髖關節發育不良髖臼BMP-2和Runx2 表達及微結構分析_《中國修復重建外科雜志》

作者：

劉瑞宇 , 王坤正 , 李永偉 , 柏傳毅 , 王春生 , 黨曉謙

西安交通大學醫學院第二附屬醫院骨科（西安，710004）;

關鍵詞：

髖關節發育不良髖臼假體松動 BMP-2 Runx2 微結構

DOI：

10.7507/1002-1892.20130039

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目的探討髖關節發育不良（developmental dysplasia of the hip，DDH）成人患者髖臼周圍骨質微結構變化及與骨質代謝相關生長因子BMP-2和Runx2（runt-related transcription factor 2）表達，分析該類患者人工全髖關節置換術后髖臼假體高松動率的原因。方法以2008年3月－9月8例行人工全髖關節置換術的DDH患者作為試驗組，男3例，女5例；年齡37～55歲；髖關節脫位程度按照Crowe等評價方法評定為30%～80%。以同期8例行人工髖關節表面置換術的股骨頭缺血性壞死（Ficat Ⅱ期）患者作為對照組，男3例，女5例；年齡36～55歲。取兩組患者髖臼臼頂內上方松質骨，采用實時定量PCR測量骨組織BMP-2和Runx2表達；Micro-CT掃描觀察其微結構，測量骨體積分數（bone volume/total volume，BV/TV），單位體積內骨小梁分支數目（connectivity density，Conn.Dens），骨小梁數目（trabecular number，Tb.N），骨小梁厚度（trabecular thickness，Tb.Th），骨小梁分離度（trabecular separation，Tb.Sp），結構模型指數（structure model index，SMI）。結果試驗組BMP-2及Runx2表達顯著低于對照組，差異均有統計學意義（P lt; 0.05）。Micro-CT掃描觀察示，試驗組骨小梁結構稀疏，單一骨小梁直徑較粗，對照組骨小梁結構致密，單一骨小梁直徑較細。試驗組BV/TV、Tb.N顯著低于對照組，SMI及Tb.Sp顯著高于對照組，差異均有統計學意義（P lt; 0.05）；兩組Conn.Dens及Tb.Th比較，差異無統計學意義（P gt; 0.05）。結論DDH患者的髖臼臼頂松質骨處于低代謝狀態，其微結構趨于骨質疏松化，較差的骨質狀況可能是DDH患者人工全髖關節置換術后髖臼假體高松動率的原因之一。

引用本文： 劉瑞宇,王坤正,李永偉,柏傳毅,王春生,黨曉謙. 髖關節發育不良髖臼BMP-2和Runx2 表達及微結構分析. 中國修復重建外科雜志, 2013, 27(2): 173-177. doi: 10.7507/1002-1892.20130039 復制

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2.	Kerner J, Huiskes R, van Lenthe GH, et al. Correlation between pre-operative periprosthetic bone density and post-operative bone loss in THA can be explained by strain-adaptive remodeling. J Biomech, 1999, 32(7): 695-703.
3.	Krischak GD, Wachter NJ, Zabel T, et al. Influence of preoperative mechanical bone quality and bone mineral density on aseptic loosening of total hip arthroplasty after seven years. Clin Biomech (Bristol, Avon), 2003, 18(10): 916-923.
4.	Jacobsen S, Rømer L, Søballe K. Degeneration in dysplastic hips. A computer tomography study. Skeletal Radiol, 2005, 34(12): 778-784.
5.	Crowe JF, Mani VJ, Ranawat CS. Total hip replacement in congenital dislocation and dysplasia of the hip. J Bone Joint Surg (Am), 1979, 61(1): 15-23.
6.	Clauss M, Ilchmann T, Zimmermann P, et al. Classification of acetabular changes in osteoarthritis: a histological and radiological analysis of 122 consecutive drill biopsies routinely taken during THA. Surg Radiol Anat, 2008, 30(7): 547-556.
7.	Kuliwaba JS, Fazzalari NL, Findlay DM. Stability of RNA isolated from human trabecular bone at post-mortem and surgery. Biochim Biophys Acta, 2005, 1740(1): 1-11.
8.	Fazzalari NL, Parkinson IH. Fractal properties of subchondral cancellous bone in severe osteoarthritis of the hip. J Bone Miner Res, 1997, 12(4): 632-640.
9.	Schnitzler CM, Mesquita JM, Wane L. Bone histomorphometry of the iliac crest, and spinal fracture prevalence in atrophic and hypertrophic osteoarthritis of the hip. Osteoporos Int, 1992, 2(4): 186-194.
10.	Amstutz HC, Ball ST, Le DuV MJ, et al. Resurfacing THA for patients younger than 50 years: results of 2- to 9-year follow up. Clin Orthop Relat Res, 2007, (460): 159-164.
11.	Onsten I, Akesson K, Obrant KJ. Micromotion of the acetabular component and periacetabular bone morphology. Clin Orthop Relat Res, 1995, (310): 103-110.
12.	Widmer KH, ZurXuh B, Morscher EW. Load transfer and fixation mode of press-fit acetabular sockets. J Arthroplasty, 2002, 17(7): 926-935.
13.	Kim YH, Kim JS. Histologic analysis of acetabular and proximal femoral bone in patients with osteonecrosis of the femoral head. J Bone Joint Surg (Am), 2004, 86-A(11): 2471-2474.
14.	Boden SD. The ABCs of BMPs. Orthop Nurs, 2005, 24(1): 49-52.
15.	Satija NK, Gurudutta GU, Sharma S, et al. Mesenchymal stem cells: molecular targets for tissue engineering. Stem Cells Dev, 2007, 16(1): 7-23.
16.	Karsenty G. Role of Cbfa1 in osteoblast differentiation and function. Semin Cell Dev Biol, 2000, 11(5): 343-346.
17.	Ducy P, Zhang R, Geoffroy V, et al. Osf2/Cbfa1: a transcriptional activator of osteoblast differentiation. Cell, 1997, 89(5): 747-754.
18.	Tsiridis E, Gamie Z, Conaghan PG. Biological options to enhance periprosthetic bone mass. Injury, 2007, 38(6): 704-713.
19.	Wilkinson JM, Eagleton AC, Stockley I, et al. Effect of pamidronate on bone turnover and implant migration after total hip arthroplasty: a randomized trial. J Orthop Res, 2005, 23(1): 1-8.
20.	Wilkinson JM, Stockley I, Peel NF, et al. Effect of pamidronate in preventing local bone loss after total hip arthroplasty: a randomized, double-blind, controlled trial. J Bone Miner Res, 2001, 16(3): 556-564.
21.	Friedl G, Radl R, Stihsen C, et al. The effect of a single infusion of zoledronic acid on early implant migration in total hip arthroplasty. A randomized, double-blind, controlled trial. J Bone Joint Surg (Am), 2009, 91(2): 274-281.

1. Arabmotlagh M, Hennigs T, Warzecha J, et al. Bone strength influences periprosthetic bone loss after hip arthroplasty. Clin Orthop Relat Res, 2005, (440): 178-183.
2. Kerner J, Huiskes R, van Lenthe GH, et al. Correlation between pre-operative periprosthetic bone density and post-operative bone loss in THA can be explained by strain-adaptive remodeling. J Biomech, 1999, 32(7): 695-703.
3. Krischak GD, Wachter NJ, Zabel T, et al. Influence of preoperative mechanical bone quality and bone mineral density on aseptic loosening of total hip arthroplasty after seven years. Clin Biomech (Bristol, Avon), 2003, 18(10): 916-923.
4. Jacobsen S, Rømer L, Søballe K. Degeneration in dysplastic hips. A computer tomography study. Skeletal Radiol, 2005, 34(12): 778-784.
5. Crowe JF, Mani VJ, Ranawat CS. Total hip replacement in congenital dislocation and dysplasia of the hip. J Bone Joint Surg (Am), 1979, 61(1): 15-23.
6. Clauss M, Ilchmann T, Zimmermann P, et al. Classification of acetabular changes in osteoarthritis: a histological and radiological analysis of 122 consecutive drill biopsies routinely taken during THA. Surg Radiol Anat, 2008, 30(7): 547-556.
7. Kuliwaba JS, Fazzalari NL, Findlay DM. Stability of RNA isolated from human trabecular bone at post-mortem and surgery. Biochim Biophys Acta, 2005, 1740(1): 1-11.
8. Fazzalari NL, Parkinson IH. Fractal properties of subchondral cancellous bone in severe osteoarthritis of the hip. J Bone Miner Res, 1997, 12(4): 632-640.
9. Schnitzler CM, Mesquita JM, Wane L. Bone histomorphometry of the iliac crest, and spinal fracture prevalence in atrophic and hypertrophic osteoarthritis of the hip. Osteoporos Int, 1992, 2(4): 186-194.
10. Amstutz HC, Ball ST, Le DuV MJ, et al. Resurfacing THA for patients younger than 50 years: results of 2- to 9-year follow up. Clin Orthop Relat Res, 2007, (460): 159-164.
11. Onsten I, Akesson K, Obrant KJ. Micromotion of the acetabular component and periacetabular bone morphology. Clin Orthop Relat Res, 1995, (310): 103-110.
12. Widmer KH, ZurXuh B, Morscher EW. Load transfer and fixation mode of press-fit acetabular sockets. J Arthroplasty, 2002, 17(7): 926-935.
13. Kim YH, Kim JS. Histologic analysis of acetabular and proximal femoral bone in patients with osteonecrosis of the femoral head. J Bone Joint Surg (Am), 2004, 86-A(11): 2471-2474.
14. Boden SD. The ABCs of BMPs. Orthop Nurs, 2005, 24(1): 49-52.
15. Satija NK, Gurudutta GU, Sharma S, et al. Mesenchymal stem cells: molecular targets for tissue engineering. Stem Cells Dev, 2007, 16(1): 7-23.
16. Karsenty G. Role of Cbfa1 in osteoblast differentiation and function. Semin Cell Dev Biol, 2000, 11(5): 343-346.
17. Ducy P, Zhang R, Geoffroy V, et al. Osf2/Cbfa1: a transcriptional activator of osteoblast differentiation. Cell, 1997, 89(5): 747-754.
18. Tsiridis E, Gamie Z, Conaghan PG. Biological options to enhance periprosthetic bone mass. Injury, 2007, 38(6): 704-713.
19. Wilkinson JM, Eagleton AC, Stockley I, et al. Effect of pamidronate on bone turnover and implant migration after total hip arthroplasty: a randomized trial. J Orthop Res, 2005, 23(1): 1-8.
20. Wilkinson JM, Stockley I, Peel NF, et al. Effect of pamidronate in preventing local bone loss after total hip arthroplasty: a randomized, double-blind, controlled trial. J Bone Miner Res, 2001, 16(3): 556-564.
21. Friedl G, Radl R, Stihsen C, et al. The effect of a single infusion of zoledronic acid on early implant migration in total hip arthroplasty. A randomized, double-blind, controlled trial. J Bone Joint Surg (Am), 2009, 91(2): 274-281.

《中國修復重建外科雜志》

髖關節發育不良髖臼BMP-2和Runx2 表達及微結構分析

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《中國修復重建外科雜志》

髖關節發育不良髖臼BMP-2和Runx2 表達及微結構分析

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