中国组织工程研究

中国组织工程研究 ›› 2018, Vol. 22 ›› Issue (27): 4364-4368.doi: 10.3969/j.issn.2095-4344.0354

• 骨与关节生物力学 bone and joint biomechanics • 上一篇    下一篇

生物力学因素诱导股骨颈骨折后股骨头坏死：单侧股骨颈骨折内固定犬模型验证

王海洋，林焱斌，余光书   

  1. 厦门大学附属福州第二医院骨科，福建省福州市 350007
  • 出版日期:2018-09-28 发布日期:2018-09-28
  • 通讯作者: 林焱斌，主任医师，教授，硕士生导师，厦门大学附属福州第二医院骨科，福建省福州市 350007
  • 作者简介:王海洋，男，1991年生，山东省济南市人，汉族，厦门大学在读硕士，主要从事关节外科的研究。
  • 基金资助:

    福建省卫生系统中青年骨干人才培养项目(2014-ZQN-JC-34)

Osteonecrosis of the femoral head after femoral neck fractures induced by biomechanical factors: testified by dog models of internal fixation for unilateral femoral neck fracture  

Wang Hai-yang, Lin Yan-bin, Yu Guang-shu   

  1. Department of Orthopedics, Fuzhou Second Hospital Affiliated to Xiamen University, Fuzhou 350007, Fujian Province, China
  • Online:2018-09-28 Published:2018-09-28
  • Contact: Lin Yan-bin, Chief physician, Professor, Master’s supervisor, Department of Orthopedics, Fuzhou Second Hospital Affiliated to Xiamen University, Fuzhou 350007, Fujian Province, China
  • About author:Wang Hai-yang, Master candidate, Department of Orthopedics, Fuzhou Second Hospital Affiliated to Xiamen University, Fuzhou 350007, Fujian Province, China
  • Supported by:

    the Young Talents Training Project of Health System of Fujian Province, No. 2014-ZQN-JC-34

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摘要：

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文题释义：
股骨头坏死：其病因大致分为创伤性和非创伤性两类，但其具体发病机制仍不清楚。股骨头血运障碍学说难以解释部分股骨颈骨折患者骨折1-5年(甚至更长时间)才发生股骨头坏死的临床现象。近来生物力学因素在股骨颈骨折后股骨头坏死发生发展过程中的作用越来越受到重视。
骨生物力学：骨组织在塑形和重建过程中受生物力学因素的影响和制约。当骨所承受的力学负荷发生变化时，其结构也可以随之变化、调整，以重新适应变化的负荷环境。负荷也会使骨发生微损伤，但骨重建过程可以修复有限数量的微损伤。然而当骨所承受的负荷超出阈值时，将会产生过多的微损伤，并超出骨自身的修复能力。随着微损伤的累积将会使得骨的脆性增加甚至发生骨折。
 
摘要
背景：生物力学因素在股骨颈骨折术后股骨头坏死的发生和病理演变过程中起着重要作用，但是目前尚缺乏与之相关的实验证据。
目的：探讨生物力学因素在股骨颈骨折后股骨头坏死发生发展过程中的作用。
方法：12只健康成年田园犬均行股骨颈中部垂直截骨和螺钉内固定，制作单侧股骨颈骨折内固定模型。造模后6周照射X射线片，确认所有动物模型骨折愈合，将其随机分为空白组、取钉联合植骨组和取钉组，每组4只。取钉联合植骨组取出螺钉联合植骨，取钉组进行取出螺钉处理，空白组不做处理。6周后一次性处死所有田园犬，对各组田园犬股骨颈Ward三角区骨组织进行组织学观察和骨组织形态计量学评估。
结果与结论：①组织学观察示，空白组的骨小梁较为宽大，分布较为密集，结构连续；取钉联合植骨组的骨小梁宽大，呈板状，分布密集，结构连续；取钉组的骨小梁纤细，分布稀疏，结构紊乱，部分骨小梁断裂；②骨组织形态计量学参数示，取钉联合植骨组和空白组的骨小梁面积百分数、骨小梁厚度显著高于取钉组(P < 0.05)，而骨小梁分离度显著低于取钉组(P < 0.05)；取钉联合植骨组的骨小梁面积百分数、骨小梁厚度显著高于空白组(P < 0.05)；取钉联合植骨组的骨小梁分离度显著低于空白组(P < 0.05)；取钉联合植骨组的骨小梁数量显著高于取钉组(P < 0.05)；空白组的骨小梁数量与取钉组比较，差异无显著性意义(P > 0.05)；取钉联合植骨组的骨小梁数量与空白组比较，差异无显著性意义(P > 0.05)；③结果提示，股骨颈骨折愈合后股骨头生物力学性能的降低会造成骨小梁出现吸收、微骨折等骨微观结构变化，最终导致股骨头塌陷、坏死。

中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程
ORCID: 0000-0002-7329-1342(王海洋)

关键词: 股骨颈骨折, 股骨头坏死, 生物力学, 骨小梁微骨折, 骨微观结构, 组织学, 田园犬, 骨组织形态计量学

Abstract:

BACKGROUND: Biomechanical factors play an important role in the pathogenesis of osteonecrosis of the femoral head (ONFH) after femoral neck fracture, but there is a lack of experimental evidence.

OBJECTIVE: To explore the roles of biomechanical factors in the development of ONFH following femoral neck fracture.
METHODS: Twelve healthy adult rural dogs received the vertical osteotomy at the middle femoral neck and screw fixation to establish the internal fixation model of unilateral femoral neck fracture. At 6 weeks after modeling, X-ray was performed to confirm the fracture healing of all animal models. The model dogs were randomized into blank control, combination (screw removal and bone grafting) and experimental (screw removal) groups (n=4 per group). Six weeks later, all dogs were executed, and the histological observation and the evaluation of bone histomorphometry were performed on the osseous tissue of the femoral neck Ward triangle.
RESULTE AND CONCLUSION: (1) Histological observation showed that the bone trabecula in the blank control group was large and dense with continuous structure. In the combination group, the trabeculae were tremendous and tabular with dense distribution and continuous structure. In the experimental group, the bone trabecula was thin, sparse, disorganized and partially fractured. (2) The percent trabecular area and trabecular thickness were highest in the combination group, followed by blank control group, and lowest in the experimental group (P < 0.05). The order of trabecular separation was as follows: combination group < blank control group < experimental group (P < 0.05). The trabecular number in the combination group was significantly more than that in the experimental group (P < 0.05). Compared with the blank control group, the trabecular number in the combination and experimental groups showed no significant difference (both P > 0.05). (3) These results indicate that the decrease in biomechanical properties of femoral head after the femoral neck fracture healing can result in the changes of absorption and microfracture of the bone trabeculae, further induces collapse and necrosis of the femoral head.

中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程

Key words: Femoral Neck Fractures, Femoral Head Necrosis, Biomechanics, Tissue Engineering

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