唑来膦酸预防股骨头坏死塌陷的效果及机制

Effect and Mechanism of Zoledronate on Prevention of Collapse in Osteonecrosis of the Femoral Head

目的观察唑来膦酸预防股骨头坏死塌陷的效果及作用机制。方法将24只雄性SD大鼠分为假手术组、安慰剂组和治疗组3组,每组8只。假手术组为阳性对照组,安慰剂组在建立股骨头坏死模型后给予生理盐水治疗,治疗组在建立股骨头坏死模型后给予唑来膦酸治疗。术后5周处死大鼠,取术侧股骨分别行X线、Micro-CT和组织学检查。结果股骨头高度与宽度的比值安慰剂组<治疗组<假手术组,差异均有统计学意义(P均<0.01)。治疗组和假手术组的股骨头体积、股骨头内骨量和骨矿盐含量差异均无统计学意义(P均>0.05),但都明显大于安慰剂组(P均<0.01)。组织学检查显示,治疗组股骨头内以死骨为主,破骨细胞、成骨细胞及血管新生的数量均低于安慰剂组。结论唑来膦酸可抑制破骨细胞和成骨细胞活动及血管新生,保存骨量和股骨头形态,具有良好的预防股骨头坏死塌陷的作用。

Objective To observe the effect and mechanism of zoledronate on prevention of collapse in an animal model of osteonecrosis. Methods Ischemic osteonecrosis was surgically induced in 16 SD rats （ which were further divided into zoledronate group and placebo group） ; another 8 rats were used as sham sur- gery group （ n = 8 ）. The animals were killed 5 weeks after surgery. Radiographic, Micro-CT, histological, and immunohistochemical assessments were performed. Results Radiographic assessment showed better pres- ervation of the femoral head shape in the zoledronate group than in the placebo group but not significantly differ- ent from the sham surgery group. Micro-CT assessment showed higher totol volume, bone volume, and total mineralized content in the zoledronate group （ all P 〈 0.01 ） than in the placebo group but not significantly dif- ferent from that in the sham surgery group （ all P 〉 0.05 ）. Compared with the placebo group, the zoledronategroup had reduced osteoclast and osteoblast activity, as confirmed by histological examinations. Conclusion Zoledronate can decrease the femoral head deformity by reducing the osteoclast activity while suppressing new bone and vessels formation in a rat model of traumatic osteonecrosis, and therefore may delay the collapse of femoral head.