摘要
目的:制作兔小腿骨筋膜间隔综合征动物模型,动态观察其血液生化指标变化,分析这些指标变化在间隔综合征早期诊断及病情评估中的作用。方法:实验于2006-06/08在南京医科大学附属南京第一医院动物实验室完成。取15只新西兰兔,用止血带紧密包扎一侧小腿8h后松开,制作间隔综合征动物模型。在实验前以及松开止血带后2,12,24,48,96h、1周和2周动态检测血浆磷酸肌酸激酶、乳酸脱氢酶、谷草转氨酶、超氧化物歧化酶活性和丙二醛浓度,同时采用Whiteside法监测小腿胫前间室内压。在松开止血带后24h由耳缘静脉注射85MBq99Tcm-PYP行SPECT静态及延迟显像,以双侧小腿为感兴趣区,半定量分析伤侧小腿与健侧小腿放射性核素摄取比值(T/NT)。实验结束后取伤侧小腿胫前肌肉和腓深神经标本行病理检查。结果:15只兔进入结果分析。①松开止血带2h后,血浆中磷酸肌酸激酶、乳酸脱氢酶、谷草转氨酶活性和丙二醛浓度即急剧升高,分别为实验前的20,6,6,2倍,24h后达到峰值,分别为实验前的37,13,12和3倍;松开止血带2h超氧化物歧化酶活性急剧降至实验前的一半,至24h为实验前1/3。至松开止血带1周,丙二醛浓度和超氧化物歧化酶活性才恢复至实验前水平,而其他指标与实验前比较仍有显著差异(P<0.05)。②松开止血带后,伤侧小腿迅速肿胀,在12h后筋膜室内压已达到4.0kPa以上,并在24h后达到峰值[(7.3±0.4)kPa],此时静态和动态显像均显示伤侧小腿吸收核素量明显大于健侧肢体,比值约为2倍左右,显示伤侧小腿静脉回流明显受阻。③病理显示肌肉和神经标本明显坏死呈不可逆性变化。结论:成功制作了兔小腿骨筋膜间隔综合征动物模型,血浆磷酸肌酸激酶、乳酸脱氢酶、谷草转氨酶、超氧化物歧化酶活性和丙二醛浓度的变化能客观反映病情严重程度。动态、连续监测这些指标能为早期诊断及评估间隔综合征病情提供帮助。
AIM： To establish models of osteo-fascial compartment syndrome （OFCS） in rabbits, and conduct dynamic study on the changes in blood biochemical indicators, and analyze their effects in early diagnosis and evaluation of OFCS.
METHODS： The experiment was completed at the Animal Laboratory of Nanjing First Hospital Affiliated to Nanjing Medical University from June to August 2006. Fifteen Zelanian rabbits were established into OFCS models by strangulating one side lower leg of each rabbit with a tourniquet for eight hours and then loosed. The levels of serum phosphocreatine kinase, lactic dehydrogenase （LDH）, aspartate aminotransferase （AST）, malondialdehyde （MDA） and superoxidedismutase （SOD） were monitored dynamically before the experiment and 2, 12, 24, 48, 96 hours as well as 1 and 2 weeks after loosing the tourniquet. Meanwhile, intracompartment pressure （ICP） was monitored by using Whiteside method. 24 hours later, 85 MBq ^99Tc^m-PYP was injected through ear edge venous, and then quiet and delayed imaging was displayed using SPECT. Both sides of the lower leg were considered the region of interesting. The radioactive nuclide uptaking ratio of pressed leg and normal leg （T/NT） was semiquantitatively analyzed. The anterior tibial muscle and deep fibular nerve preparations were pathologically inspected after the experiment.
RESULTS： A total of 15 rabbits were involved in the analysis of results. （1） Two hours later after loosing the tourniquet, the contents of serum phosphocreatine kinase, LDH, AST and MDA increased dramatically, which were 20, 6, 6 and 2 times as those before the experiment, and they all peaked at the 24^th hour, which were 37, 13, 12 and 3 times as those before the experiment. The activity of SOD decreased to half of that before the experiment and decreased to 1/3 at the 24^th hour as that before the experiment. One week after loosing the tourniquet, the concentrations of MOD and SOD recovered to the levels before experiment, whereas other indicators were significantly different from those before the experiment （P 〈 0.05）. （2） After loosing the tourniquet, the injured legs began to swell quickly, and ICP increased to 4.0 kPa at 12 hours later, and peaked at the 24^th hour [（7.3±0.4） kPa]. Meanwhile, T/NT in quiet and delayed imaging showed that the venous return was locked in pressed legs. （3） Pathological changes of muscle and nerve were irreversible.
CONCLUSION： Rabbit lower leg models of OFCS are successfully established, and the changes in phosphocreatine kinase, LDH, AST, SOD and MDA objectively reflect the progression of disease. Dynamic and continuous monitoring of biochemical indicators can provide assistant for early diagnosis of compartment syndrome and evaluating pathogenetic condition.
出处
《中国组织工程研究与临床康复》
CAS
CSCD
北大核心
2007年第16期3093-3096,共4页
Journal of Clinical Rehabilitative Tissue Engineering Research
基金
南京市重大科技项目基金资助项目(ZKX05007)~~
