股骨头坏死特殊结构的组织学观察及其临床意义  

Histopathological features of special structures in osteonecrosis of femoral head and clinical significance

作　　者：崔永锋[1] 朱宝华[1] 管功奎[1] 肖鲁伟[2] 童培建[2] 

机构地区：[1]杭州市萧山区第一人民医院骨科,311200 [2]浙江中医药大学骨伤科研究所

出　　处：《浙江医学》2011年第5期669-672,共4页Zhejiang Medical Journal

基　　金：中国博士后科学基金资助项目（20080431334） 本课题所使用股骨头标本全部来自广州中医药大学第一附属医院髋关节病治疗中心,对该中心的袁浩教授、中国中医科学院望京医院韩凤岳研究员及张平博士等工作人员、北京积水潭医院王云钊教授给予的技术支持在此表示衷心感谢

摘　　要：目的 研究人股骨头坏死特殊结构的病理特征及其对临床治疗的指导意义.方法 73个股骨头坏死标本,按抽签法随机抽取13个（按ARCO分期,Ⅲ期5例,Ⅳ期8例）,其中7例激素性（男5例,女2例）,6例酒精性（均为男性）,年龄为30～72岁,平均45.5岁.2例股骨颈骨折3d内行关节置换术的股骨头作为对照.按照股骨头4分区：（1）负重区软骨面;（2）软骨下坏死中心;（3）修复区（包含肉芽组织带和新生骨）;（4）相对正常的头颈区分别取材并制成组织切片,均行HE和Masson染色,在光镜下对囊变、修复带、蘑菇状改变进行观察.结果 囊变、修复带、蘑菇状改变具有不同的病理表现,是股骨头坏死发生过程中的重要病理结构.结论 股骨头坏死特殊病理结构的组织学观察,对研究其病理机制有重要提示意义,与临床治疗方案的选择密切相关.Objective To investigate the histopathological features of special structures in osteonecrosis of femoral heads （ONFH） and its clinical significance. Methods Thirteen specimens of femoral heads were randomly taken from 73 femoral heads with necrosis for total hip replacement, including 5 cases in stage Ⅲ, 8 cases in stage Ⅳ according to the ARCO stage system. Seven cases were induced by steroid overuse （5 men and 2 women）, 6 cases were induced by alcohol abuse （6 men）. The patients were aged 30 to 72y with average of 45.5. Two specimens of femoral heads with fresh femoral neck fracture were served as controls. The tissue sections were made from 1） weight-bearing cartilage, 2） bone tissues from the center of necrosis under cartilage, 3）renovating band and 4）the normal head-neck area, and stained by HE and improved Masson methods. The histopatho- logical features were observed with light microscopy focusing on the cystic degeneration, repairing band and mushroom-like hyperplasia. Results The cystic degeneration, repairing band, mushroom-like hyperplasia had different appearance and they were the special structure in osteonecrosis of the femoral head. Conclusion The histopathologic characteristics of special structures in ONFH are of use in understanding of the features of ONFH and the selection of therapeutic schedule.

关 键 词：股骨头坏死 组织病理学 囊变 修复带 蘑菇状改变 光镜观察 

分 类 号：R681.8[医药卫生—骨科学]