微创性坏死骨冲洗术改善未成年猪股骨头缺血性坏死骨愈合：一项实验研究。

Minimally Invasive Necrotic Bone Washing Improves Bone Healing After Femoral Head Ischemic Osteonecrosis: An Experimental Investigation in Immature Pigs.

机构信息

Center for Excellence in Hip, Scottish Rite for Children, Dallas, Texas.

Department of Orthopaedic Surgery, UT Southwestern Medical Center, Dallas, Texas.

出版信息

J Bone Joint Surg Am. 2021 Jul 7;103(13):1193-1202. doi: 10.2106/JBJS.20.00578.

DOI:10.2106/JBJS.20.00578

PMID:33877059

Abstract

BACKGROUND

Ischemic osteonecrosis of the femoral head produces necrotic cell debris and inflammatory molecules in the marrow space, which elicit a chronic inflammatory repair response. The purpose of this study was to determine the effects of flushing out the necrotic cell debris and inflammatory proteins on bone repair in a piglet model of ischemic osteonecrosis.

METHODS

Osteonecrosis of the femoral head of the right hindlimb was induced in 12 piglets by tying a ligature tightly around the femoral neck. One week after the surgery, 6 animals were treated with a percutaneous 3-needle bone washing procedure and non-weight-bearing (NWB) of the right hindlimb (wash group). The total saline solution wash volume was 450 mL per femoral head. Serial wash solutions were collected and analyzed. The remaining 6 animals were treated with NWB only (NWB group). At 8 weeks after the surgery, the femoral heads were assessed using radiography, micro-computed tomography (micro-CT), and histological analysis. In addition, we compared the results for these piglets with our published results for 6 piglets treated with multiple epiphyseal drilling (MED) plus NWB without bone washing (MED group).

RESULTS

Necrotic cells and inflammatory proteins were present in the bone wash solution collected 1 week after ischemia induction. The protein and triglyceride concentrations decreased significantly with subsequent washing (p < 0.005). At 8 weeks after ischemia induction, the wash group had a significantly higher bone volume than the MED or NWB group (p < 0.0001). Histological bone-formation measures were also significantly increased in the wash group compared with the MED group (p = 0.002) or NWB group (p < 0.0001) while macrophage numbers were significantly decreased in the wash group.

CONCLUSIONS

The percutaneous 3-needle procedure flushed out cell debris and inflammatory proteins from the necrotic femoral heads, decreased osteoclasts and macrophages, and increased bone formation following induction of ischemic osteonecrosis.

CLINICAL RELEVANCE

We believe that this is the first study to investigate the concept of washing out the necrotic femoral head to improve bone healing. The minimally invasive procedure may be useful to improve the necrotic bone environment and bone repair following ischemic osteonecrosis.

摘要

背景

股骨头缺血性坏死会在骨髓腔内产生坏死细胞碎片和炎症分子，从而引发慢性炎症修复反应。本研究旨在确定冲洗坏死细胞碎片和炎症蛋白对缺血性股骨头坏死猪模型骨修复的影响。

方法

通过在猪的股骨颈处紧扎结扎线在 12 只小猪中诱导股骨头缺血性坏死。手术后 1 周，6 只动物接受经皮三针法骨冲洗和右后肢非负重（NWB）治疗（冲洗组）。每个股骨头的生理盐水冲洗量为 450ml。收集并分析连续冲洗液。其余 6 只动物仅接受 NWB 治疗（NWB 组）。手术后 8 周，通过 X 线摄影、微计算机断层扫描（micro-CT）和组织学分析评估股骨头。此外，我们将这些小猪的结果与我们之前发表的 6 只接受多次骺板钻孔（MED）加骨冲洗的非负重（NWB）治疗的小猪的结果进行了比较（MED 组）。

结果

在缺血诱导后 1 周收集的骨冲洗液中存在坏死细胞和炎症蛋白。随着后续冲洗，蛋白质和甘油三酯浓度显著降低（p<0.005）。在缺血诱导后 8 周，冲洗组的骨体积明显高于 MED 组或 NWB 组（p<0.0001）。与 MED 组（p=0.002）或 NWB 组（p<0.0001）相比，冲洗组的组织学成骨测量值也显著增加，而冲洗组的巨噬细胞数量显著减少。