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  本文選題：股骨頭壞死　切入點：動物模型　出處：《南京醫(yī)科大學》2009年碩士論文　論文類型：學位論文

【摘要】：目的:探討運用介入方法建立犬股骨頭壞死模型的可行性及造模效果,為股骨頭壞死的治療研究提供良好的模型基礎。 方法:9只成年健康雜種犬全麻后,分別通過股動脈Seldinger法穿刺插管,超選一側股骨頭供血動脈行平陽霉素灌注及明膠海綿栓塞處理,建立股骨頭缺血壞死模型,對側股骨頭作對照。模型犬隨機分為三組,每組3只,分別于栓塞術后2、4、6周處死。所有犬均于栓塞術前及術后每周予抽取外周靜脈血檢測血液流變學變化及行雙側髖關節(jié)MRI掃描觀察股骨頭影像學改變,栓塞術前、術后即刻、處死前行雙側股骨頭供血動脈DSA造影檢查了解栓塞側股骨頭血供情況,最后一次造影結束處死動物,取雙側股骨頭標本送病理學觀察。 結果: (1)所有實驗犬栓塞造模術后無一例發(fā)生感染或死亡,無一例出現(xiàn)造模側肢體皮膚或肌肉組織壞死。術后一周內犬精神狀態(tài)差,體重明顯減輕,造模側肢體呈跛行狀態(tài);一周后犬精神狀態(tài)逐漸好轉,造模側肢體由跛行逐漸過渡到能著地負重,體重較前逐漸恢復。 (2)根據(jù)結果分析,造模術后實驗動物的血液符合股骨頭壞死發(fā)病過程中存在的高粘滯狀態(tài),表現(xiàn)為全血粘度、紅細胞聚集性增高,紅細胞變形性能力下降。血液高粘滯狀態(tài)在造模術后早期、MRI尚未出現(xiàn)異常表現(xiàn)(術后3周)之前已經(jīng)形成并持續(xù)存在于造模術后整個過程中。 (3)通過預試驗解剖及血管造影觀察,犬股骨頭區(qū)血供主要來源于髂內動脈髖關節(jié)分支和骶正中動脈髖關節(jié)分支。栓塞術后即刻造影示栓塞側股骨頭供血動脈各分支遠端主干均閉塞,術后2、4、6周造影復查均未見栓塞動脈再通,且栓塞動脈近端存留主干隨造模后時間延長縮細程度逐漸加重,6周時造影示3只犬中2只犬出現(xiàn)栓塞側骶正中動脈髖關節(jié)分支近端主干完全閉塞。 (4)MRI觀察:栓塞術后3周內模型犬雙側股骨頭信號與術前相比無明顯差異;栓塞術后4周6只犬中4只犬栓塞側股骨頭T1、T2加權像開始表現(xiàn)為彌漫性不均勻高低混雜信號;栓塞術后5周、6周剩下3只犬栓塞側股骨頭T1、T2加權像均表現(xiàn)為不均勻混雜信號,且范圍隨時間延長而擴大,T1加權像以低信號為主,T2加權像以中低信號為主。 (5)組織病理學觀察:栓塞術后2周出現(xiàn)骨髓中造血干細胞壞死,脂肪細胞增大融合、部分壞死溶解等早期病理學壞死改變;栓塞術后4周病理切片出現(xiàn)不同程度骨細胞及骨小梁壞死;栓塞術后6周病理切片可見壞死后增生及修復反應。 結論:介入栓塞法能成功制作出犬股骨頭壞死模型,具有創(chuàng)傷小、造模方法簡單、成模時間短、動物死亡率低等優(yōu)點,是一種比較理想的造模方式。
[Abstract]:Objective: to explore the feasibility and effect of establishing canine femoral head necrosis model by interventional method, and to provide a good model basis for the treatment of femoral head necrosis. Methods after general anesthesia of 9 adult healthy mongrel dogs, femoral head ischemic necrosis model was established by femoral artery Seldinger puncture and cannulation respectively. One side of femoral head feeding artery was perfused with pingyangmycin and gelatin sponge embolization was used to establish the model of avascular necrosis of femoral head. The contralateral femoral head was used as control. The model dogs were randomly divided into three groups, 3 in each group. All dogs were killed at 2 and 4 weeks after embolization. The hemorheological changes of peripheral venous blood were detected before and every week after embolization, and the imaging changes of femoral head were observed by bilateral hip MRI scanning. The changes of femoral head were observed immediately before embolization and immediately after embolization. The DSA angiography of bilateral femoral head supplying artery was performed before death to understand the blood supply of the embolized femoral head. The animals were killed at the end of the last angiography, and the specimens of bilateral femoral head were taken for pathological observation. Results:. 1) No infection or death occurred in all experimental dogs after embolization and no necrosis of skin or muscle tissue of the limb was found in all the experimental dogs. The dogs were in poor mental state and significantly reduced weight within one week after the operation, and the limb of the model side was in a limping state. One week later, the mental state of the dog gradually improved, the limb of the model was gradually transferred from limp to landing weight, and the weight gradually recovered. 2) according to the analysis of the results, the blood of the experimental animals after modeling was in accordance with the high viscosity state existing in the process of necrosis of the femoral head, showing that the whole blood viscosity and the aggregation of red blood cells were increased. The deformability of red blood cells was decreased and the hyperviscosity of blood was formed and persisted during the whole process of model making before the early stage of model making (3 weeks after operation) before the abnormal appearance of MRI was not found in the early stage of model making (3 weeks after operation). (3) Anatomy and Angiography, The blood supply in the femoral head area of dogs was mainly derived from the hip joint branch of the internal iliac artery and the hip branch of the median sacral artery. No embolization artery recanalization was found at 2 ~ 4 ~ 6 weeks after operation. And the preservation of the main trunk in the proximal end of the embolized artery was gradually aggravated with the prolongation of the duration of the model. At 6 weeks after embolization, 2 of the 3 dogs showed complete occlusion of the proximal branch of the femoral branch of the middle sacral artery in the embolized side. MRI observation showed that there was no significant difference in the signal intensity of bilateral femoral head between the two sides of the model dog within 3 weeks after embolization, and in 4 out of 6 dogs after embolization, the T _ 1 / T _ 2 weighted images of the embolized side of femoral head began to show diffuse heterogeneous mixed signal. The T _ 1 T _ 2 weighted images of the femoral head in the embolized side of the remaining 3 dogs showed inhomogeneous mixed signal at the end of 5 weeks and 6 weeks after embolization, and the range of T _ 1 weighted images increased with time, and the main T _ 1-weighted images were low and low signal intensity. (5) histopathological observation: bone marrow hematopoietic stem cell necrosis, adipocyte enlargement and fusion, partial necrolysis and other early pathological necrotic changes occurred 2 weeks after embolization. Osteocyte and trabecular necrosis were observed at 4 weeks after embolization and proliferation and repair reaction were observed in pathological sections 6 weeks after embolization. Conclusion: the canine femoral head necrosis model can be successfully made by interventional embolization, which has the advantages of small trauma, simple modeling method, short modeling time and low animal mortality. It is an ideal model making method.
【學位授予單位】：南京醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2009
【分類號】：R681.8;R-332

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