摘要目的 通过对股骨头坏死(ONFH)患者硬化带形成情况进行回顾性分析及其组织学观察,探讨骨形态蛋白(BMP4)与硬化带关系,为股骨头坏死个性化治疗提供理论依据.方法 2005年11月至2007年11月共治疗激素性ONFH全髋关节置换患者184髋,患者平均年龄(47±7)岁,依此把患者分为高(＞54岁)、中(40～54岁)和低(＜40岁)3个年龄组,分析比较3组患者硬化带形成比率.从184髋中选取部分股骨头标本,包括高年龄组患者股骨头18髋,低年龄组11髋,中年龄组股骨头标本20髋(有无硬化带形成者各10髋).股骨头冠状面正中剖开,在负重区和非负重区取材,行常规HE染色、苦味酸-天狼星红染色、电镜制备和BMP4蛋白免疫组化染色.BMP4蛋白免疫组化染色强度用图像分析软件计算其平均光密度.结果 硬化带在组织学上表现为骨小梁增粗,结构紊乱,但骨细胞结构同正常骨细胞,且处于高分泌状态.中年龄组ONFH患者硬化带形成比例为71.4%(105/147),显著高于低年龄组患者(45.5%,5/11)和高年龄组患者(38.5%,10/26)(P均＜0.01).中年组患者股骨头BMP4平均光密度为0.32±0.14,明显高于低年龄组0.20±0.17和高年龄组0.19±0.27,且差异具有统计学意义(P均＜0.05);中年龄组患者无硬化带形成者BMP4平均光密度分别为0.16±0.1l,有硬化带形成患者为0.28±0.13,差异具有统计学意义(P＜0.01).有硬化带形成患者出现髋关节疼痛到关节置换时间为(49±11)个月,显著长于无硬化带形成者(15±2)个月,差异具有统计学意义(P＜0.01).结论 ONFH患者硬化带形成与BMP4表达强弱呈正相关,BMP的高表达可能促进硬化带的形成.

abstractsObjectives To analyze retrospectively the formation and histological changes of sclerosis rim in patients with osteonecrosis of the femoral head ( ONFH), and to study the relationship between bone morphogenetic proteins (BMP4) and sclerosis rim, so as to acquire experimental and theoretical basis on individualized treatment for ONFH patients. Methods From November 2005 to November 2007,184 hips of steroid-induced ONFH inpatients were collected. The mean age was (47 ± 7 ) years, the patients weredivided into high ( more than 54 years old), middle (40-54 years old) and low ( less than 40 years old) age groups. Their clinical data were analyzed retrospectively according to gender and age. Parts of the femoral heads were selected for the study, including 18 hips in high age group,11 hips in low age group and 20 hipsin middle age group. Each 10 hips were selected with or without sclerosis rim. The femoral heads were cut along middle coronal plane, their weight-bearing and non-weight-bearing areas were used for the study. The specimens were processed by routine HE staining and picric acid-Sirius red staining and electron microscopy preparation and immunohistocheministry stain. The average optical density of BMP4 protein was calculated by image analysis software. Results The trabecular of sclerosis rim was thickening and disorder. But its osteocytes were normal and with high secretion. The ratio of sclerosis rim was 71.4% (105/147) in middle age ONFH patients, which was significantly higher than the low age group patients (45. 5% ,5/11 ) and high age group patients ( 38.5%, 10/26 ) ( P ＜ 0. 01 ). The optical density of BMP4 in middle age ONFH patients was 0. 32 ±0. 14, which was significantly higher than the low age group 0. 20 ±0. 17 and high age patients 0. 19 ±0. 27 ( P ＜ 0. 05 ). The optical density was 0. 16 ± 0. 11 in ONFH patients without sclerosis rim,which was significantly lower than with sclerosis rim (0. 28 ± 0. 13 ) (P ＜0. 01 ). The time from hip pain to joint replacement in patients with sclerosis rim was ( 49 ± 11 ) months, and ( 15 ± 2 ) months without sclerosis rim. There was significant difference between the two groups ( P ＜ 0. 01 ). Conclusions The formation of sclerosis rim is positively related to the expression of BMP4, and high expression of BMP maybe promote the formation of sclerosis rim.