高压氧治疗兔激素性股骨头坏死血栓前状态的实验研究  

Experimental study on the effect of hyperbaric oxyen on pre-thrombotic state of hormone-induced avascular necrosis of rabbit femoral head

作　　者：崔操[1] 李彬彬[1] 郭一行[2] 李厚成[3] 

机构地区：[1]湖北医药学院附属太和医院骨科,湖北省十堰442000 [2]湖北医药学院附属太和医院普外科,湖北省十堰442000 [3]湖北医药学院附属太和医院高压氧科,湖北省十堰442000

出　　处：《中华航海医学与高气压医学杂志》2013年第4期232-235,共4页Chinese Journal of Nautical Medicine and Hyperbaric Medicine

摘　　要：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.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 e

关 键 词：血栓前状态 股骨头坏死 高压氧 

分 类 号：R681.8[医药卫生—骨科学]