Methods A total of 48 healthy male New Zealand rabbits at the age of 4 months were selected. All the samples were transversely osteotomized at 0.5 cm below the right joint of the tibia and fibula to construct a rabbit tibia fracture model, steel plate internal fixation and polymeric plaster external fixation treatment were used. Forty-eight New Zealand rabbits were divided into the experimental group and the control group according to the random number table method, 24 in each group. On the 8th day after operation, the experimental group was applied external periodic compressive stress axial stress stimulation of 15 N, frequency 1 Hz, duration of slamming 5 s, interval 3 s, 30 min/time, 1 time/2 days; no stress stimulation was applied in the control group. At 2, 4, 6, and 8 weeks after operation, 6 New Zealand white rabbits from each of the 2 groups were selected in turn, and the fracture healing was checked by Lane-Sandhu X-ray film, and the Lane-Sandhu X-ray scores of the 2 groups were calculated and compared. At 2, 4, 6, and 8 weeks after the operation, 6 New Zealand rabbits were sacrificed in the 2 groups, and bone tissue samples were taken from the fracture area. The hematoxylin-eosin (HE) staining was used to observe and compare the composition and arrangement of new callus, bone marrow cavity, trabecular bone, and the proliferation of osteoblasts in the new bone tissue of the 2 groups. At 2, 4, 6, and 8 weeks after operation, 3 slices of each group of bone tissues were taken from each of the 2 groups, and the expression levels of core-binding factor α1 (Cbf-α1), osteocalcin, osteoprotegerin (OPG) and receptor activator of NF-κB ligand (RANKL) in the new callus of these 2 groups were compared by immunohistochemical staining, and the ratio of OPG/RANKL of the two groups at different time points were calculated and compared. Data were compared with independent sample t test.
Results (1) X-ray film showed that the fracture lines of the experimental group and the control group were clearly visible 2 weeks after the operation, and only a small amount of external callus grew. At 4 weeks after the operation, the fracture gap between the experimental group and the control group was significantly smaller, and the fracture line of the experimental group was lower than that of the control group. At 6 weeks after the operation, the fracture line of the experimental group was blurred, the outer callus grew densely, and there was a small amount of internal callus growth, which basically achieved bony union, the fracture line of the control group was blurred compared with 4 weeks after the operation, and the volume of the fractured callus was higher Less. At 8 weeks after the operation, the fracture line in the control group basically disappeared, the fracture line in the experimental group disappeared completely, and the amount of callus in the experimental group was still significantly more than that in the control group. At 4, 6 and 8 weeks after operation, the Lane-Sandhu scores of the experimental group were (5.17±1.07), (7.33±0.94), (9.17±1.07) points, which were higher than those of the control group [(3.50±0.76), (5.83±1.07), (7.33±1.25) points], the differences were statistically significant (t=2.84, 2.36, 2.50; P= 0.02, 0.04, 0.03). (2) HE staining observation showed that the experimental group had more osteoblasts than the control group at 2 weeks after the operation; at 4, 6, 8 weeks after the operation, the bone marrow cavity and trabecular bone tissue were formed in the experimental group earlier than the control group, and the bone tissue matured earlier than the control group. (3) Immunohistochemical staining observations showed: ① the expression levels of Cbf-α1 in the experimental group and the control group were both low at 2 weeks after the operation, reached a peak at 4 weeks after the operation, and gradually decreased at 6 to 8 weeks after the operation. At 2, 4, 6, and 8 weeks after the operation, the expression of Cbf-α1 in the experimental group was higher than that of the control group; the average absorbance values of Cbf-α1 in the experimental group at different time points were 263.20±49.95, 503.39±38.53, 377.98±12.38, 276.91±8.61, respectively, all higher than the control group (123.05±14.60, 359.51±58.98, 339.14±18.98, 224.54±23.94), the differences were statistically significant (t= 4.67, 3.54, 2.97, 3.57; P= 0.01, 0.03, 0.04, 0.03). ② At 2, 4, 6, 8 weeks after operation, the expression of osteocalcin in the experimental group and the control group gradually increased, and the expression of osteocalcin in the experimental group was higher than that of the control group. At 2, 4, 6, and 8 weeks after operation, the average absorbance values of osteocalcin in the experimental group were 45.28±4.96, 283.80±49.01, 450.06±61.42 and 619.00±105.40, which were higher than those of the control group (5.29±4.49, 20.94±7.59, 220.39±32.18, 424.98±32.84), the differences were statistically significant (t= 10.35, 9.18, 5.74, 3.05; P<0.05). ③ The expression levels of OPG in the experimental group and the control group were both low expression at 2 weeks after operation, peaked at at 4 weeks after operation, , and gradually decreased from the 6 to 8 weeks after operation. At 2, 4, 6, and 8 weeks after operation, the expression of OPG in the experimental group was higher than that in the control group; the average absorbance values of OPG in the experimental group at different time points were 443.97±23.61, 576.91±37.21, 278.28±16.38, 144.13±30.20, respectively, all higher than the control group (374.66±26.30, 454.50±49.95, 233.17±21.35, 62.82±4.16), the differences were statistically significant (t= 3.40, 3.40, 2.90, 4.62; P<0.05). ④ The expression of RANKL in the experimental group and the control group were both low at 2 and 4 weeks after operation, and the expression increased gradually at 6 and 8 weeks after operation. At 2, 4, 6 and 8 weeks after operation, the expression of RANKL in the experimental group was lower than that in the control group; the average absorbance values of RANKL in the experimental group at different time points were 203.34±18.16, 186.63±19.50, 261.78±28.33, 441.06±17.89, respectively, all lower than the control group (275.64±26.68, 277.28±9.49, 385.13±11.56, 485.20±8.15), and the differences were statistically significant (t= 3.88, 7.24, 6.98, 3.89; P<0.05). ⑤At 2, 4, 6, and 8 weeks after operation, the average absorbance ratios of OPG/RANKL in the experimental group were 2.19±0.18, 3.13±0.53, 1.08±0.18, 0.33±0.08, which were all larger than those of the control group (1.37±0.21, 1.64±0.22, 0.61±0.07, 0.13±0.01), the differences were statistically significant (t= 5.14, 4.50, 4.14, 4.50; P<0.05).