酒精性和激素性股骨头坏死的发病与脂质代谢

背景：非创伤性股骨头坏死的发病机制存在各种理论学说,脂质代谢异常是其中一种假说,但是脂质代谢如何参与骨坏死的发病机制仍不清.目的：通过对激素性和酒精性骨股头坏死患者血脂改变及股骨头置换标本形态计量学观察分析,探讨脂质代谢改变在非创伤性骨坏死中的作用.方法：选择股骨头坏死住院患者162例,包括酒精性骨股头坏死57例,激素性骨股头坏死63例,创伤性骨股头坏死42例,其国际骨循环分期为（ARCO）Ⅱ～Ⅳ期.患者入院后常规抽空腹静脉血行三酰甘油、低密度脂蛋白等血脂检测.各组选取12例关节置换股骨头标本,股骨头冠状面正中剖开,在负重区和非负重区取材,对骨髓造血面积、脂肪细胞密度、脂肪细胞直径和脂肪细胞面积等行形态计量学观察.结果与结论：酒精性股骨头坏死患者血三酰甘油升高率显著高于激素性和创伤性股骨头坏死患者（P 〈 0.05）.酒精性股骨头坏死患者血低密度脂蛋白降低率明显高于激素性和创伤性股骨头坏死（P 〈 0.05）.与激素性骨坏死患者相比,酒精性股骨头坏死患者脂肪细胞面积和脂肪细胞直径大,但造血面积减小,且差异有显著性意义.推测脂质代谢改变在酒精性股骨头坏死晚期起重要调节作用,而在激素性股骨头坏死晚期作用不明显.

Mechanism of lipid metabolism in alcohol-induced and steroid-induced osteonecrosis of the femoral head

BACKGROUND：There are various theories about the pathogenesis of non-traumatic femoral head necrosis,and lipid metabolism is just a hypothesis,but how to participate in the pathogenesis of osteonecrosis is still unclear.OBJECTIVE：To observe the change of lipid and histomorphometric index in patients with alcohol-and steroid-induced osteonecrosis of the femoral head,to explore the mechanism of lipid metabolism in non-traumatic osteonecrosis of the femoral head.METHODS：162 ARCO a!-c! cases of osteonecrosis of the femoral head were selected in the experiment,including 57 cases of alcohol-induced osteonecrosis,63 cases of steroid-induced osteonecrosis,and 42 cases of traumatic osteonecrosis.Blood tests for lipids were made for all patients,including triglyceride（TG）,low density lipoprotein（LDL）,etc.Parts of the femoral head after hip replacement were selected for the study,namely 12 cases in each group.The femoral heads were cut along the middle coronal plane,their weight-bearing and non-weight-bearing areas were processed by routine HE staining,then to analysis the area of the bone marrow,fat cell density,fat cell diameter and fat cell size in each group.RESULTS AND CONCLUSION：Increased rate of TG in alcohol-induced patients was significantly higher than those in steroid-induced osteonecrosis and,traumatic osteonecrosis.（P 0.05）;The decreased rate of LDL in alcohol-induced osteonecrosis was significantly higher than those in steroid-induced osteonecrosis and traumatic osteonecrosis（P 0.05）.Compared to the patients with steroid-induced osteonecrosis of the femoral head,the area and diameter of fat cell were larger in alcohol-induced patients,but the blood area was smaller,and there was significant difference between the two groups.Whether in weight-bearing area or in non-weight-bearing area,there was insignificant difference with histomorphometric indexes between alcohol-induced and steroid-induced patients,including blood area,fat cell density,diameter and size of fat cells.The changes of lipid metabolism play an important regulatory role in the late period of alcohol-induced osteonecrosis of the femoral head,but do not play a regulatory role in the late period of steroid-induced osteonecrosis of the femoral head.