肾虚血瘀型股骨头坏死临床、病理及影像学相关研究
发布时间：2018-07-16 18:22
【摘要】：目的：1.从骨髓微环境的改变来探讨激素性股骨头坏死(肾虚血瘀型)可能的发病机制。检测激素性股骨头坏死股骨近端髓腔内骨髓间充质干细胞的Runx2、catenin、 LRP5、OSX、PPARγ、OCN、TAZ、LEF-1 mRNA相对于健康者的表达差异,初步探讨Wnt/β-catenin信号通路在激素性股骨头坏死(肾虚血瘀型)中的表达意义,为临床治疗方案提供参考。2.收集非创伤性股骨头坏死患者和股骨颈骨折行关节置换者新鲜股骨头标本,研究患髋疼痛时间与软骨状态关系,并对激素性坏死股骨头标本进行micro-CT扫描检测不同部位的BMD和BMC等差异,观察研究坏死股骨头内不同病理区病理结构差异。3.回顾性研究资料完整的非创伤性ARCOⅡ期股骨头坏死的影像学自然进展,研究股骨头坏死负重区的保留与塌陷进展之间的关系,以期为股骨头坏死患者的预后及制定合理的个体化治疗方案提供参考依据。方法：1.从2015年11月至2016年2月,从我院6例因激素性股骨头坏死行保髋手术或关节置换术(实验组)和5例因股骨颈骨折、髋臼发育不良继发髋关节炎或髋关节炎需手术患者(对照组)术中从股骨近端抽取骨髓。每位患者术前均签署知情同意书。记录纳入研究者术前各项检查资料。分离培养骨髓间充质干细胞,对其表型进行流式鉴定,油红O染色鉴定成脂能力,茜素红染色鉴定成骨能力。将细胞培养至第3代,RT-qPCR检测各组骨髓间充质干细胞中Runx2、OSX、LRP5、catenin、PPARγ、OCN、 TAZ、LEF-1的mRNA表达差异。2.从2015年3月至2016年2月,收集我院非创伤性股骨头坏死及新鲜股骨颈骨折患者行髋关节置换术的影像学检查资料及病历资料,收集刚手术截取的新鲜股骨头标本,对标本外观分别从前、后、内、外方向拍照,记录患者患髋发病以来疼痛时间、程度,观察股骨头标本的外形、软骨色泽、表面形态、弹性及厚度等。取6例X线、CT\MRI资料齐全的新鲜的激素性股骨头坏死股骨头标本用硬组织切片机沿股骨头冠状面负重区为中心以5-8mm的间距切开,观察剖面内各病理区形态,选接近正中冠状位层面行Micro-CT扫描检测,并选取坏死区、硬化带、正常区进行三维重建后行骨矿密度(BMD)、骨矿容量(BMC)、组织体积(TV)、骨体积(BV)、骨体积分数(BVF, BV/TV)、骨表面积与骨体积比(BS/BV)、骨表面密度(BS/TV)、骨小梁厚度(Tb.Th)、骨小梁数目(Tb.N)、骨小梁分离度(Tb.Sp)等相关参数分析,其余层面按照负重区软骨、坏死区、硬化区及正常区分别取材行HE染色、masson染色及其它相关检测分析,与股骨颈骨折组相对照,比较空骨陷窝率、软骨细胞数、最大脂肪细胞直径等。3.回顾性分析2009年1月至2015年3月期间于我院骨科住院治疗的87位(102髋)影像资料完整的经MRI诊断为ARCO Ⅱ期的非创伤性股骨头坏死患者的影像学自然进展。记录双髋关节正位和蛙式侧位X片上发生塌陷的髋数及发展至塌陷的时间。按照坏死区所在股骨头前外侧部位提出蛙式侧位(FLL)分型。将蛙式侧位股骨头内的坏死区描述为后中和中心部位(I型),部分前外侧(Ⅱ型)和整个前外侧部(Ⅲ型),分别占股骨头直径的25%、50%和25%。观察坏死塌陷与股骨头前外侧部负重区骨量保留情况关系,并通过对术后切下的股骨头的形态分析进行证实。对股骨头蛙式侧位不同分型的股骨头塌陷率和塌陷时间进行总结分析并与传统的正位分型相比较。结果：1.提取骨髓间充质干细胞的实验组与对照组相比较,术前实验组血液分析中平均红细胞体积(MCV)、平均血小板体积(MPV)、血小板分布宽度(PDW)、红细胞分布宽度(RDW-CV)均高于对照组,但差异无统计学意义(P0.05)；实验组血液生化分析中总胆固醇(CHOL)、甘油三酯(TG)、载脂蛋白Al (apoAl)、载脂蛋白B(apoB)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)均低于对照组,但差异无统计学意义(P0.05)。按照患者临床症状和体征所见,结合股骨头坏死中医临床路径诊疗规范,可将激素性股骨头坏死按肾虚血瘀型辩证论治。2.成功分离培养了骨髓间充质干细胞,并经过细胞表型鉴定CD29、CD44、CD73、 CD 105阳性,CD34、CD45阴性,符合骨髓间充质干细胞表型。油红O染色、茜素红染色鉴定了其潜在的成脂、成骨分化能力。3. RT-qPCR结果表明,实验组(ONFH组)骨髓间充质干细胞的Runx2、OSX、 LRP5、catenin的mRNA表达量明显低于对照组,差异有统计学意义(P0.05)；实验组PPARy、OCN、TAZ、LEF-1于对照组,但差异无统计学意义(P0.05)。4. Micro-CT扫描影像可见坏死区骨小梁明显较稀疏,部分可见断裂,坏死区与硬化区之间存在明显的空隙(大体标本上对应为肉芽带),部分有囊变。对坏死区、硬化区与正常区进行三维重建后相关数据分析表明,与正常区相比较,坏死区的BMD、 BMC、BVF、Tb.N明显降低,差异有统计学意义(P0.05)；Tb.Sp明显升高,差异有统计学意义(K0.05)。硬化区的BMD、BMC、BVF、Tb.Th明显升高,差异有统计学意义(P0.05)；BS/BV明显降低,差异有统计学意义(P0.05)。与正常区相比较,坏死区BS/BV、BS/TV较正常区高,但差异无统计学意义(P0.05)；Tb.Th较正常区低,但差异无统计学意义(P0.05)。与正常区相比较,硬化区BS/TV较高,但差异无统计学意义(P0.05),Tb.Sp较低,但差异无统计学意义(P0.05)。统计结果表明患者患髋疼痛时间越长,一般股骨头软骨损伤程度越重。一般疼痛时间不超过6月者,股骨头软骨多较完好,建议保髋手术在患髋疼痛不超过6个月进行为宜。HE染色及masson染色观察结果显示,实验组负重区软骨细胞数明显低于对照组,差异有统计学意义(P0.05)；坏死区空骨陷窝率明显高于对照组,差异有统计学意义(P0.05)；实验组最大脂肪直径明显高于对照组,差异有统计学意义(P0.05)。实验组胶原纤维、类骨质定性分析均低于对照组。5.回顾性分析研究ARCOⅡ期非创伤性股骨头坏死的X片影像学自然进展结果表明,与正位X片相比较,蛙式侧位X片股骨头塌陷的数量明显高于正位X片的塌陷数,差异有统计学意义(P0.01)。蛙式侧位X片塌陷时间小于正位X片塌陷时间,但差异无统计学意义(P0.05)。按照股骨头坏死区蛙式侧位分型,Ⅲ型股骨头坏死的塌陷率明显高于Ⅱ型股骨头坏死,差异有统计学意义(P0.001)。Ⅲ型股骨头坏死发展至塌陷时间比Ⅱ型较短,但差异无统计学意义(P0.05)。对手术切除的坏死股骨头标本进行组织病理学分析证实塌陷区位于股骨头前外侧部。结论：1.塌陷期激素性股骨头坏死患者股骨近端骨髓内Wnt/β-catenin信号传导通路可能受到抑制,导致股骨头内成骨能力下降,破骨细胞对骨细胞再吸收的速度高于成骨细胞生成新骨的速度,修复能力变弱,修复反应引起骨强度降低,负重区承重能力下降。2.非创伤性股骨头坏死坏死区的BMD、BMC、BVF、Tb.N较正常区明显减少,Tb.Sp明显增加。坏死后其内部空间排列以及立体结构改变,导致力学强度减弱,负重区承重能力下降,应力集中的结果,骨小梁发生微骨折。股骨头内生物学、生物力学的共同改变,最终导致股骨头部分塌陷。3.股骨头坏死前外侧部的保留与塌陷进展有关。坏死区蛙式侧位分级有助于减少塌陷的漏诊率,为预测股骨头坏死塌陷的可能性和选择适当的治疗方案提供参考。在蛙位X片上,当坏死区累及前股骨头前外侧部时,塌陷风险较大,建议外科手术干预。
[Abstract]:Objective: 1. to investigate the possible pathogenesis of steroid induced osteonecrosis of the femoral head (kidney deficiency and blood stasis type) from the change of bone marrow microenvironment. Detection of the expression difference of Runx2, catenin, LRP5, OSX, PPAR gamma, OCN, TAZ, LEF-1 mRNA relative to healthy persons in the proximal intramedullary mesenchymal stem cells of femoral head necrosis of the femoral head necrosis, and to discuss the Wnt/ beta -catenin. The significance of signaling pathway in steroid necrosis of the femoral head (kidney deficiency and blood stasis), providing reference.2. for clinical treatment scheme, collecting non traumatic femoral head necrosis patients and femoral neck fractures with joint replacement of fresh femoral head specimens, studying the relationship between the time of pain of the hip and the state of cartilage, and carrying out mic for the steroid necrosis of the femoral head specimens. Ro-CT scan test the difference of BMD and BMC in different parts, observe and study the difference of the pathological structure in the different department of pathology in the necrotic femoral head..3. retrospective study data of the intact non traumatic ARCO II necrosis of the femoral head, the relationship between the retention of the necrosis of the femoral head and the progress of the collapse is studied in order to be the femoral head. Methods: 1. from November 2015 to February 2016, 6 patients with corticosteroid necrosis of the femoral head underwent hip surgery or joint replacement (experimental group) and 5 cases of femoral neck fracture, acetabular dysplasia secondary hip osteoarthritis, or hip arthritis, from November 2015 to February 2016. In the control group, the bone marrow was extracted from the proximal femur during the operation. Each patient signed the informed consent before the operation. The records were recorded before the operation of the researchers. The bone marrow mesenchymal stem cells were isolated and cultured. The phenotype was identified by flow identification, the oil red O staining was used to identify the lipid forming ability and the alizarin red staining was used to identify the osteogenesis ability. The cells were cultured to third generations, RT-qPC R detection of Runx2, OSX, LRP5, catenin, PPAR gamma, OCN, TAZ, LEF-1 mRNA expression in the bone marrow mesenchymal stem cells from March 2015 to February 2016, from March 2015 to February 2016, collection of non traumatic femoral head necrosis and fresh femoral neck fracture patients underwent hip replacement surgery imaging examination data and medical records, collection of fresh femoral intercepted fresh femoral surgery Bone specimens were photographed from the former, after, after, inside and outside, to record the time and degree of pain since the onset of hip onset, to observe the shape of the femoral head, the color of the cartilage, the shape of the cartilage, the shape, the elasticity and the thickness of the femoral head. 6 cases of fresh steroid femoral head necrosis of the femoral head specimens were taken with a hard tissue slicer along the femoral head. The coronal weight area of the bone was divided into the center of 5-8mm and observed the morphology of each department of pathology in the section. Micro-CT scan was selected close to the positive middle crown level, and the necrotic area, sclerosing zone and normal area were selected for bone mineral density (BMD), bone mineral volume (BMC), tissue volume (TV), bone volume (BV), bone volume fraction (BVF, BV/T). V), the bone surface area and bone volume ratio (BS/BV), bone surface density (BS/TV), bone small Liang Houdu (Tb.Th), bone small Liang Shumu (Tb.N), bone trabecular separation degree (Tb.Sp) and other related parameters were analyzed, and the other layers were obtained by HE staining, Masson staining and other correlation detection according to the weight region cartilage, necrotic area, sclerosis area and normal area, and the femoral neck bone. .3. retrospective analysis of the ratio of bone lacunae, the number of chondrocytes, and the diameter of the largest adipocyte in the Department of orthopedics from January 2009 to March 2015 in the Department of orthopedics, 87 (102 hip) imaging data of the patients who were diagnosed as non traumatic femoral head necrosis in stage ARCO II of the hospital during the period from January 2009 to March 2015. The number of collapsed hips and the time of development to collapse on the X of the lateral and the breaststroke lateral position. According to the anterolateral part of the femoral head in the necrotic area, the frog lateral position (FLL) is put forward. The necrotic region in the frog side of the femoral head is described as the center of the posterior neutralization (type I), the part of the anterolateral (type II) and the whole anterolateral part (type III), which account for the femoral head, respectively. The relationship between the necrotic collapse and the bone mass retention in the anterior lateral mass of the femoral head was observed by 25%, 50% and 25%. diameter. The morphological analysis of the femoral head cut down after the operation was confirmed. The collapse rate and the collapse time of the femoral head in different types of the femoral head were analyzed and compared with the traditional type of orthotopic classification. 1. compared with the control group, the average red cell volume (MCV), the average platelet volume (MPV), the distribution width of platelets (PDW) and the red blood cell width (RDW-CV) were higher in the experimental group than in the control group, but the difference was not statistically significant (P0.05). The total bile of the experimental group in the blood biochemical analysis of the experimental group was not significant. Sterol (CHOL), triglyceride (TG), apolipoprotein Al (apoAl), apolipoprotein B (apoB), high-density lipoprotein cholesterol (HDL-C), low density lipoprotein cholesterol (LDL-C) were lower than those of the control group, but the difference was not statistically significant (P0.05). According to the clinical symptoms and signs of the patients, the clinical pathway diagnosis and treatment combined with the femoral head necrosis can be stimulated. The osteonecrosis of the femoral head was successfully separated and cultured in.2.. The bone marrow mesenchymal stem cells were successfully isolated and cultured in accordance with the syndrome of kidney deficiency and blood stasis. The phenotype of CD29, CD44, CD73, CD 105, CD34, CD45 negative, was conformed to the phenotype of bone marrow mesenchymal stem cells through the cell phenotype. Alizarin red staining identified the potential lipid and.3. RT-qPCR junction of osteogenesis differentiation. The results showed that the mRNA expression of Runx2, OSX, LRP5 and catenin in the bone marrow mesenchymal stem cells in the experimental group (group ONFH) was significantly lower than that of the control group (P0.05). The experimental group was PPARy, OCN, TAZ, LEF-1 in the control group, but the difference was not statistically significant (P0.05) showed that the small bone Liang Mingxian in the necrotic area was thinner and partially available. There was a clear gap between the necrotic area and the hardened area (the gross specimen was the granulation zone), and some cystic changes were found in the necrotic area. The correlation data after three-dimensional reconstruction of the necrotic area, the hardened area and the normal area showed that the BMD, BMC, BVF, and Tb.N in the necrotic region were significantly lower than those in the normal area, and the difference was statistically significant (P0.05); Tb.Sp was obvious. The difference was statistically significant (K0.05). The BMD, BMC, BVF and Tb.Th in the hardened area were significantly higher, and the difference was statistically significant (P0.05). The difference was statistically significant (P0.05). Compared with the normal area, the necrotic region was higher than the normal region, but the difference was not statistically significant (P0.05); the Tb.Th was lower than the normal region, but the difference was not statistically significant. Learning significance (P0.05). Compared with the normal area, the hardened area BS/TV was higher, but the difference was not statistically significant (P0.05), and the Tb.Sp was lower, but the difference was not statistically significant (P0.05). The statistical results showed that the longer the pain time of the hip, the more severe the cartilage damage in the common femoral head. The pain time did not exceed the June, the cartilage of the femoral head was more perfect. The results showed that the number of chondrocytes in the weight bearing area of the experimental group was significantly lower than that of the control group (P0.05), and the rate of empty lacunae in the necrotic area was significantly higher than that of the control group (P0.05). The maximum fat diameter in the experimental group was significant (P0.05). The maximum fat diameter in the experimental group was significantly higher than that of the control group (P0.05). The maximum fat diameter in the experimental group was significant (.HE). The difference was significantly higher than that of the control group (P0.05). The qualitative analysis of collagen fiber and osteoid in the experimental group was lower than that of the control group.5. retrospective analysis of the ARCO II non traumatic femoral head necrosis of the X slice imaging nature progress results showed that the number of the frog type side X slices of the femoral head was obviously higher than that of the positive X. The collapse number of the slices was statistically significant (P0.01). The collapse time of the frog lateral X tablet was less than the collapse time of the positive X tablet, but the difference was not statistically significant (P0.05). The collapse rate of type III femoral head necrosis was significantly higher than that of type II femoral head necrosis (P0.001). The difference was statistically significant (P0.001). The time of necrotic development to collapse was shorter than that of type II, but the difference was not statistically significant (P0.05). Histopathological analysis of the necrotic femoral head specimens confirmed that the collapse area was located in the anterolateral part of the femoral head. Conclusion: 1. the Wnt/ beta -catenin signal transduction pathway in the proximal femur of the femoral head necrosis of the patients with the collapse stage may be affected by the signal transduction pathway. Inhibition resulted in a decrease in osteogenesis ability in the femoral head, the rate of osteoclast reabsorption to bone cells was higher than that of osteoblasts, the ability to repair the bone was weakened, the repair reaction caused the reduction of bone strength and the weight bearing capacity decreased in the.2. non traumatic necrosis and necrosis area of the femoral head, and the BMD, BMC, BVF, and Tb.N were significantly lower than those of the normal area, Tb.Sp After necrosis, the internal space arrangement and the three-dimensional structure change resulted in the weakening of the mechanical strength, the decline in weight bearing capacity, the result of the stress concentration, the micro fracture of the trabecular bone. The common changes of biology and biomechanics in the femoral head resulted in the retention and collapse of the anterolateral part of the femoral head.3. femoral head necrosis. Progress is related. The frogs lateral classification of the necrotic region helps to reduce the missed diagnosis rate of the collapse, and provides a reference for the possibility of predicting the collapse of the femoral head and the choice of appropriate treatment options. On the frog position X, the risk of collapse is greater when the necrotic area is involved in the anterolateral part of the anterior femoral head, and the surgical intervention is suggested.
【学位授予单位】：广州中医药大学
【学位级别】：博士
【学位授予年份】：2016
【分类号】：R274.9
本文编号：2127249
[Abstract]:Objective: 1. to investigate the possible pathogenesis of steroid induced osteonecrosis of the femoral head (kidney deficiency and blood stasis type) from the change of bone marrow microenvironment. Detection of the expression difference of Runx2, catenin, LRP5, OSX, PPAR gamma, OCN, TAZ, LEF-1 mRNA relative to healthy persons in the proximal intramedullary mesenchymal stem cells of femoral head necrosis of the femoral head necrosis, and to discuss the Wnt/ beta -catenin. The significance of signaling pathway in steroid necrosis of the femoral head (kidney deficiency and blood stasis), providing reference.2. for clinical treatment scheme, collecting non traumatic femoral head necrosis patients and femoral neck fractures with joint replacement of fresh femoral head specimens, studying the relationship between the time of pain of the hip and the state of cartilage, and carrying out mic for the steroid necrosis of the femoral head specimens. Ro-CT scan test the difference of BMD and BMC in different parts, observe and study the difference of the pathological structure in the different department of pathology in the necrotic femoral head..3. retrospective study data of the intact non traumatic ARCO II necrosis of the femoral head, the relationship between the retention of the necrosis of the femoral head and the progress of the collapse is studied in order to be the femoral head. Methods: 1. from November 2015 to February 2016, 6 patients with corticosteroid necrosis of the femoral head underwent hip surgery or joint replacement (experimental group) and 5 cases of femoral neck fracture, acetabular dysplasia secondary hip osteoarthritis, or hip arthritis, from November 2015 to February 2016. In the control group, the bone marrow was extracted from the proximal femur during the operation. Each patient signed the informed consent before the operation. The records were recorded before the operation of the researchers. The bone marrow mesenchymal stem cells were isolated and cultured. The phenotype was identified by flow identification, the oil red O staining was used to identify the lipid forming ability and the alizarin red staining was used to identify the osteogenesis ability. The cells were cultured to third generations, RT-qPC R detection of Runx2, OSX, LRP5, catenin, PPAR gamma, OCN, TAZ, LEF-1 mRNA expression in the bone marrow mesenchymal stem cells from March 2015 to February 2016, from March 2015 to February 2016, collection of non traumatic femoral head necrosis and fresh femoral neck fracture patients underwent hip replacement surgery imaging examination data and medical records, collection of fresh femoral intercepted fresh femoral surgery Bone specimens were photographed from the former, after, after, inside and outside, to record the time and degree of pain since the onset of hip onset, to observe the shape of the femoral head, the color of the cartilage, the shape of the cartilage, the shape, the elasticity and the thickness of the femoral head. 6 cases of fresh steroid femoral head necrosis of the femoral head specimens were taken with a hard tissue slicer along the femoral head. The coronal weight area of the bone was divided into the center of 5-8mm and observed the morphology of each department of pathology in the section. Micro-CT scan was selected close to the positive middle crown level, and the necrotic area, sclerosing zone and normal area were selected for bone mineral density (BMD), bone mineral volume (BMC), tissue volume (TV), bone volume (BV), bone volume fraction (BVF, BV/T). V), the bone surface area and bone volume ratio (BS/BV), bone surface density (BS/TV), bone small Liang Houdu (Tb.Th), bone small Liang Shumu (Tb.N), bone trabecular separation degree (Tb.Sp) and other related parameters were analyzed, and the other layers were obtained by HE staining, Masson staining and other correlation detection according to the weight region cartilage, necrotic area, sclerosis area and normal area, and the femoral neck bone. .3. retrospective analysis of the ratio of bone lacunae, the number of chondrocytes, and the diameter of the largest adipocyte in the Department of orthopedics from January 2009 to March 2015 in the Department of orthopedics, 87 (102 hip) imaging data of the patients who were diagnosed as non traumatic femoral head necrosis in stage ARCO II of the hospital during the period from January 2009 to March 2015. The number of collapsed hips and the time of development to collapse on the X of the lateral and the breaststroke lateral position. According to the anterolateral part of the femoral head in the necrotic area, the frog lateral position (FLL) is put forward. The necrotic region in the frog side of the femoral head is described as the center of the posterior neutralization (type I), the part of the anterolateral (type II) and the whole anterolateral part (type III), which account for the femoral head, respectively. The relationship between the necrotic collapse and the bone mass retention in the anterior lateral mass of the femoral head was observed by 25%, 50% and 25%. diameter. The morphological analysis of the femoral head cut down after the operation was confirmed. The collapse rate and the collapse time of the femoral head in different types of the femoral head were analyzed and compared with the traditional type of orthotopic classification. 1. compared with the control group, the average red cell volume (MCV), the average platelet volume (MPV), the distribution width of platelets (PDW) and the red blood cell width (RDW-CV) were higher in the experimental group than in the control group, but the difference was not statistically significant (P0.05). The total bile of the experimental group in the blood biochemical analysis of the experimental group was not significant. Sterol (CHOL), triglyceride (TG), apolipoprotein Al (apoAl), apolipoprotein B (apoB), high-density lipoprotein cholesterol (HDL-C), low density lipoprotein cholesterol (LDL-C) were lower than those of the control group, but the difference was not statistically significant (P0.05). According to the clinical symptoms and signs of the patients, the clinical pathway diagnosis and treatment combined with the femoral head necrosis can be stimulated. The osteonecrosis of the femoral head was successfully separated and cultured in.2.. The bone marrow mesenchymal stem cells were successfully isolated and cultured in accordance with the syndrome of kidney deficiency and blood stasis. The phenotype of CD29, CD44, CD73, CD 105, CD34, CD45 negative, was conformed to the phenotype of bone marrow mesenchymal stem cells through the cell phenotype. Alizarin red staining identified the potential lipid and.3. RT-qPCR junction of osteogenesis differentiation. The results showed that the mRNA expression of Runx2, OSX, LRP5 and catenin in the bone marrow mesenchymal stem cells in the experimental group (group ONFH) was significantly lower than that of the control group (P0.05). The experimental group was PPARy, OCN, TAZ, LEF-1 in the control group, but the difference was not statistically significant (P0.05) showed that the small bone Liang Mingxian in the necrotic area was thinner and partially available. There was a clear gap between the necrotic area and the hardened area (the gross specimen was the granulation zone), and some cystic changes were found in the necrotic area. The correlation data after three-dimensional reconstruction of the necrotic area, the hardened area and the normal area showed that the BMD, BMC, BVF, and Tb.N in the necrotic region were significantly lower than those in the normal area, and the difference was statistically significant (P0.05); Tb.Sp was obvious. The difference was statistically significant (K0.05). The BMD, BMC, BVF and Tb.Th in the hardened area were significantly higher, and the difference was statistically significant (P0.05). The difference was statistically significant (P0.05). Compared with the normal area, the necrotic region was higher than the normal region, but the difference was not statistically significant (P0.05); the Tb.Th was lower than the normal region, but the difference was not statistically significant. Learning significance (P0.05). Compared with the normal area, the hardened area BS/TV was higher, but the difference was not statistically significant (P0.05), and the Tb.Sp was lower, but the difference was not statistically significant (P0.05). The statistical results showed that the longer the pain time of the hip, the more severe the cartilage damage in the common femoral head. The pain time did not exceed the June, the cartilage of the femoral head was more perfect. The results showed that the number of chondrocytes in the weight bearing area of the experimental group was significantly lower than that of the control group (P0.05), and the rate of empty lacunae in the necrotic area was significantly higher than that of the control group (P0.05). The maximum fat diameter in the experimental group was significant (P0.05). The maximum fat diameter in the experimental group was significantly higher than that of the control group (P0.05). The maximum fat diameter in the experimental group was significant (.HE). The difference was significantly higher than that of the control group (P0.05). The qualitative analysis of collagen fiber and osteoid in the experimental group was lower than that of the control group.5. retrospective analysis of the ARCO II non traumatic femoral head necrosis of the X slice imaging nature progress results showed that the number of the frog type side X slices of the femoral head was obviously higher than that of the positive X. The collapse number of the slices was statistically significant (P0.01). The collapse time of the frog lateral X tablet was less than the collapse time of the positive X tablet, but the difference was not statistically significant (P0.05). The collapse rate of type III femoral head necrosis was significantly higher than that of type II femoral head necrosis (P0.001). The difference was statistically significant (P0.001). The time of necrotic development to collapse was shorter than that of type II, but the difference was not statistically significant (P0.05). Histopathological analysis of the necrotic femoral head specimens confirmed that the collapse area was located in the anterolateral part of the femoral head. Conclusion: 1. the Wnt/ beta -catenin signal transduction pathway in the proximal femur of the femoral head necrosis of the patients with the collapse stage may be affected by the signal transduction pathway. Inhibition resulted in a decrease in osteogenesis ability in the femoral head, the rate of osteoclast reabsorption to bone cells was higher than that of osteoblasts, the ability to repair the bone was weakened, the repair reaction caused the reduction of bone strength and the weight bearing capacity decreased in the.2. non traumatic necrosis and necrosis area of the femoral head, and the BMD, BMC, BVF, and Tb.N were significantly lower than those of the normal area, Tb.Sp After necrosis, the internal space arrangement and the three-dimensional structure change resulted in the weakening of the mechanical strength, the decline in weight bearing capacity, the result of the stress concentration, the micro fracture of the trabecular bone. The common changes of biology and biomechanics in the femoral head resulted in the retention and collapse of the anterolateral part of the femoral head.3. femoral head necrosis. Progress is related. The frogs lateral classification of the necrotic region helps to reduce the missed diagnosis rate of the collapse, and provides a reference for the possibility of predicting the collapse of the femoral head and the choice of appropriate treatment options. On the frog position X, the risk of collapse is greater when the necrotic area is involved in the anterolateral part of the anterior femoral head, and the surgical intervention is suggested.
【学位授予单位】：广州中医药大学
【学位级别】：博士
【学位授予年份】：2016
【分类号】：R274.9
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