摘要
目的通过对离体创伤性与非创伤性股骨头缺血性坏死(avascularnecrosis of the femoral head,ANFH)标本进行形态学及Osterix(OSX)、脂联素免疫组织化学对比观察,探讨其发病原因、病理特点及可能的发病机制,为更合理的临床治疗提供理论依据。方法收集行全髋关节置换术患者股骨头切除标本66个。创伤性ANFH(A组)24个,其中男17例,女7例;年龄21～70岁,平均56.5岁。激素性ANFH(B组)23个,其中男16例,女7例;年龄56～72岁,平均61岁。酒精性ANFH(C组)19个,均为男性;年龄55～67岁,平均58.5岁。沿冠状面剖开,股骨头行大体观察;取股骨头负重区及非负重区骨组织各1块,采用HE染色观察病理变化,并计算空骨陷窝和骨小梁面积百分比;扫描电镜观察各组股骨头的形态变化;免疫组织化学技术检测OSX、脂联素表达情况。结果大体观察3组股骨头表面粗糙、塌陷,关节软骨脱落,骨赘形成;冠状剖面A组多呈暗红色,B、C组多呈黄色胶冻样。HE染色结果显示各组ANFH负重区病理形态相似,非负重区B、C组骨髓腔内的脂肪细胞增多、肥大,而A组则有较多纤维组织。A、B、C组股骨头负重区及非负重区空骨陷窝百分比比较差异有统计学意义(P<0.001),骨小梁面积百分比比较差异均无统计学意义(P>0.05)。扫描电镜下3组病理变化均相似。OSX和脂联素蛋白阳性物质为棕黄色颗粒,主要分布于股骨头骨髓内的成骨细胞中。OSX蛋白吸光度(A)值,A组与B、C组比较差异有统计学意义(P<0.05),B、C组间差异无统计学意义(P>0.05);各组脂联素A值比较差异均无统计学意义(P>0.05)。结论激素性和酒精性ANFH脂肪变性较明显,但创伤性ANFH股骨头修复能力强于前两者。酒精和激素对OSX介导的成骨分化有抑制作用,但可能不影响成骨细胞表达脂联素及其受体。
Objective To comprehend the pathological features and possible pathogenesis of avascular necrosis of the femoral head（ANFH）by morphology and immunohistochemical observation of osterix（OSX）and adiponectin through in vitro traumatic and non-traumatic ANFH specimens,so as to provide a theoretical basis for clinical treatment.Methods Sixty-six ANFH specimens were collected from 66 clinical cases undergoing hip replacement surgery. Twenty-four cases of traumatic ANFH（group A）included 17 males and 7 females,aged 21 to 70 years with an average of 56.5 years;23 cases of steroid-induced ANFH（group B）included 16 males and 7 females,aged 56 to 72 years with an average of 61 years;and 19 cases of alcoholic ANFH（group C）were males,aged 55 to 67 years with an average of 58.5 years.Bone tissue was got from weight-bearing and non-weight-bearing area of the femoral head respectively.The basic pathological changes was observed by HE staining under the optical microscope,and the percentage of empty bone lacuna and the percentage of trabecular bone area were calculated.The morphological changes of ANFH in different groups were observed by scanning electron microscope（SEM）.OSX and adiponectin expression were detected by immunohistochemical technique. Results Gross of the femoral head surface in each group was rough,collapse,articular cartilage loss,osteophyte formation;cross section：dark red in group A,and yellow in groups B and C.HE staining showed that weight-bearing area of ANFH have similar morphological features in three groups.In non-weight-bearing area of groups B and C,the fat cells in bone marrow markedly increased and were hypertrophic;however there were more fibrous tissue in group A.There were statistically significant differences（P0.001）in the percentage of empty bone lacuna of the weight-bearing and non-weight-bearing area among three groups.There were no statistically significant differences（P0.05）in the percentage of trabecular bone area among three groups.The SEM observation showed that three groups had similar pathological changes.Brown granules for OSX and adiponectin positive substance were mainly located in the osteoblast of bone marrow of the femoral head.There was statistically significant difference（P0.05）in the average absorbency（A）value of OSX between group A and groups B,C,but there was no statistically significant difference（P0.05）between groups B and C.While there was no statistically significant difference（P 0.05）in the A value of adiponectin among three groups.Conclusion Hormones and alcohol necrosis have more obviously fatty degeneration,but the repair capacity of traumatic femoral head necrosis is stronger than that of hormones and alcohol necrosis.Alcohol and hormones have inhibitory action on the OSX-mediated osteogenic differentiation.Hormones and alcohol may not affect osteoblast expressing adiponectin and its receptors.
出处
《中国修复重建外科杂志》
CAS
CSCD
北大核心
2010年第1期17-22,共6页
Chinese Journal of Reparative and Reconstructive Surgery
关键词
股骨头缺血性坏死
扫描电镜
免疫组织化学
OSTERIX
脂联素
Avascular necrosis of the femoral head Scanning electron microscope Immunohistochemistry Osterix Adiponectin
