活血健骨汤对兔缺血性股骨头坏死的血液流变性和血脂的作用

自１９５７年Ｐｉｏｔｒｏｇｒａｄ等首次报道激素所致股骨头缺血性坏死（Ａｖａｓｃｕｌａｒｎｅｃｒｏｓｉｓｏｆｆｅｍｏｒａｌｈｅａｄ,简称ＡＮＦＨ）以来,引起医学界的广泛重视,激素短期大剂量或长期使用均可引起此病［１］,Ｊｏｎｅｓ等在作了大量研究基础上提出的脂质代谢紊乱学说［２］,目前得到了大多数学者的认可和接受。本研究针对ＡＮＦＨ的发病特点,应用自拟经验方“活血健骨汤”进行了动物实验观察,现初步报道如下。１　材料与方法１．１　实验材料动物：选用健康日本大白兔１８只,４月龄,体重２．０±０．３１ｋｇ…     

家兔激素性股骨头坏死的血液流变学改变及意义

目的：血液流变学改变在家兔激素性股骨头坏死发病机制中的作用。方法：雄性家兔30只,随机分为激素组（短期注射地塞米松）及对照组（注射生理盐水）,观察血清总胆固醇（TC）、甘油三脂（TG）血流流变学参数、免股骨头骨陷窝空虚率的阶段性变化。结果：实验15、30d,激素组的TG、TC、全血粘度,血浆粘度显著高于对照组,实验60d,激素组血清TC、血浆粘度仍然显著高于对照组。激素组合35、70d双侧股骨头骨陷窝空虚率均显著高于对照组,结论：地塞米松冲击应用可造成家兔血液流变特性恶性化,可能是激素性股骨头坏死的重要原因。     

激素性股骨头坏死与纤溶功能及血液流变性的实验研究

目的 :探讨纤溶功能紊乱和血液高粘滞性在激素性股骨头坏死中的作用。方法 :在家兔皮下注射地塞米松 (实验 1组 )、地塞米松加血速宁 (实验 2组 )后 ,动态观察 15日、3 0日、60日t PA和PAI、t PA/PAI、全血粘度和血浆粘度的变化。结果 :实验 1组t PA/API比值在实验 15日与对照组无显著差异 (P >0 .0 5) ,在实验 3 0日下降至 1/8,在 60日t PA/PAI比值有所增加 ,但仍显著低于对照组 (P <0 .0 1) ;实验 2组在实验第 15日 ,t PA/PAI比值显著低于实验 1组 (P <0 .0 1) ,在实验第 3 0日与实验 1组无显著差异 (P >0 .0 5) ;血液高切粘度、低切粘度、血浆粘度在实验第 15日均高于对照组 (P <0 .0 1) ,以后逐渐下降 ,在 60日各指标与对照组无显著差异 (P >0 .0 5)。结论 :股骨头缺血坏死可能与血液纤溶功能紊乱、血液的高粘滞性等因素造成的微循环障碍有关     

兔激素性股骨头坏死的血液流变学改变

目的　探讨血液流变学指标在激素性股骨头坏死过程中的变化规律及其作用。方法　20只兔随机分成2组，每组10只。A组（激素性股骨头坏死动物模型组）：间隔24h耳缘静脉内2次注射大肠杆菌内毒素，每次40μg/kg，注射内毒素后注射醋酸泼尼松龙20mg/kg。B组（正常对照组）。两组分别在注射后24h、72h、7d、14d 及21d，进行血浆黏度、全血黏度、血小板计数及血脂测定，21d取股骨头和肝脏行病理组织学观察。结果　A组用药后24h血浆黏度、全血黏度升高，血脂升高(P<0.01)血小板计数减少(P<0.01)，用药后72h、7d、14d 及21d，持续异常，与B组相比差异显著。A组21d时病理切片见股骨头骨细胞和肝细胞变性、坏死。结论　在激素性股骨头坏死动物模型中，血液流变学指标异常在引起血栓前状态，形成血栓导致骨坏死过程中可能发挥了重要作用。     

股骨头缺血性坏死的病理观察

对75例股骨颈骨折后的股骨头和3例正常股骨头进行了病理学观察。结果表明:①股骨颈骨折后股骨头缺血坏死的病理改变随其病期变化而异。缺血早期,骨细胞可无明显变化或仅有散在性丧失,易与正常股骨头骨细胞的生理性缺失相混淆,并提出了鉴别要点。②坏死区常伴有骨髓腔出血,不同坏死分级髓腔出血发生率的差别有高度显著性(P<0.01),以广泛坏死组的发生率最高,提示髓腔出血与坏死的发生和发展有一定关系。③后期塌陷的股骨头表现为广泛性坏死和不同程度的机化或纤维化,但负重面软骨下坏死区新骨形成很少。探讨了坏死区骨性重建障碍的病理机制。     

股骨头缺血性坏死塌陷预测的生物力学研究

目的：探索不同部位囊性变对股骨头缺血性坏死的生物力学影响，为预测股骨头的塌陷和指导临床治疗方法的选择提供基础。方法：取新鲜股骨上段标本，行螺旋CT断层扫描，所得图像用Efilm软件系统处理，利用Ansys-5．7大型计算机软件建立股骨上段三维有限元异物同构模型，模拟股骨头内囊性变。施加3种不同载荷，分析股骨头内应力分布情况。结果：股骨头受压后，中央区域表现为压应力，而前方和后方区域则表现为张力，符合球体受压后的膨胀趋势。股骨头负重区下方及其内侧和外侧的囊性变应力集中最明显，易引起股骨头塌陷。当囊性变位于股骨头的前方、后方、中心和下方时，其上下缘的应力集中不是很明显，股骨头塌陷断裂风险不大。结论：股骨头内不同部位的囊性变对股骨头缺血性坏死的生物力学影响是不同的，三维有限元应力分析法可以预测坏死股骨头的塌陷，并指导临床选用适当的显微外科治疗方法。     

微循环障碍与激素性股骨头坏死相关性实验研究

目的 研究激素性股骨头坏死的发病原因。方法 用糖皮质激素诱导出股骨头缺血坏死的兔子模型,对比检测实验组和对照组的微循环状况以及与微循环有关的毛细血管内血液的流速,血液粘滞度,成份改变和病理组织学改变,弄清发病的主要相关因素。结果 实验组毛细血管中红细胞聚集,血液流速明显缓慢;血脂、血浆蛋白含量增高;股骨头内毛细血管数量减少,血管襻迂曲变长。结论 激素性股骨头缺血坏死的发病与微循环障碍有明显的关系。     

缺血性脑血管病的血液流变性改变

<正> 缺血性脑血管病(ICVD)发病率,致残率和死亡率均很高。动脉硬化、高血压、高脂血症、糖尿病等作为ICVD的易患因素已基本肯定。血液流变性异常在其中的作用越来越受到重视。许多研究均提示ICVD患者血液存在明显“浓、粘、凝、聚化”并提出血液流变性改变是ICVD重要危险因素之一。针对此病因的防治手段也逐渐增多。     

记忆合金网球支架治疗成人股骨头缺血性坏死的生物力学研究

目的：对比研究单纯髓芯减压、髓芯减压＋松质骨移植、髓芯减压＋松质骨移植＋记忆合金网球植入治疗成人股骨头缺血性坏死的生物力学行为。方法：取新鲜人股骨头0根，模拟髓芯减压松质骨移植治疗股骨头缺血性坏死的方法做成髓芯减压后的状态，用MTS生物力学实验机测得每例标本在单纯减压、减压值及植骨＋网球三种状态下的力学刚度，对其结果进行统计学分析。结果：单纯髓芯减压组和髓芯减压＋松质骨移植组统计学无明显差异，髓芯减压＋松质骨移植＋记忆合金网球植入优于前两种状态。结论：镍钛记忆合金网球植入增加了股骨头负重区软骨下骨的机械支撑，降低局部应力有利于股骨头坏死的修复与重建。     

股骨头缺血性坏死的影像学研究现状及进展

成人股骨头缺血性坏死是常见疾病,早期诊断和疗效评估是其重要的诊疗行为,多种影像学技术的应用为其诊疗提供了重要依据。本文对成人股骨头缺血性坏死不同影像学技术的相关文献进行综述,包括X射线,计算机断层扫描（CT）,核磁共振成像（MRI）技术。分析在股骨头缺血性坏死的诊断中不同影像学技术的优缺点、对临床诊疗的作用以及研究现状和进展。     

体外冲击波疗法结合同种异体骨钉治疗成人股骨头缺血性坏死

目的探讨体外冲击波疗法（ESWT）结合同种异体骨钉治疗成人股骨头缺血性坏死的疗效。方法2003年7月～2007年1月,采用体外冲击波或结合同种异体皮质骨钉植入术治疗54例（84髋）股骨头缺血性坏死患者并随访观察。男41例,女13例;年龄20～61岁,平均30岁。按Ficat分期,Ⅱ期55髋,Ⅲ期29髋。其中40髋（Ⅱ期27髋,Ⅲ期13髋）,采用ESWT结合同种异体骨钉治疗,治疗后6、12、24个月复查双髋X线、MRI及髋关节Harris评分（HHS）。44髋（Ⅱ期28髋,Ⅲ期16髋）患者采用单纯ESWT治疗。对两组治疗结果进行统计学分析。结果随访24～29个月,平均25．7个月。二者治疗后Harris评分分别为83．71±18．76和57．20±12．82,二者比较差异有统计学意义妒〈0．01）：影像学X光片评估：ESWT结合同种异体骨钉术后随访股骨头塌陷12髋,塌陷率为30％,单纯ESWT治疗随访股骨头塌陷25髋,塌陷率为56．8％。结论体外冲击波疗法结合同种异体骨钉是治疗中期ONFH的方法之一,它不但具有冲击波疗法促进骨愈合作用,而且复合骨钉移植可起到骨传导及骨支撑作用,近期可以减少股骨头塌陷发生。     

ARCO Consensus on the Pathogenesis of Non-traumatic Osteonecrosis of the Femoral Head

Osteonecrosis of the femoral head (ONFH) is a devastating disease frequently leading to femoral head collapse and hip arthritis. Specifically, non-traumatic ONFH primarily affects young and middle-aged adults. Although compromised local circulation of the femoral head seems to be pathognomonic for the disease, the pathogenesis is perplexing and continues to be an area of scrutiny and research. Comprehension of the pathogenesis is of crucial importance for developing and guiding treatments for the disease. Therefore, we provide an up-to-date consensus on the pathogenesis of non-traumatic ONFH.     

A Canine Model of Femoral Head Osteonecrosis Induced by an Ethanol Injection Navigated by a Novel Template

There is no consensus on how to establish models of osteonecrosis of the femoral head (ONFH) in large mammals. The aim of this study was to investigate the effectiveness of a novel canine model of ONFH, induced by a navigated injection of absolute ethanol. Using three-dimensional reconstruction and rapid prototyping manufacturing techniques, a new template was designed and processed to navigate the ethanol injection. The femoral heads of 18 adult dogs were injected with ethanol. Macroscopic, X-ray and histological examinations were performed at 3, 6, and 9 weeks after the operation. Further, computed tomography (CT), magnetic resonance imaging (MRI), and radionuclide scans were performed 6 weeks postoperatively. Three weeks after the operation, the femoral heads showed evidence of osteonecrosis including increasing numbers of empty lacunae, decreased hematopoietic cells, and destroyed adipose tissue in the medullary cavity, which increased in severity at the subsequent follow-up evaluations at 6 and 9 weeks. Fractured trabeculae and fibrous tissue were noted 9 weeks postoperatively. Image analysis also revealed evidence of osteonecrosis, such as several osteopenic areas with sclerotic rims on the X-ray, several areas of low bone mineral density with sclerosis on the CT scan, increased uptake of the nuclide species in MRI, and an inhomogeneous long T2 signal on the radioisotopic images. Ethanol injection navigated by our novel template was successful in establishing a canine model of ONFH. This model can be used to test new treatment modalities for human ONFH.     

Preclinical Study of Cell Therapy for Osteonecrosis of the Femoral Head with Allogenic Peripheral Blood-Derived Mesenchymal Stem Cells

PurposeTo explore the value of transplanting peripheral blood-derived mesenchymal stem cells from allogenic rabbits (rPBMSCs) to treat osteonecrosis of the femoral head (ONFH).ResultsAfter mobilization, the cultured rPBMSCs expressed mesenchymal markers of CD90, CD44, CD29, and CD105, but failed to express CD45, CD14, and CD34. The colony forming efficiency of mobilized rPBMSCs ranged from 2.8 to 10.8 per million peripheral mononuclear cells. After local transplantation, survival of the engrafted cells reached at least 8 weeks. Therein, BMP-2 was up-regulated, while PPAR-γ mRNA was down-regulated. Additionally, bone density and bone trabeculae tended to increase gradually.ConclusionWe confirmed that local transplantation of rPBMSCs benefits ONFH treatment and that the beneficial effects are related to the up-regulation of BMP-2 expression and the down-regulation of PPAR-γ expression.     

股骨头坏死松质骨生物力学特征的空间分布规律

目的 探究股骨头坏死松质骨微观结构参数和力学性能的空间分布规律,为临床诊断中科学评估病灶对病情的影响提供理论依据。方法 结合影像学测量和数值模拟方法,定量分析不同区域松质骨的微观结构参数和力学性能,分别从冠状面、矢状面和水平面投影方向上探究松质骨生物力学特征的空间分布特点。结果 在股骨头冠状面和矢状面投影方向上,松质骨的微观结构特征与力学性能大致呈Y型分布,Y形区域内松质骨的力学性能高于其他区域,该分布特点与股骨头内的主压应力束的位置相吻合。结论 位于股骨头Y形区域内的坏死灶对股骨头内应力分布的影响程度会更大,更有可能导致病情恶化。临床诊断中应充分考虑坏死灶和Y形区域的位置关系。     

骨水泥对兔股骨头微循环影响的实验研究

目的:探讨股骨头内甲基丙烯酸甲酯(骨水泥)注入对正常股骨头微循环影响.方法:选用纯种中国大白兔30只,左侧股骨头内注入骨水泥为实验组,右侧为穿刺对照组.分别于术后4周、8周、12周各取10只动物进行墨汁灌注及股骨头标本采集.显微镜下观察骨水泥注射后股骨头内骨水泥-骨组织学形态;每个标本切片取10个低倍视野,对微血管数计数.采用SPSS12.0软件做统计分析.结果:大体观察两组股骨头外形圆而光滑,关节软骨无剥脱及变性;实验组股骨颈断面可见骨水泥嵌入骨小梁之间.骨水泥注入后沿骨小梁间隙浸润,挤占骨小梁间隙内空间,骨水泥与正常骨小梁组织成为一种嵌合状态.实验组术后4周时位于骨小梁间隙内的微血管由于与骨水泥接触密切,数目明显减少,术后8周时开始逐渐恢复,术后12周时明显增多;对照组术后骨小梁间隙内微血管数目无明显变化.结论:骨水泥注入股骨头后由于化学及热烧伤作用,初期对股骨头内骨小梁表面造成了一定程度的损伤,导致微血管数减少,随着时间的延续,微血管数目恢复,股骨头的血液供应也得到了恢复.     

三维重建及有限元分析预测股骨头坏死塌陷

通过三维重建技术对坏死股骨头的MRI影像进行重构，获得坏死股骨头的三维几何模型，并由几何模型测量得到股骨头及坏死病灶的体积；同时进行临床实验获得真实坏死股骨头的体积数据。通过对38例患者股骨头的计算机模型和数据与临床实验数据的统计分析，讨论了股骨头坏死病灶大小和部位与股骨头塌陷的关系。然后根据股骨头的坏死区域与所受载荷大小不同，共进行了15组的股骨头受力有限元分析，对坏死股骨头的塌陷情况作了验证。结果表明，本研究提供了一种有效的方法，指导临床选择最佳的治疗方案。     

Clinical Results of Auto-Iliac Cancellous Bone Grafts Combined with Implantation of Autologous Bone Marrow Cells for Osteonecrosis of the Femoral Head: A Minimum 5-Year Follow-Up

Purpose

There are no reports about bone graft and cell therapy for the osteonecrosis of femoral head (ONFH). We prospectively evaluated the clinical results of auto-iliac cancellous bone grafts combined with implantation of autologous bone marrow cells for ONFH.

Materials and Methods

Sixty-one hips in 52 patients with ONFH treated with bone graft and cell therapy were enrolled, and the average follow-up of the patients was 68 (60-88) months. Necrotic lesions were classified according to their size by the Steinberg method and location of necrosis.

Results

At the last follow-up, the percentage of excellent or good results was 80% (12/15 hips) in the small lesion group, 65% (17/26 hips) in the medium size group, and 28% (6/20 hips) in the large size group. The procedures were a clinical success in 4 of 5 hips (80%) of stage I, 23 of 35 hips (65.7%) of stage II, 7 of 18 hips (38.9%) of stage III, and 1 of 3 hips (33.3%) of stage IV grade, according to the Association Research Circulation Osseous grading system. Among the 20 cases with large sized necrotic lesions, 17 cases were laterally located and this group showed the worst outcomes, with 13 hips (76.5%) having bad or failed clinical results.

Conclusion

The results of the present study suggested that patients who have a large sized lesion or medium sized laterally located lesion would not be good candidates for the head preserving procedure. However, for medium sized lesions, this procedure generated clinical results comparable to those of other head preserving procedures.