丙烯酸树脂骨水泥复合材料对软骨下骨诱发膝骨关节炎的影响

摘要

背景：丙烯酸树脂骨水泥植入人体发生硬化后其可抵抗78-93 MPa的强度，但骨水泥凝固过程中释放大量的热能，会杀死正常细胞导致周围组织坏死。目的：观察丙烯酸树脂骨水泥复合材料替代软骨下骨后诱发兔膝骨关节炎的特点。方法：将30只日本大耳白兔随机均分为5组，实验A、B、C、D组在刮除右侧膝关节胫骨平台内侧软骨下骨后，均植入聚甲基丙烯酸甲酯粉剂/羟基磷灰石复合材料，空白对照组仅暴露左侧膝关节胫骨平台内侧骨膜。实验组A、B、C、D组分别在软骨下骨刮除后3，6，9，12周处死动物，切取复合材料上方1.5 mm处的软骨下骨标本进行苏木精-伊红染色、基质金属蛋白酶表达分析，同时检测关节液中白细胞介素1β及肿瘤坏死因子α水水平。结果与结论：实验C组的Mankin骨关节炎分级高于空白对照组和实验A组(P<0.05)，实验组D的Mankin骨关节炎分级高于实验B组(P <0.05)。基质金属蛋白酶1的灰度值比较：空白对照组>实验A组>实验B组>实验C组>实验D组(P<0.05)。白细胞介素1β及肿瘤坏死因子α水平比较：实验D组>实验C组>实验B组>实验A组>空白对照组(P <0.05)。表明丙烯酸树脂骨水泥复合材料替代软骨下骨后能引发膝骨关节炎，并且会导致基质金属蛋白酶1及细胞因子水平的升高。%BACKGROUND:The hardened acrylic resin bone cement composite after implantation into human body can resist an intensity of 78-93 MPa. But a large amount of heat energy is released by bone cement during the process of solidification and it wil kil normal cel s, leading to peripheral tissue necrosis. OBJECTIVE:To investigate the characteristics of induced knee joint osteoarthritis after application of acrylic resin bone cement composite as a bone substitute for subchondral bone. METHODS:Thirty male Japanese big ear rabbits were randomly and equal y divided into four experimental groups (A, B, C, D) and a blank control group. After removal of subchondral bone on the right medial tibial plateau, polymethyl methacrylate powder/hydroxyapatite composite materials were implanted in rabbits in the experimental groups A, B, C, and D. Rabbits in the blank control group were only subjected to exposure of periosteum on the left medial tibial plateau. At 3, 6, 9 and 12 weeks after removal of subchondral bone, rabbits in the experimental groups A, B, C and D were sacrificed, and subchondral bone specimens were taken for hematoxylin-eosin staining and matrix metal oproteinase expression analysis. At the same time, interleukin-1βand tumor necrosis factor-ɑ levels in the synovial fluid were determined. RESULTS AND CONCLUSION:Mankin score in the experimental group C was significantly higher than in the blank control group and experimental group A (P<0.05). Mankin score in the experimental group D was significantly higher than in the experimental group B (P<0.05). The gray scale of matrix metal oproteinase-1 was highest in the blank control group, fol owed by experimental groups A, B, C, and the last in the experimental group D (P<0.05). Interleukin-1β and tumor necrosis factor-ɑ levels in the synovial fluid were highest in the experimental group D, fol owed by experimental groups C, B, A and the last in the blank control group (P<0.05). These findings suggest that acrylic resin bone cement composite as a bone substitute for subchondral bone induces knee joint osteoarthritis and leads to increases in matrix metal oproteinase-1 and tumor necrosis factor-ɑ levels in the synovial fluid.