CAJ | 학술논문

目的观察高压氧(hyperbaric oxygen,HBO)治疗前后兔激素性股骨头坏死血栓前状态的病理变化,探讨HBO治疗兔激素性股骨头坏死的机制.方法采用数字表法,将60只健康日本成年大耳白兔随机分为模型组(42只)及生理盐水对照组(生理盐水组,18只).模型组每周2次肌肉注射醋酸泼尼松龙10 mg/kg,生理盐水组每周2次肌肉注射生理盐水2 ml,共6周.2组兔分别于实验2、4、6周时各处死2只,模型组另有4只兔死亡.随后再采用数字表法将模型组32只兔随机分HBO治疗组(治疗组,16只)及对照组(16只),治疗组行HBO治疗,共持续6周.对照组呼吸常压新鲜空气.2组兔分别于实验8、10、12周时各处死4只,另有8只死亡.检测兔血液流变学参数、血管内皮生长因子、组织病理学及影像学变化.结果模型组实验2、4、6周血流变学特性恶化；模型组股骨头骨质疏松,光镜下空骨陷窝数增多,脂肪细胞数增多,部分骨小梁断裂,透射电镜股骨头骨细胞体积缩小,核固缩,较多骨细胞已坏死溶解成碎片.治疗组血流变学特性趋向好转,股骨头软骨下区骨小梁表面的成骨细胞和血管出现大量血管内皮生长因子阳性表达,阳性部位主要位于血管内膜；光镜下可发现坏死的骨细胞有修复现象,透射电镜可见新生骨细胞.结论大剂量激素可造成兔多项特性恶化,可能是兔股骨头坏死的重要原因,高压氧通过多种途径可使血栓前状态特性趋向好转,对兔激素性股骨头坏死有确切疗效.
목적 관찰고압양(hyperbaric oxygen,HBO)치료전후토격소성고골두배사혈전전상태적병리변화,탐토HBO치료토격소성고골두배사적궤제.방법 채용수자표법,장60지건강일본성년대이백토수궤분위모형조(42지)급생리염수대조조(생리염수조,18지).모형조매주2차기육주사작산발니송룡10 mg/kg,생리염수조매주2차기육주사생리염수2 ml,공6주.2조토분별우실험2、4、6주시각처사2지,모형조령유4지토사망.수후재채용수자표법장모형조32지토수궤분HBO치료조(치료조,16지)급대조조(16지),치료조행HBO치료,공지속6주.대조조호흡상압신선공기.2조토분별우실험8、10、12주시각처사4지,령유8지사망.검측토혈액류변학삼수、혈관내피생장인자、조직병이학급영상학변화.결과 모형조실험2、4、6주혈류변학특성악화；모형조고골두골질소송,광경하공골함와수증다,지방세포수증다,부분골소량단렬,투사전경고골두골세포체적축소,핵고축,교다골세포이배사용해성쇄편.치료조혈류변학특성추향호전,고골두연골하구골소량표면적성골세포화혈관출현대량혈관내피생장인자양성표체,양성부위주요위우혈관내막；광경하가발현배사적골세포유수복현상,투사전경가견신생골세포.결론 대제량격소가조성토다항특성악화,가능시토고골두배사적중요원인,고압양통과다충도경가사혈전전상태특성추향호전,대토격소성고골두배사유학절료효.
Objective To observe pathological changes in the pre-thrombotic state of femoral head before and after hyperbaric oxyen (HBO) therapy,and also to explore the mechanism of hormone-induced avascular necrosis of rabbit femoral head.Methods Sixty adult Japanese rabbits were randomly divided into 2 groups:the experiment group (n =42) and the control group (n =18).The animals in the experiment group received muscular injection of prednisolone acetate twice a week at a dosage rate of 10 mg/kg,for a duration of 6 weeks,and the animals in the control group just received 2 ml physiological saline twice a week,also for a duration of 6 weeks.Then,the rabbits in the experimental group were further divided at random into the HBO group (n =16) and the control group (n =16).The HBO group received HBO treatment for a duration of 6 weeks.The animals of the control group breathed normal pressure fresh air.Changes in blood rheology,vascular endothelial growth factor (VEGF),histopathology and imaging were monitored at the time points of 2,4,6,8,10 and 12 weeks.Results For the animals of the experiment group,blood rheology deteriorated at weeks 2,4 and 6.Results showed that there were osteoporosis of the femoral head,increased numbers of empty bone lacunae and fat cells,breakage of some bone trabeculae,decreased volume of osteocytes of the femoral head,karyopycnosis and necrosis and dissolution of osteocytes into fragments.For the animals of the HBO group,blood rheology tended to improve.Positive expressions of osteoblasts on the surface of trabeculae and VEGFs in the vessels could be noted,with site of positive expression being mainly in the endangium.Repair of necrotic osteocytes and newborn osteocytes could clearly be seen under the electron microscope.Conclusions Large doses of hormones could induce deterioration of hemorrheology,which might be the culprit of avascular necrosis of the femoral head.HBO might improve the pre-thrombotic state of femoral head through different approaches,thus producing good effect in the treatment of avascular necrosis of rabbit femoral head.