股骨头成形术治疗股骨头无菌性坏死的力学实验研究

Experimental study on the therapeutic effect of femoral head plastic operation on aseptic necrosis of femoral head

目的股骨头成形术对股骨头坏死的预防和治疗的动物实验研究分析。方法 60只中国白兔,随机分为4组,每组15只。右侧股骨头作为正常组,其余3组在股骨头颈交界处钻孔造成股骨头缺损,并加用95%乙醇30min灌注造成股骨头缺损模型。自然修复组股骨头作为自然修复对照。骨水泥组股骨头造成缺损乙醇填充后填充骨水泥造影剂骨水泥组。造影剂骨水泥组股骨头造成股骨头缺损乙醇填充后填充造影剂骨水泥。4组动物于术后12周处死,立即取股骨头标本观察关节软骨性状。然后分别行病理学检查及生物力学测试。结果股骨头关节软骨观察显示骨水泥组和造影剂骨水泥组股骨头外形始终保持完整无变形,4组股骨头软骨厚度自然修复组比正常组、骨水泥组、造影剂骨水泥组降低,差异有统计学意义(P<0.05)。抗压试验正常组、骨水泥组和造影剂骨水泥组刚度荷均数均高于自然修复组,差异有统计学意义(P<0.01)。结论股骨头成形术操作简单、创伤较小,可以保持股骨头外形完整,能暂缓或替代关节置换术,有望成为治疗FicatⅡ～Ⅲ期年轻患者的新型手术方法。

Objective To observe the preventive and therapeutic effect of femoral head plastic operation on aseptic necrosis of femoral head in rabbits.Methods 60 Chinese white rabbits were randomly divided into 4 groups.Except for the group A（control group）,the rabbits in the other three groups were made a globose defect and filled with 95% alcohol tampon for 30 minutes.The group B was natural repair group,and the rabbits in group C were filled with bone cement after being made defect.The rabbits in group D were filled with bone cement plus barium sulfate agent after being made defect.After 12 weeks the rabbits in four groups were killed.The specimens were randomly divided into two parts.The one part＇s articular cartilages were observed and detected immediately.The other ones were treated by histological examination and extreme anti-pressure rigidity test.Results The femoral heads in bone cement group and the femoral head of contrast agent bone cement group kept their outline all the time identified by the articular cartilage observation.12 weeks later the cartilage thickness of natural repair group was significantly thinner than that of the other three groups（P〈0.05）.The rigidity of natural repair group had significant difference with that of the other three groups respectively（P〉0.01）.Conclusion Femoral head plastic operation is simple and can relieve pain,with little trauma,furthermore,the integrity of femoral head outline can be kept,which may become a new way that is used to treat young patients with aseptic necrosis of femoral head in FicatⅡ～Ⅲ period to substitute total hip replacement.