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Received:October 25, 2019 Published Online:July 20, 2020
Received:October 25, 2019 Published Online:July 20, 2020
中文摘要: 目的 探讨超声造影(CEUS)技术在评估移植骨早期再生血管化中的应用价值。
方法 25只SD级雄性大鼠,于左侧后肢近股骨头处肌间隙内植入重组人骨形态蛋白2/磷酸钙骨水泥(rhBMP-2/CPC)复合材料(rhBMP-2组),右侧后肢同水平肌间隙内植入普通CPC(普通组),建立大鼠肌内异位成骨模型,分别于建模后3、7、14、21、28 d对各5只大鼠进行超声检查及病理学检测,通过二维超声、CEUS评估两组骨生成及新生血管形成情况,并与病理学结果对照。
结果 病理学检查示,建模后随时间推移,两组移植骨内均可见不同程度的新生血管自外向内逐渐增加,rhBMP-2组新生血管百分数建模后14 d达最大值,普通组21 d达最大值,28 d时 rhBMP-2组外周新生骨明显较普通组成熟。CEUS检测时间-强度曲线分析结果示,建模后21、28 d rhBMP-2组到达时间(AT)较普通组提早;建模后7、14、21、28 d rhBMP-2组达峰强度(PI)较普通组增强,达峰时间(TTP)较普通组提早,同一时点两组间差异有统计学意义(P<0.05,P<0.01)。rhBMP-2组的PI 与新生血管百分数呈显著正相关(r=0.888,P<0.05),AT、TTP 与时间呈显著负相关(r=-0.839、-0.902,P均<0.05)。CEUS评估结果与病理学结果一致。
结论 CEUS技术可实时动态检测早期骨再生的血管化及不同移植材料间的差异性,可为临床早期无创评估不同移植材料内早期骨再生的血管化情况提供有价值的诊断依据。
Abstract:Obective To explore the clinical value of contrast-enhanced ultrasound(CEUS)in evaluating the early vascularization of bone grafts.
Methods Ectopic bone formation models were established in 25 male SD rats and implanted with recombinant human bone morpho genetic protein-2 (rhBMP-2) and calcium phosphate cement(CPC) composite material in the left posterior leg proximal femoral head muscle space (rhBMP-2 group) and CPC grafting material in the right posterior leg proximal femoral head muscle space(common group).At 3-,7-,14-,21- and 28-day after operation,ultrasound examination were carried out,and samples were taken in 5 rats at each time point.
Results Pathological examination showed that the number of neovascularization increased with time gradually from the outside to the inside after modeling.The percentage of new blood vessels reached the maximum on the 14-day after modeling in rhBMP-2 group and on the 21-day in common group.On the 28-day,the peripheral new bone formation was more mature in rhBMP-2 group than that in common group.The time-intensity-curve(TIC) analysis of CEUS showed that arrival time(AT)and time to peak(TTP)in rhBMP-2 group were earlier than those in common group on the 21- and 28-day after modeling,peak intensity(PI)in rhBMP-2 group was stronger than that in common group on the 7-,14-,21- and 28-day after modeling,and there were statistical differences in them at the same time point between two groups(P<0.05,P<0.01).In rhBMP-2 group,PI was positively correlated with the percentage of neovascularization (r=0.888,P<0.05);AT and TTP were negatively correlated with time (r=-0.839,-0.902,all P<0.05).In evaluating the early vascularization of bone grafts,CEUS results are consistent with pathological diagnosis.
Conclusion Neovascularization of early bone regeneration can be dynamically displayed with CEUS which can provide a valuable diagnostic evidence for early non-invasive evaluation of vascularization of early bone regeneration with different bone grafting materials.
keywords: Contrast-enhanced ultrasound Vascularization Calcium phosphate cement Recombinant human bone morphogenetic protein-2 Rats Ectopic osteogenesis
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基金项目:上海市嘉定区农业和社会事业科研项目(JDKW-2017-W14);上海市嘉定区卫生和计划生育委员会科研课题项目(2018-QN-06)
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