低分子肝素钙预防激素性股骨头坏死的实验研究-外科学(骨科)专业论文.pdf.docxVIP

低分子肝素钙预防激素性股骨头坏死的实验研究摘要目的：大剂量糖皮质激素作用下，股骨头血管内微血栓形成导致微循环障碍等病理生理改变与股骨头坏死的发生密切相关[1]。低分子肝素钙可以预防血栓的形成且一般不需要监测。本课题通过Wistar大鼠皮下注射低分子肝素钙,影响股骨头的微血管内微血栓的形成,从而减少激素性股骨头坏死的发生率,为临床药物预防激素性股骨头坏死提供理论依据.研究方法:健康Wistar大鼠共15只，随机分为激素组5只，A组，臀肌注射地塞米松磷酸钠15mg(3ml)/kg每周一次，皮下注射生理盐水1.6ml/kg每天一次；B组，臀肌注射地塞米松磷酸钠15mg(3ml)/kg每周一次，皮下注射低分子肝素2000u(1.6ml)/kg每天一次，臀肌注射生理盐水3ml/kg每周一次；C组,皮下注射生理盐水1.6ml/kg每天一次,臀肌注射生理盐水3ml/kg，每周一次。6周后用体积分数为10%的水合氯醛麻醉,手术下找到腹主动脉,结扎腹主动脉近端并在腹主动脉远端插管,用1:5000的肝素生理盐水灌注,直至静脉回流清亮,迅速取出双侧股骨头,观察外观后脱钙做切片,行HE 染色计算空骨陷窝率、观察骨小梁面积,PTAH 染色观察血栓。最后对数据进行统计学分析。结果:（1）三组股骨头外观无明显差别；（2）空骨陷窝率差别有统计学意义；（3）微血栓染色观察可见激素组有血栓形成;（4）骨小梁面积比差别有统计学意义。结论：低分子肝素钙通过预防血栓的形成降低了激素性股骨头坏死的发生率，是预防激素性股骨头坏死的途径之一，但却不能预防骨质疏松的发生。[关键词]股骨头坏死，低分子肝素钙，地塞米松，骨坏死LowmolecularweightheparintopreventnecrosisoffemoralheadAbstractObjective:theroleofhigh-dosecorticosteroids,thefemoralheadwithinthemicro-vascularthrombosisandotherpathophysiologicalchangesleadtomicrocirculatorydisturbanceandiscloselyrelatedtofemoralheadnecrosis[1].Lowmolecularweightheparintopreventthrombosisandgenerallydoesnotrequiremonitoring.Wistarratsbysubcutaneousinjectionoftheissueoflowmolecularweightheparin,thefemoralheadaffectedtheformationofmicrothrombiwithincapillaries,therebyreducingtheincidenceoffemoralheadnecrosisrateforclinicaldrugpreventionfemoralheadnecrosisprovideatheoreticalbasis.Methods:Atotalof15healthyWistarratsweredividedintohormonegroupfive,glutealmuscleinjectionofdexamethasonesodiumphosphate15mg/kg,onceaweek,theothergroupwereinjectednormalsaline,onceaweek;hormonelowmolecularweightheparingroup 5,injectionoflowmolecularweightheparin300u/kgonceaday,theothergroupnormalsalinesubcutaneouslyoncedaily;controlgroup5.After6weeks,withthevolume fraction of 10%chloralhydrateanesthesia,surgerytofindtheabdominalaorta,ligationoftheproximalabdominalaortaanddistalabdominalaorticcannulation,salineinfusionwith1:5000heparin,untiltheveinBackclear,andquicklyremovethefemoralheadwereobservedaftertheappearanceofdecalcifiedbiopsy,HEstaincalculatedrateofemptylacunaewereobservedtr