摘要
目的 通过分析中日友好医院(CJFH)分型L2及L3型股骨头坏死(osteonecrosis of the femoral head,ONFH)标本的外侧柱、中间柱、内侧柱在骨小梁等骨微结构、细胞凋亡表型上的异同,对ONFH“三柱结构”进行量化,并为股骨颈基底部旋转截骨术治疗ONFH提供研究支持。方法 以2020年4月—2021年2月16例(16髋)CJFH分型L2型及L3型ONFH患者行人工全髋关节置换术后产生的废弃股骨头标本为研究对象。首先使用Micro-CT三维分割股骨头“三柱结构”,分析外侧柱、中间柱、内侧柱结构中骨体积分数(bone volume to total volume,BV/TV)、骨表面积骨体积比(bone surface area to bone volume ratio,BS/BV)、骨小梁分离度(trabecular spacing/separation,Tb.Sp)、骨小梁厚度(trabecular thickness,Tb.Th)和骨小梁数量(trabecular number,Tb.N)等指标,比较三柱间骨量和骨小梁结构相关参数的异同。然后用摆锯切割标本制作石蜡切片,行HE染色和细胞凋亡相关因子B淋巴细胞瘤-2(B-cell lymphoma-2,Bcl-2)、Bcl-2相关X蛋白(Bcl-2 associated X protein,Bax)免疫组织化学染色,通过比较空骨陷窝率、阳性细胞率评估CJFH分型L2型及L3型ONFH标本三柱间细胞凋亡表型的异同。结果 CJFH分型L2型ONFH股骨头,三柱间BV/TV、Tb.Th和Tb.N比较差异均有统计学意义(P<0.05),内侧柱最大,外侧柱最小;外侧柱BS/BV和Tb.Sp显著大于内侧柱和中间柱(P<0.05),内侧柱和中间柱比较差异无统计学意义(P>0.05)。L3型ONFH股骨头三柱间各骨参数指标比较差异均无统计学意义(P>0.05)。CJFH分型L2型和L3型ONFH股骨头三柱间空骨陷窝率比较差异均无统计学意义(P>0.05)。免疫组织化学染色出现大量组织切片脱片,未脱片的切片仅见少量非特异性染色,无法进行阳性细胞率计算。结论CJFH分型L2型ONFH的中间柱和内侧柱较外侧柱拥有更好的骨小梁结构,L3型ONFH三柱间骨小梁结构无显著差异。
Objective To analyze the similarities and differences of bone microstructure and apoptosis phenotype of lateral column, middle column, and medial column in type L2 and L3 osteonecrosis of the femoral head(ONFH) specimens classified by China-Japan Friendship Hospital(CJFH) classification, so as to carry out a quantitative study of ONFH “three-columns structure theory” and to provide research support for the treatment of ONFH by rotational osteotomy through the base of femoral neck. Methods Discarded femoral head specimens from 16patients(16 hips) with CJFH type L2 and L3 ONFH undergone total hip arthroplasty between April 2020 and February2021 were selected as the research objects. First, the “three-column structure” of the femoral head was threedimensionally segmented by Micro-CT, and the bone volume to total volume(BV/TV), bone surface area to bone volume ratio(BS/BV), trabecular spacing/separation(Tb.Sp), trabecular thickness(Tb.Th), and trabecular number(Tb.N) in the lateral column, middle column, and medial column were analyzed to compare the similarities and differences of parameters related to bone mass and trabecular structure among the three columns. Then, the specimens were cut with a oscillating saw and made into paraffin sections for HE staining and immunohistochemical staining of B-cell lymphoma-2(Bcl-2) and Bcl-2 associated X protein(Bax). The differences of apoptosis phenotype between the three columns of ONFH samples of CJFH type L2 and L3 were evaluated by comparing the rate of empty lacunae and the rate of positive cells of immunohistochemical staining. Results There were significant differences in BV/TV, Tb.Th, and Tb.N among the three columns of CJFH type L2 ONFH femoral head(P<0.05), with the largest in the medial column and the smallest in the lateral column;BS/BV and Tb.Sp of the lateral column were significantly greater than those of the medial column and middle column(P<0.05), no significant difference was found between the middle column and medial column(P>0.05).There was no signi
作者
高润子
夏天卫
刘金柱
袁兆丰
环大维
沈计荣
GAO Runzi;XIA Xiawei;LIU Jinzhu;YUAN Zhaofeng;HUAN Dawei;SHEN Jirong(Department of Orthopedics and Traumatology,Nanjing Hospital of Chinese Medicine Affiliated to Nanjing University of Chinese Medicine,Nanjing Jiangsu,210029,P.R.China;Department of Orthopedics and Traumatology,Affiliated Hospital of Nanjing University of Chinese Medicine,Nanjing Jiangsu,210001,P.R.China)
出处
《中国修复重建外科杂志》
CAS
CSCD
北大核心
2022年第8期1003-1010,共8页
Chinese Journal of Reparative and Reconstructive Surgery
基金
江苏省中医院研究者发起的临床研究项目(YJZ202026)。
关键词
股骨头坏死
中日友好医院分型
MICRO-CT
病理学
Osteonecrosis of the femoral head
China Japan Friendship Hospital classification
Micro-CT
pathology
