/RANK信号通路抑制破骨细胞的分化和成熟,此作用可能与BMSCs的Wnt/β-catenin信号通路的激活有关。     

跖骨感染骨外露的显微外科治疗

[目的]回顾总结跖骨骨感染骨外露的显微外科治疗方法。[方法]自1995年～2005年采用显微外科技术治疗214例跖骨骨外露骨感染患者。[结果]全部病例获得随访1～10年，平均随访3年，14例游离植皮术后皮肤成活良好，199例术后皮瓣全部成活，1例腓肠神经营养血管皮瓣移位修复术出现远端部分皮肤坏死，后经换药处理后，伤口自然愈合。皮瓣移植术后质地良好，无溃疡复发。患足均可负重走路。[结论]应用显微外科技术治疗跖骨骨感染骨外露可获得较好的疗效。     

Assessment of bone density and bone loss

Osteoporosis International - Dual-energy X-ray absorptiometry has become the standard for the evaluation of osteoporosis. It is useful both for identifying those people who are going to be at risk...     

骨胶原与骨质疏松骨密度及骨生物力学的相关性研究

目的探讨骨胶原含量在绝经后骨质疏松症的发生、发展及在骨质疏松性骨折中的作用。方法取7个月龄未交配雌性SD大鼠60只，随机分为四组，A组：对照组（sham组）；B组：切除卵巢组；C组：切除卵巢＋雌激素治疗组；D组：切除卵巢＋降钙素治疗组。除A组外，其他三组通过切除双侧卵巢法12周后制成骨质疏松模型，24周后分别行k的力学特性、右侧股骨三点弯曲试验、羟脯氨酸含量、k骨密度（BMD）测定，Masson三色染色法显示骨胶原形态。结果A、C、D组与B组在k羟脯氨酸含量、BMD、k压缩力学参数值、右侧股骨生物力学参数值、骨胶原染色含量及形态方面差异均有统计学意义（P〈0．05），而A、C、D组之间差异无统计学意义（P〉0．05）。统计学分析显示羟脯氨酸含量与BMD及骨生物力学参数值呈直线相关性。结论骨质疏松的发生与骨胶原含量下降有关。骨胶原含量的下降与BMD降低及骨生物力学改变呈相关性。应用雌激素和降钙素治疗去势后骨质疏松大鼠，不仅可以提高其BMD含量和骨生物力学性能，而且还可以提高骨胶原的含量。     

Repair of long bone defects with demineralized bone matrix and autogenous bone composite

Background:

Repair of diaphyseal bone defects is a challenging problem for orthopedic surgeons. In large bone defects the quantity of harvested autogenous bone may not be sufficient to fill the gap and then the use of synthetic or allogenic grafts along with autogenous bone becomes mandatory to achieve compact filling. Finding the optimal graft mixture for treatment of large diaphyseal defects is an important goal in contemporary orthopedics and this was the main focus of this study. The aim of this study is to investigate the efficacy of demineralized bone matrix (DBM) and autogenous cancellous bone (ACB) graft composite in a rabbit bilateral ulna segmental defect model.

Materials and Methods:

Twenty-seven adult female rabbits were divided into five groups. A two-centimeter piece of long bone on the midshaft of the ulna was osteotomized and removed from the rabbits’ forearms. In group 1 (n=7) the defects were treated with ACB, in group 2 (n=7) with DBM, and in group 3 (n=7) with ACB and DBM in the ratio of 1:1. Groups 4 and 5, with three rabbits in each group, were the negative and positive controls, respectively. Twelve weeks after implantation the rabbits were sacrificed and union was evaluated with radiograph (Faxitron), dual-energy x-ray absorptiometry (DEXA), and histological methods (decalcified sectioning).

Results:

Union rates and the volume of new bone in the different groups were as follows: group 1 - 92.8% union and 78.6% new bone; group 2 - 72.2% union and 63.6% new bone; and group 3 - 100% union and 100% new bone. DEXA results (bone mineral density [BMD]) were as follows: group 1 - 0.164 g/cm², group 2 - 0.138 g/cm², and group 3 - 0.194 g/cm².

Conclusions:

DBM serves as a graft extender or enhancer for autogenous graft and decreases the need of autogenous bone graft in the treatment of bone defects. In this study, the DBM and ACB composite facilitated the healing process. The union rate was better with the combination than with the use of any one of these grafts alone.     

Treatment of aneurysmal bone cysts by introduction of demineralized bone and autogenous bone marrow

BACKGROUND: On the assumption that an aneurysmal bone cyst has an intrinsic potential to heal by ossification, a new, minimally invasive protocol was developed. Demineralized bone powder mixed with bone-marrow aspirate was introduced into the cyst to halt the expansion phase and to allow the cyst to ossify. We hypothesized that, in order to induce bone-healing, cells from the cyst are needed to respond to the inductive material but that curettage or extensive surgery is not necessary. The goals of the present study were to assess cyst-healing and to determine the prevalence of recurrence associated with this new procedure. METHODS: Thirteen biopsy-proven primary aneurysmal bone cysts were entered through a small incision, and a paste of demineralized bone and autologous bone marrow was introduced with an applicator. The study group included three male and ten female patients with a mean age of 16.6 years. The cyst was located in a long bone in six patients, the pelvis in five patients, and the scapular glenoid and the calcaneus in one patient each. Five patients had not received treatment previously, whereas one had had a preoperative embolization and seven had recurrent lesions that had been treated previously. RESULTS: After a mean duration of follow-up of 3.9 years, healing was achieved in eleven patients. CONCLUSIONS: This minimally invasive method is able to promote the self-healing of a primary aneurysmal bone cyst. As no curettage is required, the proposed treatment avoids extensive surgery and blood loss and is convenient for the treatment of poorly accessible lesions such as those occurring in the pelvis. LEVEL OF EVIDENCE: Therapeutic Level IV.     

Spinal fusions: bone and bone substitutes

Vertebral arthrodesis is one of the most commonly performed, yet incompletely understood, procedures in spinal surgery. Despite major progress in internal fixation techniques, the high rate of non-unions indicates that physiologic, biologic and molecular events that are crucial to this process are not well known. This article will analyze the general biology of bone regeneration, and particularly discuss the properties and use of various bone graft materials and graft substitutes. Received: 9 August 2000/Accepted: 11 August 2000     

Aneurysmal bone cyst and solitary cyst of bone]

Results of treatment of 7 cases of aneurysmal bone cysts and 12 cases of solitary bone cysts in 19 patients treated in our Department between 1991 and 1996 are presented. Changes were found in the humerus, femur, tibia and fibula. Curettage or excision was the mode of treatment. Recurrence of the condition has been noted in 4 cases. Excision of the change and filling of the defect with autologous or homologous bone graft is more efficient than curettage alone.     

小鼠骨组织形态学特征及泼尼松对骨量及骨钙的影响

目的探讨小鼠骨组织形态学和小鼠骨钙含量的研究方法,并观察不同剂量的泼尼松对小鼠骨形态学及骨钙含量的影响.方法 24只昆明种♀小鼠,随机分为4组正常对照组,泼尼松低、中、高剂量组,对照组给予生理盐水,其余3组分别按泼尼松0.75、1.5、6.3 mg.kg-1@d-1灌胃给药,实验21 d后,眼眶放血,取右胫骨进行硬组织包埋切片,作骨组织形态计量学检测,取右股骨测骨钙含量.结果小鼠骨形态学与大鼠相似,但松质骨骨量个体差异大.形态学中骨量与骨钙含量有正相关(P＜0.05).对不同剂量泼尼松作用的检测表明低、高两剂量泼尼松对骨钙含量无明显影响,中剂量可增加骨钙含量(P＜0.05);骨形态计量学观察可见低、中剂量的泼尼松有增加骨量的趋势,中剂量差异有显著性(P＜0.05),高剂量泼尼松有减少骨量的趋势.中剂量增加松质骨表面双荧光强度(P＜0.05).结论小鼠骨形态学特征和骨钙含量有低的相关关系,泼尼松低的剂量可增加小鼠的骨钙含量、骨量和骨小梁表面荧光,当剂量增加时却有减少骨量和骨表面荧光的作用.提示测定药物对骨钙含量影响在一定程度上反映形态学中骨量的变化,提示若用高剂量泼尼松可致小鼠骨量减少模型.