高压氧治疗激素性股骨头坏死的血液流变学改变与意义

目的:观察血液流变学在激素性股骨头坏死造模及高压氧治疗过程中的阶段性变化,探讨激素性股骨头坏死的发病机理。方法:健康日本成年大耳白兔60只,随机分模型组(42只)及对照组(18只)。模型组每周2次肌肉注射醋酸泼尼松龙10 mg/kg,对照组每周2次肌肉注射生理盐水2 ml,共6周。随后将模型组随机分高压氧治疗组(16只)及对照组(16只),治疗组行高压氧治疗,对照组呼吸常压新鲜空气。检测实验后2,4,6,8,10,12周兔血液流变学参数变化、组织病理学变化及影像学变化。结果:模型组实验2,4,6周全血黏度,血浆黏度均显著高于对照组;模型组股骨头骨质疏松,光镜下空骨陷窝数增多,脂肪细胞数增多,部分骨小梁断裂,透射电镜股骨头骨细胞体积缩小,核固缩,较多骨细胞已坏死溶解成碎片。高压氧治疗组全血粘度,血浆黏度均低于对照组,光镜下可发现坏死的骨细胞有修复现象,透射电镜可见新生骨细胞。结论:大剂量激素可造成兔血流变学特性恶化,可能是兔股骨头坏死的重要原因,高压氧可使恶化的血液流变学趋向好转,对股骨头坏死有治疗作用。

Hemorrheologic Changes in Steroid-induced Avascular Necrosis of Femoral Head After Hyperbaric Oxygen Treatment

Objective: To investigate the hemorheologic changes in different stages of in the steroid-induced avascular necrosis of femoral head after hyperbaric oxygen treatment,and to explore the pathogenesis.Methods: Sixty adult Japanese rabbits were randomly divided into two groups as model group(n=42) and blank control group(n=18).Prednisolone acetate at 10 mg/kg for twice per week was injected in each rabbit of the model group,while in the control group the normal saline was injected for six weeks.Then,rabbits in the model group were randomized into hyperbaric oxygen(HBO) group(n=16) and model control group without HBO treatment(n=16).At the end of 2,4,6,8,10,12 weeks,hemorheologic and pathological changes of femoral head in light microscope,electron nicroscope or X-ray were observed.Results: At the end of the 2nd week,4th week and 6th week,blood viscosity and plasma viscosity in model group were higher than those in control group.Osteoporosis of the femoral head,increased numbers of empty bone lacunae and fat cells,shrinked nuclei,dissolved osteocytes and fragments were observed under electron microscope in the model group.In the HBO treatment group,the above changes were less than in the model control group.Conclusion: The large dosage of hormone could cause the characters of hemorrheology get worse,which may be the cause of avascular necrosis of femoral head.