Drescher W, Schneider T, Becker C, Hobolth J, Rüther W, Hansen E S, Bünger C
University Hospital, Aarhus, Denmark.
J Bone Joint Surg Br. 2001 Mar;83(2):274-7. doi: 10.1302/0301-620x.83b2.10323.
Treatment with corticosteroids is a risk factor for non-traumatic avascular necrosis of the femoral head, but the pathological mechanism is poorly understood. Short-term treatment with high doses of methylprednisolone is used in severe neurotrauma and after kidney and heart transplantation. We investigated the effect of such treatment on the pattern of perfusion of the femoral head and of bone in general in the pig. We allocated 15 immature pigs to treatment with high-dose methylprednisolone (20 mg/kg per day intramuscularly for three days, followed by 10 mg/kg intramuscularly for a further 11 days) and 15 to a control group. Perfusion of the systematically subdivided femoral head, proximal femur, acetabulum, humerus, and soft tissues was determined by the microsphere technique. Blood flow in bone was severely reduced in the steroid-treated group. The reduction of flow affected all the segments and the entire epiphysis of the femoral head. No changes in flow were found in non-osseous tissue. Short-term treatment with high-dose methylprednisolone causes reduction of osseous blood flow which may be the pathogenetic factor in the early stage of steroid-induced osteonecrosis.
使用皮质类固醇进行治疗是股骨头非创伤性缺血性坏死的一个风险因素，但其病理机制尚不清楚。大剂量甲基强的松龙短期治疗用于严重神经创伤以及肾脏和心脏移植后。我们研究了这种治疗对猪股骨头及全身骨骼灌注模式的影响。我们将15只未成熟猪分配至接受大剂量甲基强的松龙治疗组（每天20mg/kg肌肉注射，共三天，随后10mg/kg肌肉注射，再持续11天），15只猪分配至对照组。通过微球技术测定系统细分的股骨头、股骨近端、髋臼、肱骨和软组织的灌注情况。在接受类固醇治疗的组中，骨内血流严重减少。血流减少影响了所有节段以及股骨头的整个骨骺。在非骨组织中未发现血流变化。大剂量甲基强的松龙短期治疗会导致骨血流减少，这可能是类固醇诱导的骨坏死早期的致病因素。
