激素性股骨头坏死发病机理的实验研究

An Experimental Study of Pathogenesis of Steriod-induced Avascular Necrosis of Femoral Head in Rabbits

目的:探讨激素性股骨头缺血坏死的发病机理。方法:成年日本大耳白兔 32 只,随机分为模型组与对照组。模型组每周2次肌肉注射醋酸泼尼松龙10 mg·kg-1, 对照组每周 2 次肌肉注射生理盐水每只 2 ml,共 6周。观察实验前及实验后第2,4,6周两组动物血清总胆固醇(TC)、甘油三酯(TG)、血液流变学参数和股骨头光镜及透射电镜组织病理学变化。结果:模型组实验 2 周、4 周 TG、TC、全血粘度、血浆粘度显著高于对照组(P<0.01)。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,透射电镜股骨头部分骨细胞体积缩小,核固缩,较多骨细胞已坏死溶解成碎片。结论:①大剂量激素可导致兔股骨头缺血性坏死;②高脂血症和血液流变学因素在激素性股骨头坏死的发病机理中可能起重要作用。

Objective: To investigate the pathogenesis of steroid-induced avascular necrosis of femoral head. Methods: 32 impubic Japanese rabbits were randomly devided into two groups as experiment group and control group. In the experiment group, each one was injected with 10 mg·kg -1 of prednisolone, two times per week, and in the control group, each one with 2 ml of normal saline. The experiment lasted for six weeks. Hemorheological parameters, serum total cholesterol (TC) and triglyceride (TG) were determined before the treament and 2 weeks, 4 weeks, and 6 weeks after the beginning of the treatment. At the same time, pathological changes of femoral head were observed with light microscope and electron microscope. Results: At the end of 2 weeks and 4 weeks, the serum TG and TC concentrations, and blood viscosity increased greatly in experiment group compared with those in control group (all P<0.01). Osteoporosis was found in the femoral head in rabbits treated with prednisolone. Increased numbers of empty bone lacunae and fat cells was observed with light microscope in the experiment group compared with the control group. Some osteocytes decreased in volume and pyknosis were found. Many osteocytes underwent necrosis, dissolving and became fragments. Conclusion: ① A large dose of hormone may cause avascular necrosis of femoral head in rabbits; ② Hyperlipidemia and hemorheological parameters may play an important role in the pathogenesis of avascular necrosis of femoral head.