高压氧治疗兔激素性股骨头坏死关节软骨的实验研究  

Capillary vessel changes in rabbits with hormone-induced avascular necrosis of femoral head and the mechanism involved in the treatment of the disorder with hyperbaric oxygen

作　　者：崔操[1] 李厚成[1] 郭一行[1] 李彬彬[1] 

机构地区：[1]湖北医药学院附属太和医院,湖北省十堰442000

出　　处：《中华航海医学与高气压医学杂志》2015年第1期32-36,共5页Chinese Journal of Nautical Medicine and Hyperbaric Medicine

摘　　要：目的 观察兔激素性股骨头坏死过程中关节软骨的变化及在高压氧治疗过程中的病理变化,探讨高压氧治疗促进关节软骨修复的作用机制.方法 健康日本成年大耳白兔60只,按照数字表法随机分模型组（42只）及空白对照组（18只）.模型组每周2次肌肉注射醋酸泼尼松龙10 mg/kg,对照组每周2次肌肉注射生理盐水2 ml,共6周.随后将模型组同样按照数字表法随机分为高压氧治疗组（16只）及对照组（16只）,治疗组行高压氧治疗,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）、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;空白对照组与模型组比较,活化部分凝血活酶时间测定（APTT）第2、4、6周分别为[[（22.68±4.12）,（21.68±7.45）;（26.38±0.38,20.9±1.23）;（27.00±1.21）,（13.5±1.60）s];血浆凝血酶原时间测定（PT）第2、4、6周分别为[（7.42±0.13）,（7.36±0.20）;（7.47±0.24）,（4.78 ±0.24）;（7.38 ±0.10）,（4.19±0.83）s;血小板数量第2、4、6周分别为[（418.75 ±64.23）,（584.50±30.87）;（396.00±54.49）,（656.70 ±33.84）;（427.00±45.32）,（775.00±64.68）×10^9/ml].上述3项比较,2组差异均有统计学意义（P＜0.05）.模型组兔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,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Objective To observe capillary vessel changes in rabbits with hormone-induced avascular necrosis of femoral head and the possible mechanism involved in the treatment of the disorder with hyperbaric oxygen （HBO）.Methods Forty-eight adult Japanese white rabbits were randomly divided into 2 groups：the experimental model group （n =36） and the control group （n =12）.The animals in the experimental model group were injected with prednisolone acetate （10 mg/kg）,twice a week and the animals in the control group were injected with physiological saline （2 ml） also twice a week for 6 weeks.Then,rabbits in experimental group were randomized into the HBO group （n =18） and the control group （n =18）.The HBO group received HBO treatment for 6 weeks,while the control group was treated with normobaric air.Hemorrheology paramcters,vascular endothelial growth factor （VEGF）,changes in tissue pathology,as well as changes in radiographic imaging were detected at week 2,4,6,8,10 and 12 following experiment.Results Features of hemorrheology for the model group deteriorated at weeks 2,4 and 6.Endangium in the femoral head capillary vessel of the experimental group was disrupted,and there were thrombosis and osteoporosis in the femoral head.Optical microscopy revealed that the number of empty bone lacunae and fat cells increased,and some bone trabeculae were disrupted.Electron microscopy indicated that cell volume of the femoral head decreased and nuclei shrank,more osteocytes after necrosis occurred were dissolved into fragments.For the HBO treatment group,features of hemorrheology improved,and positive expressions of VEGF in large amounts could be detected in osteogenic cells and blood vessels on thc surface of bone trabeculae in the femoral head,with the positive site being mainly located in endangium.Under optical microscope,repair of necrotic osteocytes could be found,and nascent osteocytes could be detected by transmission microscopy.Conclusions Large dosage of hormones could induce damage to endangiu

关 键 词：关节软骨 股骨头坏死 高压氧 血管内皮生长因子 

分 类 号：R681.8[医药卫生—骨科学]