影像及生物力学测试尼古丁剂量与腰椎后外侧植骨融合率的相关性

摘要

背景：临床上出现因吸烟影响植骨区周围血供，最终影响脊柱融合。对于不同剂量尼古丁对脊柱融合影响的相互比较国内外尚未见报道。　　目的：探讨尼古丁对家兔脊柱融合模型的影响，阐明尼古丁的剂量与脊柱融合率的相关性。　　方法：选择60只6-8月龄的成年健康家兔，随机分为4组，每组15只。4组动物均在肌肉注射麻醉下行L5/6后路腰椎横突间融合术。术后第1天开始，对照组每天皮下注射生理盐水1 mL/(kg•次)，3次/d；其他3组均给予不同剂量的尼古丁溶液，每天皮下注射尼古丁剂量分别为2，4，8 mg/(kg•次)，3次/d。术后12周，通过生物力学测试、手触法检测和影像学评估分析尼古丁对脊柱后外侧横突间融合手术融合率的影响。　　结果与结论：①手触法检测和影像学评估结果：2 mg/(kg•次)的尼古丁对脊柱融合无明显影响，4，8 mg/(kg•次)的尼古丁阻碍了脊柱的融合，降低了融合率；②生物力学测试结果：3个尼古丁剂量组与对照组相比，差异均有显著性意义(P<0.01)；3个尼古丁剂量组的差异均有显著性意义(P<0.01)；4 mg/(kg•次)尼古丁组和8 mg/(kg•次)尼古丁组的差异无显著性意义(P>0.05)；说明所有剂量的尼古丁均影响了骨痂形成，降低了融合率，并且随剂量的增加，融合率明显下降；③结果提示，所有剂量的尼古丁均可降低脊柱融合率，而且尼古丁对脊柱融合的影响具有剂量依赖性。%BACKGROUND:Smoking affects blood supply around the graft area, ultimately affecting spinal fusion. Few studies reported the effects of different doses of nicotine on spinal fusion. OBJECTIVE:To evaluate nicotine effects on rabbit model of spinal fusion, and to clarify the correlation between the dose of nicotine and spinal fusion rate. METHODS:Sixty healthy adult white rabbits aged 6-8 months were selected and randomly divided into four groups, with 15 rabbits in each group. Rabbits in the four groups received L5/6 posterior lumbar intertransverse fusion under intramuscular anesthesia. On day 1 after surgery, rabbits in the control group were subcutaneously injected with physiological saline 1 mL/kg, three times a day. Rabbits in other groups received different doses of nicotine solution:2, 4, 8 mg/kg through subcutaneous injection, three times a day. 12 weeks after surgery, effects of nicotine on the fusion rate of posterolateral lumbar interbody fusion surgery were determined by biomechanical testing, hand touch detection and imaging. RESULTS AND CONCLUSION:(1) Hand touch detection and imaging:2 mg/kg nicotine did not have significant effect on spinal fusion. 4 and 8 mg/kg nicotine blocked spinal fusion and decreased fusion rate. (2) Biomechanical testing:Significant differences were detected between nicotine groups and control group (P<0.01). Significant differences were detectable among the three nicotine groups (P<0.01). No significant difference was determined between 4 mg/kg nicotine and 8 mg/kg nicotine groups (P>0.05). Al doses of nicotine affected cal us formation, reduced fusion rate;moreover, with the increased dose, the fusion rate obviously diminished. (3) These findings concluded that al doses of nicotine could decrease spinal fusion. Moreover, the effect of nicotine on spinal fusion was dose-dependent.