THE OSTEOGENIC RESPONSE TO DISTANT SKELETAL INJURY
THE OSTEOGENIC RESPONSE TO DISTANT SKELETAL INJURY
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DOI：
10.2106/00004623-199072090-00016
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发表时间：
1990-10-01
影响因子：
5.3
通讯作者：
VIGORITA, VJ
中科院分区：
文献类型：
--
作者：
EINHORN, TA;SIMON, G;VIGORITA, VJ
我们测试了这样一个假设：当骨骼的一块骨头受伤时，其他骨头会产生成骨反应。虽然以前也观察到类似或相关的现象，但本研究的目的是确定这种反应是否可重复，从其强度和持续时间方面对其进行表征，并显示其与所受伤害的类型之间的关系。为了获得这一信息，我们使用了一个模型，将髓内钉植入股骨，随后产生标准的闭合性骨折。成骨反应采用组织形态测定法测定。84只9周大的雄性Sprague-Dawley大鼠被分成7组，每组12只。第1组和第2组为未造成损伤的对照动物。iii组大鼠进行右股骨髁间切迹和梨状窝皮质钻孔，不进行髓内钉。IV组至VII组各有一半患者仅行髓内钉治疗，另一半患者行髓内钉治疗并形成闭合性骨干横向骨折。用两种不同的荧光标记，测量了所有动物左胫骨和右胫骨的矿物附着率。每组的标记时间不同，目的是确定何时出现峰值反应，持续多长时间，以及实验过程中的年龄是否影响反应。股骨髓内钉的引入导致所有动物胫骨中矿物质堆积率的显著和可重复的增加。这种反应的开始是迅速的，峰值刺激的幅度是对照动物的350%，并且在三周内逐渐恢复到基线水平。没有髓内钉的皮质损伤不会产生这种反应，并且已经接受髓内钉的股骨骨折也不会改变这种反应。在此期间，矿物堆积率的差异与年龄无关。由于所研究的胫骨骨吸收没有发生可观察到的变化，因此矿物质附着率的增加被解释为成骨反应。发现这种反应发生在远离损伤的未损伤骨骼中，表明它可能是由循环成骨因子产生的。髓内钉植入骨骼的一根骨可能与刺激其他骨的成骨有关。这表明，在骨科研究中使用的模型中，对一块骨头所做的事情可能会影响另一块作为对照的骨头的能力。由于这些发现与循环成骨因子的存在相一致，因此以这种方式受伤的骨可能会释放出一种物质，在愈合期间影响骨的代谢。
We tested the hypothesis that when one bone of the skeleton is injured, others experience an osteogenic response. Although similar or related phenomena have been observed previously, the purposes of the study were to determine if this response was reproducible, to characterize it in terms of its magnitude and duration, and to show how it is related to the type of injury sustained. To obtain this information, a model was used in which an intramedullary nail was implanted in the femur and a standard closed fracture was subsequently produced. The osteogenic response was measured by histomorphometry. Eighty-four nine-week-old male Sprague-Dawley rats were divided into seven groups of twelve animals each. Groups I and II consisted of control animals in which no injury was produced. In Group-III rats, cortical drilling of the intercondylar notch and piriformis fossa of the right femur was performed, without intramedullary nailing. In Groups IV through VII, half of each group received intramedullary nails only, and in the other half intramedullary nailing was done and a closed transverse diaphyseal fracture was produced. With two different fluorochrome labels, rates of mineral apposition were measured in the left and right tibiae of all animals. The labeling periods differed in each group and were designed to determine when the peak response occurred, how long it lasted, and whether aging during the course of the experiment affected the response. The introduction of an intramedullary femoral nail resulted in a significant and reproducible increase in the rate of mineral apposition in both tibiae of all animals studied. The onset of this response was rapid, the magnitude of peak stimulation was as much as 350 per cent of the rate for the control animals, and the gradual return to baseline levels occurred over a period of three weeks. Injury to the cortex without intramedullary nailing did not produce this response, and the addition of a fracture to a femur that had already been subjected to intramedullary nailing did not alter the response. The differences in rates of mineral apposition during this period were not related to aging. Since no observable changes in resorption of bone occurred in any of the tibiae that were studied, the increase in the rate of mineral apposition was interpreted as an osteogenic response. The finding that this response occurs in uninjured bones distant from the injury suggests that it may be produced by a circulating osteogenic factor. The implantation of an intramedullary nail into one bone of the skeleton may be associated with the stimulation of osteogenesis in others. This suggests that, in models used in orthopaedic research, what is done to one bone could affect the ability of another bone to serve as a control. Since these findings are consistent with the existence of a circulating osteogenic factor, it is possible that bone injured in this way releases a substance that affects the metabolism of bone during the period of healing.