激素性骨坏死关节软骨下皮质骨病理改变的实验研究_医学论文.docVIP

激素性骨坏死关节软骨下皮质骨病理改变的实验研究_医学论文 激素性骨坏死关节软骨下皮质骨病理改变的实验研究_医学论文 作者：张德志，胡蕴玉，费正奇，吕荣，王军 【关键词】 激素性骨坏死 　　摘 要： 　　［目的］观察激素性骨坏死关节塌陷早期软骨下皮质骨的病理形态改变，分析关节塌陷的原因。［方法］将新西兰白兔分为两组，A组复制激素增强的Shwanzman反应骨坏死模型，B组为空白对照组。停药后10周获取肱骨头标本，分别制备脱钙和不脱钙切片，脱钙标本HE染色，观察软骨下皮质骨改变，哈佛管计数。不脱钙标本进行荧光观察，比较软骨下皮质骨形态、结构；扫描电镜观察，比较软骨下微循环改变、软骨下方骨组织形态、结构改变。［结果］A组标本出现坏死改变。软骨下方骨组织内哈佛管减少消失，即软骨下皮质骨及由其构成的球拱、桥拱结构破坏，支撑软骨层的骨组织呈松质骨改变。有部分肱骨头出现关节塌陷早期改变。软骨下微血管内广泛存在红细胞淤滞、填塞现象。B组软骨下方骨组织具有较丰富的哈佛管，为皮质骨。完整且连续的皮质骨支撑关节软骨，同时构成球拱、桥拱结构。软骨下微血管内无红细胞淤滞、填塞现象。［结论］关节软骨下皮质骨缺失是关节发生塌陷的原因。软骨下微循环障碍是其重要原因。 　　关键词：激素性骨坏死； 软骨下皮质骨； 关节塌陷； 兔 　　Abstract：［Objective］To investigate the morphological changes that take place in the subchondral cocortical bone in steroidinduced osteonecrosis and analyze the reasons leading to humeral head collapse in juvenile rabbits. ［Method］Fivesix monthold female rabbits were separated by two groups. A modified version of the methods was used to replicate steroid enhanced osteonecrosis anminal humeral head models with Shwartzman reaction in group A,and group B served as the single control. Each humeral head was obtained 10 weeks after the drugs injection. Subchondral cortical bone was observed,and the number of haversian canals was counted. The microcirculatory changes were also detected with scanning electron microscope. ［Result］In group A, the Haversian canals in subchondral area almost disappearedthe subchondral cortical bone disappeared with its arch,dome and bridge structures. Microcirculatory stasis happened in the subchondral vessels. Some humeral heads collapse were observed. While in group B, subchondral cortical bone is integrity and continuity, forming arch,dome and brige structures with subtrabecular bone. ［Conclusion］The disappearance of the subchondral cortical bone is a major reason leading humeral head collapse,and ischemia is the critical reason of it. 　　Key words: Steroid induced osteonecrosis Subchondral cortical bone； Collapse； Rabbits 　　激素应用是非创伤性骨坏死的常见诱因之一。随着激素使用量的逐年增加，激素的副作用日益受到重视。激素性骨坏死尚缺乏有效的预防和治疗方法。关节塌陷是影