摘要
背景:目前关于激素性股骨头缺血性坏死的研究多集中在治疗已形成的坏死,对在使用激素过程中如何预防股骨头坏死,报道较少。目的:观察激素性股骨头坏死预防性给药对股骨头组织结构和血流量的影响。设计:随机对照实验。单位:韶关学院医学院药学教研室和解剖学教研室;广东省粤北人民医院核医学科。材料:成年新西兰大白兔30只,雌雄不拘,体质量(2.5±0.5)kg。方法:实验于2005-04/07在韶关学院医学院中心实验室、广东省粤北人民医院核医学科和中山大学北校区电镜室完成。①30只兔随机分为3组,每组10只。对照组肌注生理盐水1mL/kg,2次/周,生理盐水10mL/d灌胃;激素组肌注地塞米松磷酸钠注射液1mL/kg,2次/周,生理盐水10mL/d灌胃;治疗组肌注地塞米松磷酸钠注射液1mL/kg,2次/周,从注射地塞米松第1天开始每天灌喂血塞通25mg/kg、脂必妥350mg/kg和阿仑膦酸钠5mg/kg。连续用药8周。②停药1周后3组动物同时采用放射性微球技术测量股骨头血流量;光镜及电镜观察组织学改变。主要观察指标:①各组兔股骨头血流量。②各组兔股骨头软骨组织形态及超微结构。结果:①治疗组血流量显著多于激素组(0.261±0.042),(0.197±0.053)mL/(min·g),q=6.10,P<0.01,与对照组(0.243±0.039)mL/(min·g)比较差异无显著性意义。②治疗组空骨陷窝显著少于激素组(15.22±5.49),(24.78±7.87)个,q=6.35,P<0.01,与对照组(10.38±3.78)个比较差异无显著性意义。③治疗组细胞正常,内质网丰富,细胞核呈正常形态;激素组骨细胞体积缩小,核固缩,染色质边聚,骨陷窝扩大。结论:在长程使用类固醇激素同时应用血塞通、脂必妥和阿仑膦酸钠可提高股骨头血流量,改善骨组织结构,预防或减缓激素性股骨头坏死。
BACKGROUND： At present; the researches on steroid-induced avascular necrosis of the femoral head are mostly concentrated on the treatment of formed necrosis. And there are fewer reports on how to prevent the ostoenecrosis of the femoral head in the course of steroid therapy.
OBJECTIVE： To observe the effect of preventive medication on femoral head structure and blood flow in steroid-induced osteonecrosis.
DESIGN： Randomized controlled experiment.
SETTING： Department of Pharmacology, Department of Anatomy, Medical College of Shaoguan University; Department of Nuclear Medicine, Guangdong Province Yuebei People＇s Hospital.
MATERIALS： Thirty adult New Zealand rabbits of either sex, whose body mass was （2.5±0.5） kg.
METHODS： The experiment was carried out in the Central Laboratory, Medical College of Shaoguan University, the Department of Electron Microscope, the Northern Campus of Guangzhou, Sun Yat-sen University, and the Department of Nuclear Medicine, Guangdong Province Yuebei People＇s Hospital from April to July 2005. ①Thirty rabbits were divided randomly into 3 groups with 10 rabbits in each group： control group with intramuscular injection of 1 mL/kg normal saline twice a week and meanwhile, intragastric administration of normal saline（10 mL/d）, steroid group with intramuscular injection of dexamethasone sodium phosphate（1 mL/kg） twice a week and meanwhile, intragastric administration of normal saline（10 mL/d）, treatment group with intramuscular injection of dexamethasone sodium phosphate（1 mL/kg） twice a week and meanwhile, intragastric administration of Xuesaitong（25 mg/kg）, Zhibituo（350 mg/kg） and alendronate（5 mg/kg） daily for 8 weeks. ②After 1 week of drug withdrawal, the blood flow of femoral head was measured in all the rabbits with radioactive microsphere technique, and the histological changes were observed under light microscope and electron microscope.
MAIN OUTCOME MEASURES：①Blood flow of the femoral head in each group.②Histological and morphological changes, and ultrastructure of the femoral head cartilage in each group.
RESULTS： ①The blood flow in the treatment group was more than that in the steroid group[（0.261±0.042）, （0.197±0.053） mL/（min·g）, q=6.10, P 〈 0.011. Compared with.the control group[（0.2.43±0.039） mL/（min ·g）], the difference was not significant. ②The number of empty bone lacunae in the treatment group was fewer significantly than that in the steroid group [（15.22±5.49）, （24.78±7.87） pieces, q=6.35, P 〈 0.01]. However, there was no difference between the treatment group and control gruop [（10.38±3.78） pieces].③In the treatment group, the bone cells were normal, the endoplasmic reticula were abundant and the cellular nuclei were of normal shape. In the steroid group, the bone cells contracted in volume, the pyknosis occurred, the chromatin gathered to the edge and the bone lacuna enlarged.
CONCLUSION： While using steroid hormone for long, using Xuesaitong, Zhibituo and alendronate may elevate the blood flow of femoral head, improve the tissue structure of bone and prevent or lighten steroid-induced necrosis of femoral head.
出处
《中国临床康复》
CSCD
北大核心
2006年第24期184-186,F0003,共4页
Chinese Journal of Clinical Rehabilitation
基金
韶关市科技计划项目(韶科(卫)2004-28)~~
