高能震波对缺血性坏死股骨头微血管及组织细胞超微结构的影响

Effect of high energy shock waves on microvessei density and cellular ultrastructure of the necrotic femoral head

目的观察高能震波对缺血性坏死股骨头微血管密度（MVD）和组织细胞超微结构的影响，探讨高能震波治疗股骨头缺血性坏死的作用机制。方法健康雄性新西兰白兔32只，3．0—4．0kg，平均3．4kg。联合应用甲泼尼龙和内毒素6周诱发早期股骨头缺血性坏死的动物模型。所有实验兔左后腿作为治疗侧，采用能流密度0．26mJ／mm^2，频率1Hz，冲击量为2000次的高能震波治疗，右后腿作为对照侧，不予治疗。分别于治疗后4、8、12周对股骨头行微血管墨汁灌注，研究股骨头MVD的变化，制作半薄切片，在透射电镜下分别观察治疗侧和对照侧股骨头组织细胞的超微结构。结果高能震波治疗后4—12周，治疗侧股骨头微血管增粗增多，与对照侧相比MVD显著增加（P〈0．05）。治疗后8-12周，治疗侧股骨头骨小梁面积百分比显著高于对照侧（P〈0．05）。透射电镜下观察可见治疗侧股骨头与对照侧相比成骨细胞和血管内皮细胞数目较多，功能状态活跃。结论高能震波治疗能有效促进缺血性坏死股骨头的血管生成，改善成骨细胞和血管内皮细胞的功能状态，加速股骨头坏死的修复。

Objective To investigate the effect of high energy shock waves on microvessel density and cellular ultrastructure of the necrotic femoral head, and the mechanism of avascular femoral head necrosis treated with high energy shock waves. Methods Thirty-two male adult New Zealand white rabbits, weighing 3.0 to 4.0 kg （average weight, 3.4 kg）, were used to establish animal models of avascular femoral head necrosis. Bilateral femoral head necroses were induced by methylprednisolone and lipepelysaccharide. The left hind limbs （treatment side） of all rabbits received shock wave treatment to the femoral heads while their right limbs （control side） received no shock wave treatment. At 4, 8 and 12 weeks after the shock wave treatment, vascular infusion with Chinese ink was made to evaluate the morphological changes of blood vessels in the femoral heads and cellular ultrastructure of the femoral head was observed by transmission electron microscope （TEM）. Results At 4, 8 and 12 weeks after shock wave treatment, microvessel density of the femoral heads at the treatment side was significantly higher than that at the control side （ P =0. 001, P = 0. 001, P =0. 000）. At 8 and 12 weeks after shock wave treatment, trabecular bone area of the femoral head at the treatment side was also significantly larger than that at the control side （ P =0. 011, P =0. 003）. TEM showed that the number and the function of osteoblasts and vascular endothelia at the treatment side were higher than at the control side. Conclusion High energy shock waves may have promoting effect on angiogenesis of necrotic femoral head, improving the function of osteoblasts and vascular endothelia in the femoral head and accelerating repair process of the necrotic femoral head.