Hirano K, Tsutsui H, Sugioka Y, Sueishi K
Department of Pathology I, Faculty of Medicine, Kyushu University, Fukuoka, Japan.
Clin Orthop Relat Res. 1997 Sep(342):192-204.
To probe into the pathogenesis of osteonecrosis of the femoral head, the authors obtained 37 asymptomatic human femoral heads at autopsy; of these, 13 were cases of high dosage corticosteroid therapy (steroid group) and 24 were cases without steroid therapy (nonsteroid group). The steroid group included two asymptomatic cases of osteonecrosis incidentally recognized. These femoral heads then were studied histologically and morphometrically using 2-mm stepwise tissue sections of the whole femoral head and serial sections to examine the histopathologic alterations of superior retinacular arteries and veins in detail. There was no significant difference in the luminal stenotic rate of the superior retinacular arteries between the steroid and nonsteroid groups. However, the draining veins morphometrically were more stenotic or obliterated in the steroid group than were those in the nonsteroid group. In fact, the number of stenotic veins was significantly greater in the steroid group. These findings indicate that the stenotic changes of the draining veins may participate in the development and progression of steroid induced osteonecrosis of the femoral head.
为探究股骨头坏死的发病机制，作者在尸检时获取了37个无症状的人类股骨头；其中，13例为高剂量皮质类固醇治疗病例（类固醇组），24例为未接受类固醇治疗的病例（非类固醇组）。类固醇组包括2例偶然发现的无症状股骨头坏死病例。然后，使用整个股骨头的2毫米阶梯式组织切片和连续切片对这些股骨头进行组织学和形态计量学研究，以详细检查上支持带动脉和静脉的组织病理学改变。类固醇组和非类固醇组在上支持带动脉的管腔狭窄率方面没有显著差异。然而，与非类固醇组相比，类固醇组的引流静脉在形态计量学上更狭窄或闭塞。事实上，类固醇组中狭窄静脉的数量明显更多。这些发现表明，引流静脉的狭窄变化可能参与了类固醇诱导的股骨头坏死的发生和发展。
