激素性骨坏死发病机理的实验研究

目的 :研究激素与血管炎、血液黏度间的相互关系 ,进一步探究激素性骨坏死的发病机理。方法 :选新西兰白兔 6 0只。A组 :2 0只 ,经静脉 2次单纯注射马血清 10ml/kg ,间隔 3wk。B组 :15只 ,连续 3d腹腔内注射甲基强的松龙 45mg/kg。C组 :2 0只 ,先静脉 2次注射马血清 10ml/kg ,间隔 2wk。第 2次注射马血清后 2wk ,再按B组处理。D组 :5只 ,对照组。分别于最后一次给药后 1、2、3、5、7wk处死取材。标本常规组织病理学检查 ,并进行血液流变学及动脉墨汁灌注观察。结果 :在马血清和激素协同作用的C组中 ,表现为全血黏度、血浆黏度、红细胞聚集性明显增高 ,股骨头内小动脉损害严重 ,血栓形成广泛 ,软骨下灌注血管数量减少明显 ,共有 74%标本发生骨坏死。结论 :在血管炎基础上应用激素加重了微血管损伤 ,促进了血液高黏、高凝状态 ,在小动脉断裂、栓塞、出血的基础上导致骨组织缺血性坏死。

EXPERIMENTAL STUDY ON PATHOGENESIS OF STEROID-INDUCED OSTEONECROSIS

Objective:To study the relationship between corticosteroid and vasculitis,blood viscosity,to further investigate the pathogenesis of steroid-induced osteonecrosis.Methods:60 rabbits were divided into four groups.Group A(20) was received 10ml/kg of horse serum intravenously two times at three week intervals.Group B(15) was received an intraperitoneal injection of 45 mg/kg of methylprednisolone acetate for three consecutive days.Group C(20) was treated with a combination of the protocols for group A and group B.Group D(5) was used as the control.These rabbits were killed respectively one,two,three,five,seven weeks after their final treatment.Results:The findings of artery perfusion and histological studying showed that vascular wall of the arterioles was severely impaired,multiple thrombi came into being,the number of perfusion vascular decreased significantly and 74% rabbits developed osteonecrosis in group C.Findings of hemorheological measurement showed the state of blood hyperviscosity in group C.Conclusion:Steroid caused avascular osteonecrosis of femoral head under blood vessels rupture,thromboembolism,hemorrhages.