CAJ | 학술논문

目的观察激素性股骨头坏死微血管变化及高压氧治疗激素性股骨头坏死的作用机制.方法健康成年日本大耳白兔48只,按数字表法随机分为模型组(36只)及生理盐水组(12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/kg,共6周.2组各处死2只行病理检查后,随后按数字表法将模型组随机分高压氧治疗组(17只)及对照组(17只).高压氧治疗组在常规治疗基础上行高压氧治疗,共持续6周,对照组呼吸常压新鲜空气.检测实验后2、4、6、8、10、12周兔血液流变学参数、血管内皮生长因子(VEGF),并观察其组织病理学变化及影像学变化.结果模型组实验2、4、6周血流变学特性恶化;模型组股骨头微血管内膜断裂、血栓形成,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.高压氧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的VEGF阳性表达细胞,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股骨头微血管内膜损伤,可能是兔股骨头坏死的重要原因,高压氧通过促进VEGF等细胞因子的分泌,加速股骨头的再血管化和再骨化进程,促进骨修复,可能是高压氧治疗激素性股骨头坏死的重要理论依据.
목적 관찰격소성고골두배사미혈관변화급고압양치료격소성고골두배사적작용궤제.방법 건강성년일본대이백토48지,안수자표법수궤분위모형조(36지)급생리염수조(12지).모형조매주2차기육주사작산발니송룡10 mg/kg,생리염수조매주2차기육주사생리염수2 ml/kg,공6주.2조각처사2지행병리검사후,수후안수자표법장모형조수궤분고압양치료조(17지)급대조조(17지).고압양치료조재상규치료기출상행고압양치료,공지속6주,대조조호흡상압신선공기.검측실험후2、4、6、8、10、12주토혈액류변학삼수、혈관내피생장인자(VEGF),병관찰기조직병이학변화급영상학변화.결과 모형조실험2、4、6주혈류변학특성악화;모형조고골두미혈관내막단렬、혈전형성,고골두골질소송,광경하공골함와수증다,지방세포수증다,부분골소량단렬,투사전경고골두골세포체적축소,핵고축,교다골세포이배사용해성쇄편.고압양치료조혈류변학특성추향호전,고골두연골하구골소량표면적성골세포화혈관출현대량적VEGF양성표체세포,양성부위주요위우혈관내막;광경하가발현배사적골세포유수복현상,투사전경가견신생골세포.결론 대제량격소가조성토고골두미혈관내막손상,가능시토고골두배사적중요원인,고압양통과촉진VEGF등세포인자적분비,가속고골두적재혈관화화재골화진정,촉진골수복,가능시고압양치료격소성고골두배사적중요이론의거.
Objective To observe microvascular changes in hormone-induced bone necrosis and also to study the mechanism of hyperbaric oxygen (HBO) in the treatment of femoral head bone necrosis.Methods Forty-eight adult Japanese white rabbits were randomly divided into 2 groups:the experiment group (n =36) and the control group (n =12).The animals in the model group (or the experimental group) were injected with 10mg/kg of prednisone acetate,twice a week for a duration of 6 weeks,while the animals in the control group were injected with 2 ml of normal saline,also twice a week for a duration of 6 weeks.Then,the rabbits in the experimental group were randomly divided into the HBO group (n =17) and the control group (n =17).The HBO group received HBO treatment,for 6 successive weeks,while the control group breathed normal fresh air.At the end of 2,4,6,8,10 and 12 weeks after experiment,blood rheology,vascular endothelial growth factor (VEGF),pathological changes in the tissue involved and radiological imaging changes were observed closely.Results At the end of the 2nd week,4th week and 6th week after experiment,features of hemorheology in the model group deteriorated.The animals of the model group developed endangium,thrombosis,osteoporosis of the femoral head,increased numbers of empty bone lacunae and fat cells,rupture of certain bone trabecula,volume reduction of bone cells of the femoral head and quite a few bone cells were seen to be dead and dissolved into fragments under the electron microscope.In the HBO treatment group,hemorheologic features tended to be better,positive expressions of VEGF could be seen in the osteoblasts on the bone trabecula surface and blood vessels as well,and positive expressions were mainly detected in endangium.Repair of necrostic bone cells to some extent could be seen under the light microscope,and neogenetic bone cells could also be seen under the transmission electron microscope.Conclusions Large dosage of hormone could induce damage to endangium,which might be the main cause of avascular necrosis of the femoral head.HBO could accelerate the processes of vascular regeneration and bone ossification through the expressions of VEGF and other cytokines and promote bone repair,which might provide an important theoretical evidence for the treatment of hormone-induced bone necrosis of femoral head.