创伤性和激素性成人股骨头坏死的病理对照研究
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摘要
目的：探讨创伤性与激素性股骨头坏死脂肪细胞的病理变化,以人体股骨头为标本,分析其与动物实验结果的异同,进一步明确脂肪代谢紊乱在股骨头坏死发病机理中所起的作用,为进一步阐明股骨头缺血坏死的发病机制和在病因水平防治方面为本病提供新的理论依据。
方法：取成人股骨头缺血坏死髋关节置换术后切取的股骨头(40例,43个股骨头),作为研究对象,另取10例正常股骨头(意外死亡尸体)作对照。全部病人中,激素性20例23个股骨头,创伤性20例。以上标本按病因分组后采用三种方法进行病理对照研究。①病理组织学检查,HE染色,镜下观察并用计算机图像分析脂肪细胞直径、周长、面积的变化,并分别计算造血组织与脂肪组织的比值。②透射电镜观察骨细胞超微结构变化；观察骨细胞内脂肪滴的情况。③脂肪染色,重点显示脂肪成份的变化。
结果：激素性股骨头坏死患者其髓内脂肪组织与造血组织比明显高于创伤性及正常者,脂肪细胞数量增多,体积增大,且骨细胞内有脂肪滴。空骨陷窝数明显增多,骨坏死不仅发生在负重区,非负重区也存在,骨髓脂肪化在各个区域都存在,有的被大量纤维组织取代,骨小梁坏死、骨折明显增多。创伤性者及另两组无脂肪组织变化。
结论：激素性股骨头坏死患者骨髓脂肪细胞体积增大,数量增多,与多数动物实验结果相似,但与全身脂代谢紊乱无密切关联。而创伤性者无此变化,说明二者确与脂类代谢紊乱有关,骨髓脂肪化与激素性股骨头坏死的发生有密切关系。早期的股骨头内压增高、局部缺血与此有关。这将有助于病理机制的确定及治疗方案的选择,为防治股骨头坏死提供一个新的思路。
Objective:To discuss the pathological change in avascular osteonecrosis of the femoral head(ONFH) caused by trauma. Using human femoral head as the specimen and comparing the similarities and differences with the femoral head of the animas. To define the pathogenesis action of the disord er fo the fat metabolism in causing osteonecrosis of the femoral head (ONFH). It cold clarify the pathogenesis osteonecrosis of the femoral head (ONFH) and provide new theories basis for prevention and cure the osteonecrosis of the femoral head.
Methods:40 casses osteonecrosis of the femoral head(ONFH) 43 femoral heads as studying specimen. Another 10 cases femoral head as normal group. Include 20 cases caused by taking glucocorticoid,20 cases caused by trauma. All specimen were divided into a few groups according it's pathogeny which studied with three methods:1). General pathological histological analyze by HE stainings Observing configuration of the fat cell under microscope and using computer image analysis system to analyze the change of diameter, perimeter and area of the fat cell. To account the ratio of the marrow cell and fat tissue 2). To observe the change of the ultrastructure of the bone cell by transmission electron microscopy(TEM) and observe the lipid tissue in the bone cell3). Fat staining to display the change of the lipid component.
Results:In cases caused by glucocorticoid which the ratio of fat tissue and the marrow cell is higher than other groups. The quantity of the fat cell increase, the volume of the fat cell enlarge and lipid was found in bone cell. The quantity of the empty bone lacuna increased. The area of the osteonecrosis not only found at the bearing region but also found in the non-bearing region. Part of the marrow cavity was filled with lipid tissue. Osteonecrosis and fracture of the bone trabecula were increased remarkably. However, the traumatic group and the other group were not found the change that mentioned above.
Conclusion:Fat cell in the bone marrow increase in quantity and volume were found in patients with osteonecrosis of femoral head(ONFH) caused by taking hormone. This result is analogous to most animal experiments, but is not closely relevant to total body's lipid metabolism. In traumatic group, there are not increase of fat cell in quantity and volume. Glucocorticoid correlate to lipid metabolism disorder. The bone marrow cavity are filled with lipid tissue, which correlate closely with osteonecrosis caused by taking glucocorticoid Early high pressure in the osteonecrosis of the femoral head and local ischemic in the femoral head correlate closely with taking glucocorticoid. It will help us to ascertain the pathologeny and choice the appropriate method to treat ONFH and provide a new way for the prevention and treatment of ONFH.
方法：取成人股骨头缺血坏死髋关节置换术后切取的股骨头(40例,43个股骨头),作为研究对象,另取10例正常股骨头(意外死亡尸体)作对照。全部病人中,激素性20例23个股骨头,创伤性20例。以上标本按病因分组后采用三种方法进行病理对照研究。①病理组织学检查,HE染色,镜下观察并用计算机图像分析脂肪细胞直径、周长、面积的变化,并分别计算造血组织与脂肪组织的比值。②透射电镜观察骨细胞超微结构变化；观察骨细胞内脂肪滴的情况。③脂肪染色,重点显示脂肪成份的变化。
结果：激素性股骨头坏死患者其髓内脂肪组织与造血组织比明显高于创伤性及正常者,脂肪细胞数量增多,体积增大,且骨细胞内有脂肪滴。空骨陷窝数明显增多,骨坏死不仅发生在负重区,非负重区也存在,骨髓脂肪化在各个区域都存在,有的被大量纤维组织取代,骨小梁坏死、骨折明显增多。创伤性者及另两组无脂肪组织变化。
结论：激素性股骨头坏死患者骨髓脂肪细胞体积增大,数量增多,与多数动物实验结果相似,但与全身脂代谢紊乱无密切关联。而创伤性者无此变化,说明二者确与脂类代谢紊乱有关,骨髓脂肪化与激素性股骨头坏死的发生有密切关系。早期的股骨头内压增高、局部缺血与此有关。这将有助于病理机制的确定及治疗方案的选择,为防治股骨头坏死提供一个新的思路。
Objective:To discuss the pathological change in avascular osteonecrosis of the femoral head(ONFH) caused by trauma. Using human femoral head as the specimen and comparing the similarities and differences with the femoral head of the animas. To define the pathogenesis action of the disord er fo the fat metabolism in causing osteonecrosis of the femoral head (ONFH). It cold clarify the pathogenesis osteonecrosis of the femoral head (ONFH) and provide new theories basis for prevention and cure the osteonecrosis of the femoral head.
Methods:40 casses osteonecrosis of the femoral head(ONFH) 43 femoral heads as studying specimen. Another 10 cases femoral head as normal group. Include 20 cases caused by taking glucocorticoid,20 cases caused by trauma. All specimen were divided into a few groups according it's pathogeny which studied with three methods:1). General pathological histological analyze by HE stainings Observing configuration of the fat cell under microscope and using computer image analysis system to analyze the change of diameter, perimeter and area of the fat cell. To account the ratio of the marrow cell and fat tissue 2). To observe the change of the ultrastructure of the bone cell by transmission electron microscopy(TEM) and observe the lipid tissue in the bone cell3). Fat staining to display the change of the lipid component.
Results:In cases caused by glucocorticoid which the ratio of fat tissue and the marrow cell is higher than other groups. The quantity of the fat cell increase, the volume of the fat cell enlarge and lipid was found in bone cell. The quantity of the empty bone lacuna increased. The area of the osteonecrosis not only found at the bearing region but also found in the non-bearing region. Part of the marrow cavity was filled with lipid tissue. Osteonecrosis and fracture of the bone trabecula were increased remarkably. However, the traumatic group and the other group were not found the change that mentioned above.
Conclusion:Fat cell in the bone marrow increase in quantity and volume were found in patients with osteonecrosis of femoral head(ONFH) caused by taking hormone. This result is analogous to most animal experiments, but is not closely relevant to total body's lipid metabolism. In traumatic group, there are not increase of fat cell in quantity and volume. Glucocorticoid correlate to lipid metabolism disorder. The bone marrow cavity are filled with lipid tissue, which correlate closely with osteonecrosis caused by taking glucocorticoid Early high pressure in the osteonecrosis of the femoral head and local ischemic in the femoral head correlate closely with taking glucocorticoid. It will help us to ascertain the pathologeny and choice the appropriate method to treat ONFH and provide a new way for the prevention and treatment of ONFH.
引文
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9. Cui Q, Wang GJ, Balian GJ. Steroid-induced adipogenesis in a pluripotential cell line from bone marrow. J Bone Joint Surg (Am),79A:1054-1063.1997
10. OrefforO VrdiAS, Triffitt J T. Modulatior osteogenesis and adipogenesis by human bone marrow cultures. Eur J Gell Biol,74:251～2619 1997
11.贺西京,毛履真,王坤正,等.激素性股骨头坏死与骨细胞脂肪变性的实验研究.中华骨科杂志,16(1)：44.1996
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26. Matsui M, Saito S, Ohzono K, et al. Experimental steroid induced osteonecrosis in adult rabbit with hypersensitive vasculitis. Clin Orthop,277:61.1992
27. Fisher D E, Bickle EH. Corticosteroid-induced avascular necrosis:A clinical study of seventy-seven patients. J Bone Joint Surg(Am),54:859.1971
28. Jones JP Jr. Intravascular coagulation and osteonecrosis[J]. Clin Orthop, 277:41.1992
29. Glueck CT, Freiberg R, Tracy T, et al. Thrombopilia and hypotibrinolysis [J]. Clin othop,334:43-56.1997
30. Kisker CT, Robillard JE, Bohlken DP. Glucocorticoid stimulation of blood coag-ulation factor activities in the fetal lamb [J]. J Lab Clin Med,101, 569.1983
31. Spencer JD, Humphreys S, Tighe JR, et al. Early avascular necrosis of the femoral head. J. Bone Joint Surg(Am).68:414.1986
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