Scanning electron microscopic study of subchondral bone tissues in osteoarthritic femoral head.

During total hip replacement for 12 cases of advanced osteoarthritis of the hip joint in aged women, three types of diseased or abnormal articular cartilage with different degrees of severity (white articular cartilage, white and hyperplastic articular cartilage, and yellowish articular cartilage) and ivory bone were obtained together with their subchondral bone tissues. These specimens were processed and studied under scanning electron microscope and were compared with sex- and age-matched non-osteoarthritic femoral head articular cartilage specimens. The following findings were observed: 1. In non-osteoarthritic femoral head, the subchondral bone plate was quite thin. The bone plate connected on its deep surface with the lattice-work of trabeculae of the epiphyseal region. The trabeculae were fine and smooth and some revealed round or spindle-shaped callus resulted from microfracture. 2. In osteoarthritic femoral heads, with increased the severity of the articular lesion, the articular cartilage gradually became thinned out and eventually lost. The subchondral bone plate was markedly thickened. The epiphyseal trabeculae were also thickened and turned rough so that the lattice-work pattern gradually disappeared. The thickened trabeculae finally fused into a large piece of dense bone tissue. No microfracture was detected. These changes were attributable to the increased stress imposed on the subchondral bone tissues as a result of defective articular cartilage. Consequently, the changes on the part of the subchondral bone tissues of the osteoarthritic femoral heads were the sequent, rather than the cause, of the articular lesions.

     

股骨头坏死早期 CT 表现分析

目的：分析股骨头坏死的早期CT表现。方法回顾分析23例早期股骨头坏死的CT片,并在6个月～1年内进行回访。结果23例中,双侧股骨头坏死10例,单侧股骨头13例,共33个股骨头,主要表现为局部骨纹理改变及骨密度改变。结论股骨坏死的早期CT表现,具有特征性,对该病诊断是有重要意义。     

股骨头缺血坏死的病理改变与影像学表现的对比分析

目的 探讨股骨头缺血坏死(ANFH)影像学表现对应的病理改变.方法 收集北京中日友好医院15位患者的20个坏死股骨头普通平片、CT、MRI表现与大体切片、组织病理做对照研究.结果 ANFH均累及股骨头前部的外上方,大体标本上坏死股骨头由软骨、坏死区、周围的增生反应区和病灶外正常区组成,增生反应区包绕坏死区.影像学改变:①坏死区在平片和CT上表现为等密度11个、低密度7个、稍高密度2个,MRI上股骨头坏死区3个呈脂肪样信号、1个呈血液样信号、2个为水样信号、9个呈纤维样信号、5个呈混杂信号.②增生反应区分隔坏死区和正常区,于平片和CT上呈高密度硬化带,其中CT、平片分别显示12个和7个股骨头于硬化带内侧见伴行的低密度透光带;MRI上增生反应区于T1WI和T2WI上均呈低信号,其中3个股骨头于T2WI上见双线征.结论 平片、CT、MRI能准确地显示ANFH大体标本上的坏死区、增生反应区和病灶外正常区,ANFH特征性影像学改变在病变的增生反应区.     

早期非创伤性股骨头坏死的CT表现及与预后的关系

目的 分析早期非创伤性股骨头坏死的CT表现及与预后的关系。方法 选取2019年3月—2020年3月于诸暨市中医医院就诊的疑似早期非创伤性股骨头坏死患者168例。所有患者均接受CT及MRI检查,以手术病理检查结果为金标准,分析CT、MRI及两者联合诊断对早期非创伤性股骨头坏死的诊断效能。根据随访结果分为预后良好组和预后不良组,比较两组的CT参数[血容积（BV）、血流量（BF）及平均通过时间（MMT）],绘制受试者工作特征（ROC）曲线,分析CT各参数及联合预测早期非创伤性股骨头坏死患者预后的价值。结果168例患者经CT检查结果显示,74例以骨小梁增粗或骨质硬化、股骨头呈拥挤融合及扇状硬化改变为主;94例以骨小梁微骨折及股骨头关节面轻微塌陷、部分出现新月征为主;CT、MRI及两者联合诊断早期非创伤性股骨头坏死与金标准一致性分别为0.535、0.676和0.870;联合诊断的敏感性及准确性均高于CT及MRI单一诊断（P <0.05）,但CT与MRI的敏感性及准确性比较,差异无统计学意义（P>0.05）。预后良好组BF、BV均大于预后不良组,MMT长于预后不良组（P <0.0...     

股骨头坏死早期CT表现及临床价值

目的研究股骨头缺血坏死（ANFH）早期CT表现及临床价值。方法126例双侧股骨头行CT扫描，并对其CT表现进行分期。结果CT发现早期ANFH 126例共198个部位。其中Ⅰ期81个，表现为星芒结构变形、骨质疏松和骨硬化；Ⅱ期65个，表现为骨硬化及囊状透亮区；Ⅲ期52个，以“新月征”为特征。结论CT特别是高分辨力CT能清楚显示早期股骨头坏死范围并准确地进行分期，为临床医师制定治疗方案提供可靠的依据。     

Ultrastructural investigation of granulation tissues on the osteoarthritic femoral head. A scanning electron microscopic and transmission electron microscopic study.

From the femoral heads of nine cases of advanced osteoarthritis of hip joint, three categories of granulation tissues with different colors (bright red, dark-red and white granulation tissues) and texture were obtained. After processing, the specimens were observed under scanning electron microscope and transmission electron microscope. With transformation of the granulation tissues from bright red to white, the collagen fibers therein contained gradually changed from fine to thick ones. Nevertheless, the cellular components in these three types of granulation tissues always possessed the characteristics of both fibroblasts and chondrocytes, i.e., fibroblastic configuration with pericellular Type I collagen fibrils bearing 64 nm periodicity; and chondrocytic scallop-shaped cytoplasmic membrane with intracytoplasmic fat droplets and glycogen granules and pericellular Type II collagen fibrils. All these indicated that in osteoarthritis of hip joints, the granulation tissues of the femoral heads transformed eventually into fibrocartilage, irrespective of their color and texture.

     

股骨头骨折不同治疗方法疗效探讨

目的:探讨用不同方法治疗股骨头骨折的临床疗效。方法:回顾性分析16例股骨头骨折患者的治疗效果,其中11例采用切开复位内固定术进行治疗、2例采用非手术治疗、2例行人工全髋关节置换术、1例行骨折块清除术。结果:随访1.5～11年,平均3年8个月,优良率为71.4%。结论:对髋关节脱位进行及时的复位,切开解剖复位、牢固内固定骨折,可以取得满意的疗效。     

股骨头坏死保头治疗的研究进展

股骨头坏死是骨科常见的难治性疾病，尤其非创伤性股骨头坏死高发于中青年患者（平均年龄38岁），如不治疗，80％的患者将在4年内出现股骨头塌陷和骨性关节炎。尽管人工关节技术日趋成熟，但由于此类患者年龄偏小、活动量较大，人工关节置换术的远期疗效并不理想。因此，股骨头坏死的保头治疗具有特别重要的意义。     

皮质类固醇致股骨头缺血性坏死的磁共振成像早期改变的实验研究

目的:探讨磁共振(MR)灌注成像对皮质类固醇所致股骨头缺血性坏死早期诊断的意义。方法:40只健康成年新西兰大白兔,随机分为4组,分别以大剂量皮质类固醇冲击应用、长期应用和小剂量皮质类固醇短期应用法和生理盐水对照,在给药前及给药后1、3、5、8、12、16周分别行MR常规、MR灌注成像及Gd-DTPA增强MR检查,并在扫描后分批处死动物进行病理检查。结果:大剂量皮质类固醇冲击应用和长期应用组动物均有80%发生股骨头缺血性坏死,小剂量皮质类固醇短期应用组动物未发生股骨头缺血性坏死。MR常规检查5周时敏感性为40%,8周后为100%。MR增强检查3周时敏感性50%,5周时敏感性70%,8周后为100%。MR灌注成像在应用皮质类固醇后1周即发现血流灌注异常;在3周后改变更加明显,表现为最大信号强度下降减小,峰值时间延迟。其敏感性自1周起均为100%。结论:MR灌注成像是早期诊断股骨头血流灌注异常及坏死最敏感的方法,可在超早期对股骨头缺血坏死作出预测及诊断并可反映病理过程;MR增强扫描早期诊断股骨头缺血坏死的敏感性高于MR常规扫描。三者结合可更好地反映病理学改变及病程。     

股骨头坏死的MRI应用研究

股骨头坏死是一种多病理机制,最终达到同一转归,导致骨髓细胞缺血和骨细胞坏死的多因素疾病[1-3].股骨头坏死是一种难治的疾病,多见于20～50岁的患者.我院应用干细胞移植治疗早期股骨头坏死,中晚期患者应用干细胞移植结合血管束植入、钻孔减压、死骨病灶清除、滑膜部分切除、取髂骨植骨,取得了较好的临床效果.     

卡式双极人工股骨头置换治疗老年人股骨颈骨折

目的: 探讨卡式双极人工股骨头置换治疗老年人股骨颈骨折的方法及临床疗效。方法: 2001年4月~2004年10月,施行卡式双极人工股骨头置换术治疗老年人股骨颈骨折35例,平均年龄74.4岁。结果: 随访时间6~40个月,采用Harris'评定标准评估临床疗效,本组中优23例,良8例,中4例,优良率88.6%。结论: 双极人工股骨头置换术是治疗老年股骨颈骨折的一种较好的治疗方法。     

小切口双极股骨头置换治疗老年人股骨颈骨折

股骨颈骨折是一种常见的、多发于老年的骨折,由于老年人的特殊体质及对手术耐受性差的特点,手术方式选择至关重要.微创人工股骨头置换术,切口小、损伤轻、术后关节功能恢复快,该术式正逐渐被关节外科医生所接受.     

Relationships among magnetic resonance imaging, histological findings, and IGF-I in steroid-induced osteonecrosis of the femoral head in rabbits

Objective： To study the relationships among magnetic resonance imaging （MRI）, histological findings, and insulin-like growth factor-Ⅰ （IGF-Ⅰ） in steroid-induced osteonecrosis of the femoral head in rabbits. Methods： Thirty rabbits were randomly divided into experimental Group A （n= 15） and control Group B （n= 15）. The 7.5 mg/kg （2 ml） of dexamethasone （DEX） and physiological saline （2 ml） were injected into the right gluteus medius muscle twice at one-week intervals in animals of Groups A and B, respectively. At 4, 8 and 16 weeks after obtaining an MRI, the rabbits were sacrificed and the femoral head from one side was removed for histological study of lacunae empty of osteocytes, subchondral vessels, and size of fat cells under microscopy, and the femoral head from the other side was removed for enzyme-linked immunoadsorbent assay （ELISA） for IGF-Ⅰ. Results： At 4, 8 and 16 weeks after treatment, no necrotic lesions were detected in Group B, while they were detected in Group A. Light microscopy revealed that the fat cells of the marrow cavity were enlarged, subchondral vessels were evidently decreased, and empty bone lacunae were clearly increased. The IGF-Ⅰ levels in Group A were significantly higher than those in Group B. At 8 weeks after the DEX injection, the MRI of all 20 femora showed an inhomogeneous, low signal intensity area in the femoral head, and at 16 weeks, the findings of all 10 femora showed a specific ＂line-like sign＂. The MRI findings of all femora in Group B were normal. Conclusion： MRI is a highly sensitive means of diagnosing early experimental osteonecrosis of the femoral head. However, the abnormal marrow tissues appeared later than 4 weeks when the expression of IGF-Ⅰ increased. This reparative factor has an early and important role in response to steroid-induced osteonecrosis of the femoral head, and provides a theoretical foundation for understanding the pathology and designing new therapies.     

激素性兔股骨头坏死的动物模型研究

目的研究内毒素脂多糖（LPS）＋甲基强的松龙（MPSL）兔股骨头坏死模型的组织学、Micro-CT及免疫组化特点。方法22只新西兰兔静脉注射LPS10μg/kg,24h后肌注MPSL20mg/kg,1次/d,共3d。存活动物6周观察Micro-CT骨计量学、组织病理学等项目,并与20只未用药新西兰兔对比。结果LPS＋MPSL造模后动物死亡2只,存活动物的骨坏死率为80.0%（16/20）,骨陷窝空虚率为（33.6±2.4）%;Micro-CT骨计量学各项指标显著低于对照组,组织病理学显示造模组出现明显骨坏死灶。结论LPS与MPSL联合应用可有效建立骨坏死模型。     

基于视觉化工具库的股骨头坏死图像三维重建及坏死体积测量研究

目的 通过使用可视化工具包视觉化工具库(VTK)的二维轮廓线的表面重建算法,在VC++的编译环境下实现对股骨头的三维表面重建,并计算股骨头坏死体积及坏死区域,建立坏死评分,并验证其准确性.方法 应用数字化可视人体数据获取技术,对股骨头坏死患者的股骨头进行计算机三维重建,并通过建立股骨头坏死体积及坏死区域计算公式进行坏死评分估算.收集30例股骨头标本随机分为两组,与股骨头实体及病理标本进行测量对比,从而验证基于VTK的股骨头坏死三维CT诊断分析系统的可行性.结果 基于VTK所重建出股骨头的三维立体图,不仅能任意旋转,而且能估算出股骨头坏死体积的大小,并能确切地区分出为哪一区域,所占的体积比为多少,通过本系统测量的坏死体积与实体标本及病理标本测量所得结果差异均无统计学意义(均P ＞0.05).结论 本研究以可视化工具包VTK为基础,实现了对人体股骨头可视化三维重建,并能计算出股骨头坏死评分,为进一步深入研究股骨头塌陷的预测,同时为股骨头坏死的辅助诊断和手术治疗提供了参考.     

双极人工股骨头置换术治疗高龄股骨颈骨折

目的 通过对６６例７０岁以上老年人股骨颈骨折临床分析,探讨其手术可行性、术式选择。方法 回顾分析患者的术前并存症、术前准备、术式选择、麻醉方式、术中情况、术后处理及随诊情况。结果 本组无术中死亡病例,平均住院２８天,平均随访２６个月。良好率６３．６％。结论 ７０岁以上老人股骨颈骨折行双极股骨头置换术治疗是可行的。     

经皮髋关节腔及股骨头髓腔减压治疗股骨头缺血坏死的疗效分析

目的：探讨髋关节腔及股骨头髓腔联合减压治疗股骨头缺血坏死(ANFH)的疗效。方珐：对41例66个股骨头缺血坏死的病例行髋关节腔减压术和股骨头髓腔减压术。结果：均随访1年，ANFHⅡ、Ⅲ期患者的54个髋关节中：优，38个髋关节，占70．4％；良，14个髋关节，占25．9％；中，2个髋关节，占3．7％，优良率为96．3％。ANFH Ⅳ、V期患者的12个髋关节中：良，3个髋关节，占25．0％；中，7个髋关节，占58．3％；差，2个髋关节，占16．7％，优良率为25．0％。结论：行髋关节腔及股骨头髓腔减压治疗股骨头缺血坏死可以有效地缓解疼痛，改善Ⅱ、Ⅲ期股骨头坏死患者髋关节的功能。