股骨头软骨下骨的显微组织形态学研究

发布时间：2018-03-08 20:03

本文选题：骨性关节炎　切入点：髋关节发育不良　出处：《上海交通大学》2015年博士论文　论文类型：学位论文

【摘要】：目的:软骨下骨由软骨下骨板(SBP)和软骨下松质骨(STB)构成,参与调节、维持关节的生物力学和生物化学的稳态。软骨下骨在多种关节疾病的发生与发展中发挥重要作用,尤其是骨性关节炎(OA)和类风湿性关节炎(RA)。本实验研究在髋关节OA中,股骨头STB的显微结构、骨重建水平与年龄、性别的相关性;评估在髋关节OA中,SBP完整性与STB稳态的相关性;探索髋关节发育不良(HD)引起的继发性骨性关节炎(HD-OA)与骨质疏松(OP)患者的股骨头软骨下骨的显微结构、骨重建水平及病理改变方面的差异;评估RA与OA患者的股骨头软骨下骨的显微结构及骨重建水平方面的差异。方法:第一部分:本研究入组110例髋关节OA患者,髋关节置换术后在股骨头负重区钻取STB和深层松质骨(DTB)标本。通过显微CT(Micro-CT)和组织形态学方法分析各个标本的显微结构和骨重建水平。第二部分:入组110例髋关节OA患者,髋关节置换术后在股骨头负重区钻取软骨下骨标本。通过micro-CT检测分析SBP完整性、STB显微结构和软骨下骨囊性变(SBCs)。通过组织形态学方法分析STB的骨重建水平和SBCs内的病理变化。第三部分:入组20例HD-OA患者和20例骨质疏松性股骨颈骨折患者,髋关节置换术后在股骨头负重区和非负重区钻取软骨下骨标本。通过micro-CT和组织学方法分析各个标本的显微结构、骨重建水平和病理变化。第四部分:入组20例RA患者和40例OA患者,髋关节置换术后在股骨头负重区钻取STB和DTB标本。通过micro-CT、组织形态学方法和电镜检测,分析标本的显微结构和组织学变化。结果:第一部分:STB和DTB在显微结构和骨重建水平方面有显著差异。在STB和DTB中,OA均改变了骨组织的稳态与年龄、性别的正常关系。第二部分:在OA进展中,SBP完整性的破坏与STB退变密切相关。第三部分:在HD-OA中,整个股骨头的软骨下骨均发生关节炎性退变,但关节负重区较非负重区更容易受到累及。第四部分:RA和OA在临近关节骨组织(包括STB和DTB)中有相似的显微结构,但RA的STB骨吸收水平更高。结论:在OA和RA的发展过程中,软骨下骨受到严重累及,表现出异常的显微结构、骨重建活动和组织病理学变化。研发改善软骨下骨稳态的药物将给OA和RA的防治开辟一条崭新的道路。
[Abstract]:Objective: the subchondral bone is composed of SBP (subchondral bone plate) and STB (subchondral cancellous bone). It is involved in regulating and maintaining the biomechanical and biochemical homeostasis of the joint. The subchondral bone plays an important role in the occurrence and development of various joint diseases. In particular, osteoarthritis (OA) and rheumatoid arthritis (RA) were used to study the microstructures, bone remodeling level, age and sex of femoral head STB in hip OA, and to evaluate the correlation between STB integrity and STB homeostasis in hip OA. To explore the differences in microstructure, bone reconstruction level and pathological changes of femoral head subchondral bone in patients with secondary osteoarthritis (HD-OA) and osteoporosis (OPO) caused by hip-joint dysplasia (HDD). To evaluate the differences in microstructure and bone reconstruction level of femoral head subchondral bone between RA and OA patients. After hip arthroplasty, the specimens of STB and deep cancellous bone were drilled in the load-bearing area of femoral head. The microstructure and bone reconstruction level of each specimen were analyzed by microCT-Micro-CTand histomorphology. After hip arthroplasty, subchondral bone specimens were drilled in the load-bearing area of the femoral head. The microstructures and subchondral bone cysts of SBP were analyzed by micro-CT. The bone remodeling level of STB and the level of STB in SBCs were analyzed by histomorphology. Pathological changes. Part three: 20 patients with HD-OA and 20 patients with osteoporotic femoral neck fracture. The subchondral bone specimens were drilled in the load-bearing and non-weight-bearing areas of the femoral head after hip arthroplasty. The microstructure of each specimen was analyzed by micro-CT and histology. Bone reconstruction level and pathological changes. Part 4th: 20 patients with RA and 40 patients with OA underwent hip arthroplasty, STB and DTB specimens were drilled in the load-bearing area of the femoral head. MicroCTs, histomorphology and electron microscopy were used. Results: in the first part, there were significant differences in microstructure and bone reconstruction between STB and DTB. In STB and DTB, OA changed the steady-state and age of bone tissue. Normal gender relationship. Part two: the destruction of the integrity of STB in OA progression is closely related to the degeneration of STB. Part three: in HD-OA, the subchondral bone of the whole femoral head is degenerative of arthritis. 4th parts of RA and OA have similar microstructure in adjacent joint bone tissues (including STB and STB), but the bone resorption level of RA is higher. Conclusion: during the development of OA and RA, the bone resorption of RA is higher. The subchondral bone is seriously involved, showing abnormal microstructure, bone reconstruction activity and histopathological changes. The development of drugs to improve the stability of subchondral bone will open a new way for the prevention and treatment of OA and RA.
【学位授予单位】：上海交通大学
【学位级别】：博士
【学位授予年份】：2015
【分类号】：R684.3

【相似文献】