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[1]周勇,徐祖健,柴天朋,等.非創(chuàng)傷性股骨頭壞死骨髓水腫與磁共振分期的關(guān)系及骨髓水腫發(fā)生機(jī)制的初步研究[J].中醫(yī)正骨,2016,28(08):8-12.
　ZHOU Yong,XU Zujian,CHAI Tianpeng,et al.A pilot study on relationship between bone marrow edema and magnetic resonance staging and pathogenesy of bone marrow edema in patients with non-traumatic osteonecrosis of femoral head[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2016,28(08):8-12.
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非創(chuàng)傷性股骨頭壞死骨髓水腫與磁共振分期的關(guān)系及骨髓水腫發(fā)生機(jī)制的初步研究()
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《中醫(yī)正骨》[ISSN:1001-6015/CN:41-1162/R]

卷:
第28卷
期數(shù):
2016年08期
頁(yè)碼:
8-12
欄目:
臨床研究
出版日期:
2016-08-20

文章信息/Info

Title:
A pilot study on relationship between bone marrow edema and magnetic resonance staging and pathogenesy of bone marrow edema in patients with non-traumatic osteonecrosis of femoral head
作者:
周勇1; 徐祖健2; 柴天朋3; 任菲菲1; 楊茂清1; 雷孝勇2
1.四川省成都市雙流區(qū)中醫(yī)醫(yī)院,四川 成都 610200; 2.西南醫(yī)科大學(xué)附屬中醫(yī)醫(yī)院, 四川 瀘州 646000; 3.四川省新津縣中醫(yī)醫(yī)院,四川 新津 611400
Author(s):
ZHOU Yong1; XU Zujian2; CHAI Tianpeng3; REN Feifei1; YANG Maoqing1; LEI XIaoyong2
1.Shuangliu Hospital of Traditional Chinese Medicine,Chengdu 610200,Sichuan,China 2.The TCM Hospital Affiliated to Southwest Medical University,Luzhou 646000,Sichuan,China 3.Xinjin Hospital of Traditional Chinese Medicine,Xinjin 611400,Sichuan,China
關(guān)鍵詞:
股骨頭壞死;  骨髓;  水腫;  血管內(nèi)皮生長(zhǎng)因子類;  骨形態(tài)發(fā)生蛋白2;  免疫組織化學(xué)
Keywords:
femur head necrosis;  bone marrow;  edema;  vascular endothelial growth factors;  bone morphogenetic protein 2;  immunohistochemistry
摘要:
目的:初步探討非創(chuàng)傷性股骨頭壞死(non-traumatic osteonecrosis of femoral head,NONFH)骨髓水腫與磁共振分期的關(guān)系及骨髓水腫的發(fā)生機(jī)制。方法:分析40例接受單側(cè)人工髖關(guān)節(jié)置換術(shù)的NONFH患者的術(shù)前髖關(guān)節(jié)磁共振影像,對(duì)比不同的股骨頭壞死國(guó)際骨循環(huán)研究會(huì)(association research circulation osseous,ARCO)分期時(shí)骨髓水腫的發(fā)生情況,并根據(jù)有無(wú)骨髓水腫將40例患者分為2組。將從單側(cè)人工髖關(guān)節(jié)置換術(shù)中取得的40個(gè)股骨頭沿冠狀面自正中用擺鋸剖開(kāi),在交界區(qū)鑿取1塊約1.0 cm×1.0 cm×0.4 cm的骨塊,制成石蠟切片,采用免疫組織化學(xué)法測(cè)定血管內(nèi)皮生長(zhǎng)因子(vascular endothelial growth factor,VEGF)和骨形態(tài)發(fā)生蛋白2(bone morphogenetic protein 2,BMP-2)的表達(dá)情況,并做組間對(duì)比。結(jié)果:①不同ARCO分期骨髓水腫的發(fā)生情況。ARCOⅢ期骨髓水腫25例、無(wú)骨髓水腫4例,ARCOⅣ期骨髓水腫3例、無(wú)骨髓水腫8例,ARCOⅢ期骨髓水腫發(fā)生率高于ARCOⅣ期(χ2=10.533,P=0.000); ARCOⅢ期輕度骨髓水腫3例、重度骨髓水腫22例,ARCOⅣ期輕度骨髓水腫1例、重度骨髓水腫2例,ARCOⅢ期骨髓水腫嚴(yán)重程度與ARCOⅣ期比較,差異無(wú)統(tǒng)計(jì)學(xué)意義(P=0.382)。②VEGF和BMP-2的表達(dá)情況。骨髓水腫組VEGF和BMP-2的陽(yáng)性面積百分比均高于無(wú)骨髓水腫組[(21.04±3.87)%,(15.25±3.36)%,t=4.490,P=0.000;(19.04±4.56)%,(13.67±2.77)%,t=3.780,P=0.001],VEGF和BMP-2的平均灰度均低于無(wú)骨髓水腫組[29.93±4.26,36.33±2.96,t=4.730,P=0.000; 39.43±4.59,45.50±2.94,t=4.210,P=0.001]。結(jié)論:NONFH骨髓水腫易發(fā)生于ARCOⅢ期,其發(fā)生與VEGF和BMP-2的表達(dá)有關(guān)。骨髓水腫可能是NONFH病變過(guò)程中的一種繼發(fā)反應(yīng)和局部組織自我修復(fù)增強(qiáng)的表現(xiàn),但仍需今后進(jìn)一步研究證實(shí)。
Abstract:
Objective:To explore the relationship between bone marrow edema(BME)and magnetic resonance(MR)staging and the pathogenesy of BME in patients with non-traumatic osteonecrosis of femoral head(NONFH).Methods:The preoperative hip magnetic resonance images(MRI)of 40 patients who received unilateral artificial hip replacement for treatment of NONFH were analyzed,and the incidence rate of BME were compared between different clinical stages of femur head necrosis issued by association research circulation osseous(ARCO).The patients were divided into BME group and non-BME group.Forty necrotic femoral heads that achieved via unilateral artificial hip replacements were splited along the median coronal plane by using swing saw,and a 1.0×1.0×0.4-cm specimen was fetched from the junctional zone of each femoral head and was made into paraffin sections.Then the expressions of vascular endothelial growth factor(VEGF)and bone morphogenetic protein 2(BMP-2)were detected by using immunohistochemical method and were compared between the 2 groups.Results:Twenty-five patients with BME and 4 patients without BME were categorized as ARCO phaseⅢ,while 3 patients with BME and 8 patients without BME were categorized as ARCO phaseⅣ.The incidence rate of BME was higher in ARCO phaseⅢ compared to ARCO phaseⅣ(χ2=10.533,P=0.000).Mild BME(3)and severe BME(22)were found in ARCO phaseⅢwhile mild BME(1)and severe BME(2)were found in ARCO phaseⅣ,and there was no statistical difference in severity of BME between ARCO phaseⅢ and phaseⅣ(P=0.382).The positive area percentages of VEGF and BMP-2 were higher in BME group compared to non-BME group(21.04+/-3.87 vs 15.25+/-3.36%,t=4.490,P=0.000; 19.04+/-4.56 vs 13.67+/-2.77%,t=3.780,P=0.001),and the average gray values of VEGF and BMP-2 were lower in BME group compared to non-BME group(29.93+/-4.26 vs 36.33+/-2.96,t=4.730,P=0.000; 39.43+/-4.59,45.50+/-2.94,t=4.210,P=0.001).Conclusion:BME occurs more frequently in ARCO phaseⅢin patients with NONFH and its occurence may be related to the expression of VEGF and BMP-2.BME may be a secondary response and manifestations of self-repair enhancement in local tissues in the pathological process of NONFH.However,further study is needed to verify the deduction in the future.

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備注/Memo

備注/Memo:
基金項(xiàng)目:四川省衛(wèi)生廳科研項(xiàng)目(100238) 通訊作者:徐祖健 E-mail:[email protected]
更新日期/Last Update: 1900-01-01