99Tc-亚甲基二膦酸盐治疗股骨头坏死动物研究及初步临床应用

目的 地塞米松诱导兔股骨头坏死后用^99Tc-亚甲基二膦酸盐治疗并观察疗效，以供初步临床应用于中、晚期股骨头无菌性坏死参考，了解^99Tc-亚甲基二膦酸盐的治疗价值。方法 新西兰白兔33只为动物模型制作材料，其中18只采用注射地塞米松针剂建立股骨头坏死模型，模型建立后分成3组，每组6只；正常对照组、股骨头坏死模型组和股骨头坏死模型^99Tc-亚甲基二膦酸盐治疗组。^99Tc-亚甲基二膦酸盐治疗14周后取实验兔股骨头作病理切片,分析^99Tc-亚甲基二膦酸盐治疗前、后股骨头X线、CT摄片、^99Tc-MDP骨显像检查结果。临床明确诊断为股骨头无菌性坏死患者67例，分为^99Tc-亚甲基二膦酸盐治疗组39例和传统保守治疗对照组28例。治疗40周后比较^99Tc-MDP骨显像、X线摄片、CT检查，同时结合患者的症状作出综合评价。结果采用肌肉注射地塞米松针剂4周的新西兰白兔病理证实股骨头骨质疏松伴坏死模型成立。在^99Tc-亚甲基二膦酸盐治疗前、后时间内取各组实验兔股骨头X线、CT摄片、^99Tc-MDP骨显像和病理分析比较：正常对照组无变化，股骨头坏死模型组对照组股骨头骨质疏松加重，模型^99Tc-亚甲基二膦酸盐治疗组的股骨头骨质疏松有较明显的改善。临床所采用^99Tc-亚甲基二膦酸盐治疗组40周随访结果：^99Tc-亚甲基二膦酸盐治疗组中6例改善，31例稳定，仅2例无效。常规保守治疗对照组6例稳定，19例无效，仅3例改善。结论 ^99Tc-亚甲基二膦酸盐是一种核素锝-99(^99Tc)标记二膦酸盐的化合物，动物试验结果显示对骨质疏松有较明显的稳定病情发展和镇痛作用，部分有修复作用。初步临床应用表明：^99Tc-亚甲基二膦酸盐治疗组与传统保守治疗对照组比较，前者治疗骨头无菌性坏死疗效较明显。

The animal experiment and preliminary study of femur head necrosis treated by 99Tc-MDP

Objective 99Tc-MDP was used to treat aseptic necrosis of femur head of rabbit model induced by DXM.The result was refered to clinical trial in the theatment of middle and late stage aseptic necrosis of femur head in order to understand its value.Methods Thirty-three New Zealand rabbits were chosen as the animal model.Eighteen of them were made into femur head necrosis model by injecting DXM. All animal models were divided into 3 groups with 6 in each:normal group,femur head necrosis group and 99Tc-MDP therapy group.Forteen weeks after therapy,the pathology of femur head was studied. Bone X-ray radiograph,CT and 99mTc-MDP bone scan were tested before and after 99Tc-MDP therapy.Sixty-seven cases of clinical diagnosed aseptic necrosis of femur head patients were separated into 99Tc-MDP therapy group(39 cases) and traditional conservative therapy group(28 cases).After 40 weeks of 99Tc-MDP therapy,99mTc-MDP bone scan,X-ray radipgraph,CT were compared together with clinical symptoms to get a comprehensive evaluation.Results Pathology study proved that the osteoporosis animal model was successfully set up after 4 weeks' injection of DXM.Before and after 99Tc-MDP therapy,the femur heads of animal models were studied and compared by X-ray radiograph,CT,99mTc-MDP bone scan and pathology. The result showed no change in normal control group,but aggravated in femur head necrosis group and improved in 99Tc-MDP therapy group. The clinical result of 99Tc-MDP therapy after 40 weeks showed that 6 cases were improved and 31 were stable and only 2 cases had no effect in 99Tc-MDP therapy group.In conservative therapy group,19 cases showed no effect and only 3 cases were improved.Conclusion 99Tc-MDP is a compound of technetium-99 labeled biphosphonate.Animal experiment showes that it has remarkable effect on osteoporosis.Preliminary clinical study also demonstrates its apparent therapeutic effect on aseptic necrosis of femur head compared with traditional conservative therapy.