[1]周勇,徐祖健,柴天朋,等.非创伤性股骨头坏死骨髓水肿与磁共振分期的关系及骨髓水肿发生机制的初步研究[J].中医正骨,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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非创伤性股骨头坏死骨髓水肿与磁共振分期的关系及骨髓水肿发生机制的初步研究()
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《中医正骨》[ISSN:1001-6015/CN:41-1162/R]

卷:
第28卷
期数:
2016年08期
页码:
8-12
栏目:
临床研究
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; 杨茂清1; 雷孝勇2
1.四川省成都市双流区中医医院,四川 成都 610200; 2.西南医科大学附属中医医院, 四川 泸州 646000; 3.四川省新津县中医医院,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
关键词:
股骨头坏死;  骨髓;  水肿;  血管内皮生长因子类;  骨形态发生蛋白2;  免疫组织化学
Keywords:
femur head necrosis;  bone marrow;  edema;  vascular endothelial growth factors;  bone morphogenetic protein 2;  immunohistochemistry
摘要:
目的:初步探讨非创伤性股骨头坏死(non-traumatic osteonecrosis of femoral head,NONFH)骨髓水肿与磁共振分期的关系及骨髓水肿的发生机制。方法:分析40例接受单侧人工髋关节置换术的NONFH患者的术前髋关节磁共振影像,对比不同的股骨头坏死国际骨循环研究会(association research circulation osseous,ARCO)分期时骨髓水肿的发生情况,并根据有无骨髓水肿将40例患者分为2组。将从单侧人工髋关节置换术中取得的40个股骨头沿冠状面自正中用摆锯剖开,在交界区凿取1块约1.0 cm×1.0 cm×0.4 cm的骨块,制成石蜡切片,采用免疫组织化学法测定血管内皮生长因子(vascular endothelial growth factor,VEGF)和骨形态发生蛋白2(bone morphogenetic protein 2,BMP-2)的表达情况,并做组间对比。结果:①不同ARCO分期骨髓水肿的发生情况。ARCOⅢ期骨髓水肿25例、无骨髓水肿4例,ARCOⅣ期骨髓水肿3例、无骨髓水肿8例,ARCOⅢ期骨髓水肿发生率高于ARCOⅣ期(χ2=10.533,P=0.000); ARCOⅢ期轻度骨髓水肿3例、重度骨髓水肿22例,ARCOⅣ期轻度骨髓水肿1例、重度骨髓水肿2例,ARCOⅢ期骨髓水肿严重程度与ARCOⅣ期比较,差异无统计学意义(P=0.382)。②VEGF和BMP-2的表达情况。骨髓水肿组VEGF和BMP-2的阳性面积百分比均高于无骨髓水肿组[(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的平均灰度均低于无骨髓水肿组[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]。结论:NONFH骨髓水肿易发生于ARCOⅢ期,其发生与VEGF和BMP-2的表达有关。骨髓水肿可能是NONFH病变过程中的一种继发反应和局部组织自我修复增强的表现,但仍需今后进一步研究证实。
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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备注/Memo

备注/Memo:
基金项目:四川省卫生厅科研项目(100238) 通讯作者:徐祖健 E-mail:xuzujian@21cn.com
更新日期/Last Update: 1900-01-01