远隔缺血后适应对老龄大鼠骨折愈合的影响及研究

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摘要目的明确远隔缺血后适应是否能够提高老龄大鼠体内骨折愈合过程中各因子的表达，进而促进骨折愈合。方法选取64只老龄大鼠(18~20月龄)，制作胫骨干闭合骨折模型后随机分为远隔缺血后适应组(32只)和对照组(32只)，应用大鼠肢体缺血适应仪对远隔缺血后适应组进行缺血后适应干预，对照组做空白对照。在骨折后第7、14、28、42天取材。然后通过Micro-CT、生物力学、qRT-PCR以及Westenblot等方法检测两组老年大鼠骨折侧骨组织的结构、骨强度、成骨标志物以及低氧相关因子的变化情况。结果在术后第14、28天和42天远隔缺血后适应组的骨痂体积以及灰度值明显高于对照组(P＜0.01)；远隔缺血后适应组大鼠胫骨标本所能承受的最大负荷和强度相对于对照组有明显优势(P＜0.05)；在术后第7、14、28天时，远隔缺血后适应组低氧诱导因子1α(hypoxia inducible factor-1α，HIF-1α)的蛋白表达含量明显高于对照组(P＜0.01)。结论骨折后短期的适宜频率的远隔缺血后适应可以促进老龄大鼠胫骨骨折愈合，其促进作用是通过诱导成骨以及促进血管生成两方面实现的。

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关键词 ：骨折愈合, 远隔缺血后适应, 低氧诱导因子

Abstract：Objective To clarify whether remote ischemic post-conditioning can promote the expression of various factors in the process of fracture healing，and thus promote fracture healing.Methods 64 aged rats(18~20 months old)were randomly divided into two groups.The ischemic postconditioning group was treated with limb remote ischemic post-conditioning and the control group was blank.At 7，14，28，42 days after fracture，rats were sacrificed subsequent.Micro-computed tomography was performed to measure healing of the bone tissue and biomechanical testing was used to test mechanical strength.In addition，the two primary angiogenic mediators，HIF-1α and vascular endothelial growth factor，as well as the osteoblast markers runt-related transcription factor 2，alkaline phosphatase and osteocalcin，were determined at the mRNA and protein levels by reverse transcription-quantitative polymerase chain reaction and western blot analysis.Results The callus volume and gray value of the hypoxia treatment group were significantly higher than those in the control group at 14，28 days and 42 days after operation(P＜0.01).The maximal force，stiffness and work to fracture of the tibial specimens in the hypoxic treatment group were significantly higher than those in the control group(P＜0.05).The expression of HIF-1α protein was significantly higher than that of the control group(P＜0.01).The protein expression levels of ALP，OCN and Runx2 in the remote ischemic post-conditioning group were significantly higher than those in the control group at three time points.Conclusion Fracture after short-term appropriate frequency of ischemic post-ischemic adaptation can promote aged rat tibial fracture healing，its role is to promote osteogenesis and promote angiogenesis in two ways to achieve.

Key words： fracture healing remote ischemic post-conditioning hypoxia induction factor

基金资助:北京市优秀人才骨干项目(2015000020124G116)

通讯作者: 曹光磊

作者简介: 周萌(1989－ )，男，医师，北京积水潭医院骨科，100035。

引用本文:

周萌 1，黄江 2，安帅 2，曹光磊 2*，沈惠良 2. 远隔缺血后适应对老龄大鼠骨折愈合的影响及研究[J]. 实用骨科杂志, 2018, 24(8): 715-720.
Zhou Meng 1，Huang Jiang 2，An Shuai 2，et al. The Effects of Remote Ischemic Post-conditioning on Fracture Healing in Aged Rats. sygkzz, 2018, 24(8): 715-720.

链接本文:

http://www.sygkzz.com/CN/ 或 http://www.sygkzz.com/CN/Y2018/V24/I8/715

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