激素性股骨头坏死的病理改变和发病机制.docVIP

激素性股骨头坏死的病理改变和发病机制 现代医学对SONFH发病的始动机制仍未完全明了，为了阐述激素与骨坏死的关系出现了许多假说，但尚无一种学说能比较圆满地解释清楚二者的关系，比较有代表性的是以下三种：⑴激素诱导的血液流变学异常和血管内凝血假说；⑵细胞毒性与细胞损伤假说；⑶遗传易感性和“二次碰撞假说”。 1、早期的血管病理改变与激素诱导的血液流变学异常和血管内凝血假说 1.1早期的血管病理改变 早期SONFH头内的动脉、静脉均发生一系列病理改变：小血管受压迫和闭塞，局部区域内血管数量减少；血管内膜增生，血管内血栓形成，脂肪或气体栓塞；窦状血管充血、外渗，小血管周围炎性细胞浸润，组织间隙内出血。 1.1.1动脉病变 主要表现在股骨头区域内的小动脉上，临床病理活检发现，小动脉病理改变主要集中在肌层，表现为弹性蛋白、胶原纤维变性和消失，内弹力层断裂，平滑肌细胞坏死addin KingyeeNoteCount2/CountReferenceIReferenceIDRefTypeID00002/RefTypeIDTitleEpidemiologlcal risk factors for non-traumatic osteonecrosis[J]/TitleTitleTrans/TitleTransSecondTitleOrthopade/SecondTitlePYear2000/PYearSubAuthor/SubAuthorAuthorJones JP/AuthorSdyAuthor/SdyAuthorTtyAuthor/TtyAuthorVolume29(5)/VolumeNumVolume/NumVolumeIssue/IssuePages370-379/PagesPubDate/PubDatePlacePub/PlacePubPublisher/PublisherEdition/EditionTertiaryTitle/TertiaryTitleTypeWork/TypeWorkReferenceID100000513/ReferenceID1RefTypeID100002/RefTypeID1Title1Early artempathy and postulated pathogenesis of the femoral head[J]/Title1TitleTrans1/TitleTrans1SecondTitle1Clin Orthop/SecondTitle1PYear11992/PYear1SubAuthor1/SubAuthor1Author1Saito S.Ohzono K,Ono K/Author1SdyAuthor1/SdyAuthor1TtyAuthor1/TtyAuthor1Volume1277/Volume1NumVolume1/NumVolume1Issue1/Issue1Pages198/Pages1PubDate1/PubDate1PlacePub1/PlacePub1Publisher1/Publisher1Edition1/Edition1TertiaryTitle1/TertiaryTitle1TypeWork1/TypeWork1ReferenceID200000508/ReferenceID2RefTypeID200002/RefTypeID2Title2Role of blood supply of the femoral head in the pathogenesis of idiopathic osteonecrosis[J]/Title2TitleTrans2/TitleTrans2SecondTitle2Clin Orthop/SecondTitle2PYear21992/PYear2SubAuthor2/SubAuthor2Author2Atsumi T,Yoshikatsr K/Author2SdyAuthor2/SdyAuthor2TtyAuthor2/TtyAuthor2Volume2277/Volume2NumVolume2/NumVolume2Issue2/Issue2Pages222/Pages2PubDate2/PubDate2PlacePub2/PlacePub2Publisher2/Publisher2Edition2/Edition2TertiaryTitle2/TertiaryTitle2TypeWork2/TypeWork2/KingyeeNote[1- 3]。而动脉内皮层病理改变轻微，仅有轻微增厚，血管外层未见病变，坏死区血管数减少。股骨头微血管造影检查发现，SONFH有外侧骺动脉损伤，损害部位在其进人股骨头内10.7 mm处，