中国组织工程研究
中國組織工程研究
중국조직공정연구
Journal of Clinical Rehabilitative Tissue Engineering Research
2013年
35期
6364-6374
,共11页
张天浩%董英海%俞思明%张超%姚兵
張天浩%董英海%俞思明%張超%姚兵
장천호%동영해%유사명%장초%요병
骨关节植入物%骨与关节临床实践%止痛药%骨质疏松性骨折%骨折愈合%动物实验%临床观察%内固定%盐酸曲马多%中枢性镇痛药%双氯酚酸钠%非类固醇药物
骨關節植入物%骨與關節臨床實踐%止痛藥%骨質疏鬆性骨摺%骨摺愈閤%動物實驗%臨床觀察%內固定%鹽痠麯馬多%中樞性鎮痛藥%雙氯酚痠鈉%非類固醇藥物
골관절식입물%골여관절림상실천%지통약%골질소송성골절%골절유합%동물실험%림상관찰%내고정%염산곡마다%중추성진통약%쌍록분산납%비류고순약물
bone and joint implants%clinical practice of bone and joint implants%painkil ers%osteoporotic fracture%fracture healing%animal experiments%clinical observation%fixation%tramadol hydrochloride%central analgesic drugs%diclofenac sodium%non-steroidal drugs
背景：研究表明，非类固醇药物在镇痛的同时还可以对骨折愈合产生不利影响。然而，非类固醇抗炎药对骨质疏松性骨折愈合是否有影响国内外报道较少。
<br> 目的：分别选择常用的非类固醇抗炎药双氯酚酸钠和中枢性镇痛药盐酸曲马多进行动物实验和临床观察，探讨2种药物对骨质疏松性骨折愈合的影响。
<br> 方法：①动物实验：雌性SD大鼠予双侧卵巢切除后喂养3个月建立骨质疏松模型，之后行股骨中段骨折后髓内钉内固定，灌胃给药，1次/d，用药时间均为6周。随机分为4组，对照组骨折后灌注生理盐水；盐酸曲马多组骨折后灌注盐酸曲马多；双氯酚酸钠1组建立骨质疏松模型后、骨折之前灌注双氯酚酸钠；双氯酚酸钠2组骨折后灌注双氯酚酸钠。术后不同时间分别行X射线摄片及灰度值测定。②临床观察：21例骨质疏松性胸腰椎压缩性骨折患者随机分为3组，对照组6例，盐酸曲马多组(100 mg/d)7例，双氯酚酸钠组(75 mg/d)8例。各组予相同抗骨质疏松药物治疗并令回家卧板床修养，盐酸曲马多组、双氯酚酸钠组予1个月药物治疗。记录3组患者的疼痛目测类比评分、临床症状消失时间、骨折椎体高度变化及L3椎体骨密度值变化。
<br> 结果与结论：①动物实验结果：在第2，3周双氯酚酸钠1，2组大鼠的骨折端新生骨痂数量和密度低于其他2组，第2周X射线灰度值低于其他2组(P<0.01)。第4，6周双氯酚酸钠2组的骨折端新生骨痂数量和密度值低于其他3组，X射线灰度低于其他3组(P<0.05)。②临床观察结果：在首诊日、1、2、3周盐酸曲马多组、双氯酚酸钠组患者的目测类比评分低于对照组(P <0.01)。各组临床症状消失时间差异无显著性意义(P>0.05)。治疗后第1个月双氯芬酸钠组患者受压椎体平均灰度值及L3椎体骨密度均低于对照组(P<0.05)。提示非类固醇抗炎药会延缓骨质疏松性骨折愈合时间，降低愈合强度，且主要影响骨质疏松性骨折的早期愈合。建议急性期骨质疏松性骨折患者不宜首选非类固醇抗炎药，但可选用中枢性镇痛药，如盐酸曲马多等。
揹景：研究錶明，非類固醇藥物在鎮痛的同時還可以對骨摺愈閤產生不利影響。然而，非類固醇抗炎藥對骨質疏鬆性骨摺愈閤是否有影響國內外報道較少。
<br> 目的：分彆選擇常用的非類固醇抗炎藥雙氯酚痠鈉和中樞性鎮痛藥鹽痠麯馬多進行動物實驗和臨床觀察，探討2種藥物對骨質疏鬆性骨摺愈閤的影響。
<br> 方法：①動物實驗：雌性SD大鼠予雙側卵巢切除後餵養3箇月建立骨質疏鬆模型，之後行股骨中段骨摺後髓內釘內固定，灌胃給藥，1次/d，用藥時間均為6週。隨機分為4組，對照組骨摺後灌註生理鹽水；鹽痠麯馬多組骨摺後灌註鹽痠麯馬多；雙氯酚痠鈉1組建立骨質疏鬆模型後、骨摺之前灌註雙氯酚痠鈉；雙氯酚痠鈉2組骨摺後灌註雙氯酚痠鈉。術後不同時間分彆行X射線攝片及灰度值測定。②臨床觀察：21例骨質疏鬆性胸腰椎壓縮性骨摺患者隨機分為3組，對照組6例，鹽痠麯馬多組(100 mg/d)7例，雙氯酚痠鈉組(75 mg/d)8例。各組予相同抗骨質疏鬆藥物治療併令迴傢臥闆床脩養，鹽痠麯馬多組、雙氯酚痠鈉組予1箇月藥物治療。記錄3組患者的疼痛目測類比評分、臨床癥狀消失時間、骨摺椎體高度變化及L3椎體骨密度值變化。
<br> 結果與結論：①動物實驗結果：在第2，3週雙氯酚痠鈉1，2組大鼠的骨摺耑新生骨痂數量和密度低于其他2組，第2週X射線灰度值低于其他2組(P<0.01)。第4，6週雙氯酚痠鈉2組的骨摺耑新生骨痂數量和密度值低于其他3組，X射線灰度低于其他3組(P<0.05)。②臨床觀察結果：在首診日、1、2、3週鹽痠麯馬多組、雙氯酚痠鈉組患者的目測類比評分低于對照組(P <0.01)。各組臨床癥狀消失時間差異無顯著性意義(P>0.05)。治療後第1箇月雙氯芬痠鈉組患者受壓椎體平均灰度值及L3椎體骨密度均低于對照組(P<0.05)。提示非類固醇抗炎藥會延緩骨質疏鬆性骨摺愈閤時間，降低愈閤彊度，且主要影響骨質疏鬆性骨摺的早期愈閤。建議急性期骨質疏鬆性骨摺患者不宜首選非類固醇抗炎藥，但可選用中樞性鎮痛藥，如鹽痠麯馬多等。
배경：연구표명，비류고순약물재진통적동시환가이대골절유합산생불리영향。연이，비류고순항염약대골질소송성골절유합시부유영향국내외보도교소。
<br> 목적：분별선택상용적비류고순항염약쌍록분산납화중추성진통약염산곡마다진행동물실험화림상관찰，탐토2충약물대골질소송성골절유합적영향。
<br> 방법：①동물실험：자성SD대서여쌍측란소절제후위양3개월건립골질소송모형，지후행고골중단골절후수내정내고정，관위급약，1차/d，용약시간균위6주。수궤분위4조，대조조골절후관주생리염수；염산곡마다조골절후관주염산곡마다；쌍록분산납1조건립골질소송모형후、골절지전관주쌍록분산납；쌍록분산납2조골절후관주쌍록분산납。술후불동시간분별행X사선섭편급회도치측정。②림상관찰：21례골질소송성흉요추압축성골절환자수궤분위3조，대조조6례，염산곡마다조(100 mg/d)7례，쌍록분산납조(75 mg/d)8례。각조여상동항골질소송약물치료병령회가와판상수양，염산곡마다조、쌍록분산납조여1개월약물치료。기록3조환자적동통목측류비평분、림상증상소실시간、골절추체고도변화급L3추체골밀도치변화。
<br> 결과여결론：①동물실험결과：재제2，3주쌍록분산납1，2조대서적골절단신생골가수량화밀도저우기타2조，제2주X사선회도치저우기타2조(P<0.01)。제4，6주쌍록분산납2조적골절단신생골가수량화밀도치저우기타3조，X사선회도저우기타3조(P<0.05)。②림상관찰결과：재수진일、1、2、3주염산곡마다조、쌍록분산납조환자적목측류비평분저우대조조(P <0.01)。각조림상증상소실시간차이무현저성의의(P>0.05)。치료후제1개월쌍록분산납조환자수압추체평균회도치급L3추체골밀도균저우대조조(P<0.05)。제시비류고순항염약회연완골질소송성골절유합시간，강저유합강도，차주요영향골질소송성골절적조기유합。건의급성기골질소송성골절환자불의수선비류고순항염약，단가선용중추성진통약，여염산곡마다등。
BACKGROUND:Studies have shown that non-steroidal drugs have analgesic effect and can also adversely
<br> affect the fracture healing. However, the effect of non-steroidal anti-inflammatory drugs on osteoporotic fracture healing is reported less at home and abroad.
<br> OBJECTIVE:To perform the animal experiment and clinical observation with the commonly used non-steroidal anti-inflammatory drug diclofenac sodium and central inflammatory drug tramadol hydrochloride, in order to
<br> investigate the effect of pain-kil er on the union of osteoporotic fracture.
<br> METHODS: Animal experiment: female rats received double side castrations and were fed for three months to make osteoporosis model. Then the rats received intramedul ary nail fixation for the treatment of middle femur
<br> fracture. Al drugs were applied by intragastric administration, once per day, and lasted for 6 weeks. The animals were randomly divided into four groups. The control group was injected with normal saline after fracture;tramadol
<br> hydrochloride group was injected with tramadol hydrochloride after fracture;diclofenac sodium A group was injected with diclofenac sodium before fracture and after establishment of osteoporosis model;diclofenac sodium B group was
<br> injected with diclofenac sodium after fracture. Gray value was measured by X-ray film at different time points after operation. Clinical observation:21 patients with osteoporotic thoracolumbar vertebral compression fractures were
<br> randomly divided into three groups:control group (n=6), tramadol hydrochloride group (n=7, 100 mg/d) and diclofenac
<br> sodium group (n=8, 75 mg/d). Al patients were treated with anti-osteoporosis drugs in the same dose and required to lie on broad bed. The patients in the tramadol hydrochloride group and diclofenac sodium group received drug treatment for 1 month. The visual analogue scale score, clinical symptoms disappeared time, vertebral height variation, and L 3
<br> vertebral bone mineral density changes were recorded.
<br> RESULTS AND CONCLUSION:Animal experiment results:the quantity and density of newly formed bone cal us and
<br> the gray value of fracture site on X-ray film in the diclofenac sodium A and B groups were lower than those in the control group and the tramadol hydrochloride group at 2, 3, 4 and 6 weeks after operation (P<0.01). The quantity and density of newly formed bone cal us and the gray value of fracture site on X-ray film in the diclofenac sodium B group were lower than those in the other three groups at 4 and 6 weeks after operation (P<0.05). Clinical observation results:the visual analogue scale score of the patients in the tramadol hydrochloride group and diclofenac sodium group at the first day,1, 2 and 3 weeks after operation was lower than that in the control group (P<0.01). There was no statistical y significant
<br> difference in disappeared time of clinical symptoms between groups (P>0.05). The average gray value of vertebral
<br> compression and L 3 vertebral bone mineral density in the diclofenac sodium group at 1 month after treatment were lower than those in the control group (P<0.05). The non-steroidal anti-inflammatory drugs can delay the osteoporotic fracture healing and degrade the intensity of fracture healing, and mainly affect early osteoporotic fracture healing. So,
<br> non-steroidal anti-inflammatory drugs should not be the first choice for acute osteoporotic fracture. Central analgesic drugs should be the first choice, such as tramadol hydrochloride.
