股骨头表面置换对正常股骨头组织学的影响

Effect of femoral head surface replacement on the histology of normal femoral head

背景:拟通过建立动物模型探讨目前的髋关节表面置换的假体设计是否达到成熟、是否能引起股骨头坏死。目的:观察健康新西兰大白兔股骨头表面置换后的组织形态变化。方法:60只健康大白兔行左股骨头表面置换,右侧为正常对照侧。分3,6,9,12周共4次分批处死取股骨头标本行大体、光镜、扫描电镜观察。结果与结论:股骨头表面置换后,股骨头骨质仅在与骨水泥接触界面(骨-水泥界面)有小范围的骨细胞坏死和肉芽组织增生纤维化、以及骨吸收;与金属假体接触的界面(骨-假体界面)亦有轻度小范围骨细胞坏死和肉芽组织增生纤维化,但无骨吸收表现;在远离骨水泥和假体的股骨头中心部位既无骨坏死表现,亦无骨吸收表现,组织表现与正常未手术骨质相同。结果可见股骨头表面置换不会引起正常股骨头的坏死,股骨头坏死与术式及假体本身无因果关系,在一定程度上肯定了表面置换治疗髋关节疾患的安全性和优越性。

BACKGROUND： The author plans to investigate whether prosthesis design of hip surface replacement reaches mature, and whether causes femoral head necrosis by establishing animal models. OBJECTIVE： To observe the histological changes of normal femoral head after femoral head surface replacement through the experimental study of the New Zealand rabbits. METHODS： Sixty healthy rabbits had undergone left femoral head surface replacement, and the right side served as the normal control group. They were killed at time intervals of 3, 6, 9 and 12 weeks to remove the femoral head. Macroscopic, light microscopy, scanning electron microscope had used to observe the removed femoral head. RESULTS AND CONCLUSION： After the femoral head surface replacement, a small region of bone necrosis, granulation tissue hyperplasia fibrosis and bone resorption were found at the bone-cement interface. At the bone-implant interface, a smaller region of bone necrosis and granulation tissue hyperplasia fibrosis were also found, but without bone resorption. In the region of far from cement and implant, neither bone necrosis nor bone resorption was found. The pathological character was same to the healthy bone. This histological evaluation indicated that femoral head surface replacement cannot cause femoral head necrosis, and there is no cause and effect relationship between operation type, implant and femoral head necrosis, which confirmed the security and superiority of the femoral head surface replacement for the treatment of hip disease.