介入配合骨复活汤对激素性股骨头缺血性坏死股骨头局部血管内皮生长因子表达的影响

目的：观察股动脉药物灌注配合骨复活汤治疗实验性激素性股骨头缺血性坏死（SANFH）股骨头局部血管内皮生长因子（VEGF）的表达。探讨介入配合骨复活汤对骨坏死再血管化和再骨化的机理。方法：新西兰兔24只，利用大肠杆菌内毒素和大剂量甲基强的松龙造成兔股骨头坏死模型，造模后第2周随机分为3组：介入组：经左侧股动脉注射尿激酶3万U和丹参注射液2mL；介入配合骨复活汤组：给药同介入组，同时每天给予骨复活汤灌胃给药；对照组：经股动脉注射生理盐水4mL。在治疗后4周，对股骨头标本进行VEGF免疫组化染色。计数VEGF阳性成骨细胞率、阳性软骨细胞率和阳性血管率，并进行统计学分析。结果：介入配合骨复活汤组比介入组能提高VEGF阳性成骨细胞率、阳性软骨细胞率和阳性血管率（P〈0．05），改善骨坏死。结论：介入配合骨复活汤能改善骨坏死，其机理在于促进VEGF等细胞因子的分泌从而加速股骨头的再血管化和再骨化进程。

Effect of Interventional Therapy Combined with Gu Fuhuo Decoction on Expression of Vascular Endothelial Growth Factor in Rabbits with Steroid -induced Avascular Necrosis of Femoral Head

Objective: To observe the expression of vascular endothelial growth factor(VEGF) in rabbits with steroid-induced avascular necrosis of femoral head(SANFH) after medicine intervention through femoral artery and oral use of Gu Fuhuo Decoction,and to explore the mechanism of interventional therapy combined with Gu Fuhuo Decoction for affecting the revascularization and re-ossification in the femoral necrosis.Methods:SANFH was induced in 24 New Zeland rabbits by the method of Shwartzman reaction and large-dose methylprednisolone(MP).On the second day of modeling,the rabbits were randomly divided into 3 groups,the intervention group(injection of 30 000 unit of urokinase and 2 mL of Danshen Injection though the left femoral artery),combination group(oral use of Gu Fuhuo Decoction every day on the basis of the treatment for intervention group),and model group(injection of 4 mL of normal saline through the left femoral artery).After treatment for 4 weeks,the VEGF positive ratios of osteoblasts,chondrocytes and blood vessels of the femoral head were observed through immunohistochemical staining.Results:Interventional therapy combined with Gu Fuhuo Decoction increased the VEGF positive ratios of osteoblasts,chondrocytes and blood vessels of the femoral head and relieved osteonecrosis,the effect being superior to that of interventional therapy alone(P < 0.05).Conclusion:The therapeutic mechanism of interventional therapy combined with Gu Fuhuo Decoction for SAFNH is probably related with enhancing revascularization and re-ossification in the femoral head necrosis through promoting the excretion of VEGF.