Platelet-Rich Plasma Combined With Hydroxyapatite for Lumbar Interbody Fusion Promoted Bone Formation and Decreased an Inflammatory Pain Neuropeptide in Rats
Platelet-Rich Plasma Combined With Hydroxyapatite for Lumbar Interbody Fusion Promoted Bone Formation and Decreased an Inflammatory Pain Neuropeptide in Rats
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DOI：
10.1097/brs.0b013e31825567b7
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发表时间：
2012-09-15
期刊：
影响因子：
3
通讯作者：
Ohtori, Seiji
中科院分区：
文献类型：
--
作者：
Kamoda, Hiroto;Yamashita, Masaomi;Ohtori, Seiji
研究设计。一项使用大鼠腰椎间融合术模型的前瞻性介入试验。目的：探讨富含血小板血浆(PRP)应用于腰椎间融合术的潜在疗效。PRP是一种自体产品，含有少量血浆中的高浓度血小板，具有骨诱导作用。羟基磷灰石具有骨传导能力，已与自体骨复合用于脊柱融合。然而，将PRP与HA用于脊柱融合的报道很少。本研究旨在探讨PRP与HA在脊柱椎体间融合术中的应用效果，同时观察支配脊盘的背根节(DRG)神经元中炎性神经肽--降钙素基因相关肽(CGRP)的免疫反应变化。本研究共选用35只SD大鼠。21只大鼠进行椎间融合实验，7只大鼠作为免疫染色对照，7只大鼠作为供血者制作PRP。21只大鼠分别用HA+PRP(n=7)、HA+低血小板血浆(n=7)或HA+生理盐水(n=7)进行L5-L6椎体间融合。同时，将荧光金显像剂应用于椎间隙，检测支配椎间盘的DRG神经元。取L5~L6腰椎X线片，对腰椎背根神经节进行CGRP免疫组织化学染色。比较不同组间的骨愈合率和支配椎间盘的CGRP免疫反应DRG神经元的变化。PRP+HA组L5~L6腰椎间盘全部融合(7/7)，而低血小板血浆组仅1例融合(1/7)，单纯HA组无1例融合(0/7)，差异有统计学意义。免疫组织化学分析显示，骨不连组L5~L6节段有CGRP阳性神经元分布，较愈合组明显增多。我们的研究表明，使用PRP和HA有利于脊柱融合。这种结合可能促进骨愈合，并减少支配椎间盘的感觉神经元中的炎性神经肽。
Study Design. A prospective interventional trial, using a rat model of lumbar interbody fusion.Objective. To examine the potential efficacy of platelet-rich plasma (PRP) for lumbar interbody fusion, using hydroxyapatite (HA).Summary of Background Data. PRP is an autologous product containing a high concentration of platelets in a small volume of plasma and has osteoinductive effects. HA has osteoconductive ability and has been used in combination with autogenous bone for spine fusion. However, reports using PRP with HA for spine fusion are very few. The purpose of this study was to examine the efficacy of PRP with HA for spinal interbody fusion and at the same time to estimate the change in immunoreactivity of the inflammatory neuropeptide, calcitonin gene-related peptide (CGRP), in dorsal root ganglion (DRG) neurons innervating spinal discs.Methods. A total of 35 Sprague-Dawley rats were used in this study. Twenty-one rats were used for conducting interbody fusion experiments, 7 rats were used as immunostaining controls, and 7 other rats were used as blood donors for making PRP. L5-L6 interbody fusion was performed on 21 rats using HA + PRP (n = 7), HA + platelet-poor plasma (n = 7), or HA + saline (n = 7). Simultaneously, Fluoro-Gold neurotracer was applied to the intervertebral space to detect DRG neurons innervating the discs. L5-L6 lumbar radiographs were obtained and lumbar DRGs were immunostained for CGRP. The rate of bone union and the change in CGRP immunoreactive DRG neurons innervating the discs were evaluated and compared among groups.Results. All L5-L6 lumbar discs were fused in the PRP + HA group (fused 7/total 7), whereas only 1 case was fused in the platelet-poor plasma group (1 of 7) and no cases in the HA-only group (0 of 7), which was a significant difference. Upon immunohistochemical analysis, CGRP-positive neurons innervated L5-L6 intervertebral discs in nonunion cases, and these were significantly increased compared with those in union cases.Conclusion. Our study suggests that using PRP with HA was beneficial for spine fusion. This combination may promote bone union and also decrease inflammatory neuropeptide in sensory neurons innervating the discs.