| Objective:Non-traumatic avascular necrosis of femoral head is one of thecommon and refractory diseases in orthopedics and the patients are increasedyear by year.Although many experts and scholars has expended some time onthis study, the histomorphological features of non-traumatic avascular necrosisof femoral head are still need further research. In this study,by the research onhistomorphological observation between non-traumatic avascular necrosis offemoral head group and femoral neck fracture group, we analyzed thehistomorphological features of non-traumatic avascular necrosis of femoralhead in order to provide a theoretical basis on prevention and treatment.Method:30patients’ femoral head examples were collected fromunilateral hip replacement between March2010and November2011.20examples(steroid using history10,drinking history8,both had steroid usingand drinking history2,ARCO stage Ⅳ)belonged to non-traumatic avascularnecrosis of femoral head group and as the experimental group,the other10examples(without avascular necrosis of femoral head,operated on in one weekafter injured)belonged to neck fracture group and as the control group.In thisstudy,we regarded the weight-bearing area as the center to saw the femoralhead. After that, weight-bearing area of cartilage, subchondral necrotic centerof the loading area, repair area and normal area were taken from non-traumaticavascular necrosis of femoral head group, and weight-bearing area of cartilageand bone under the cartilage of weight-bearing area were taken from neckfracture group.Next,used formalin fixed and made biopsy. Last,we used anoptical microscope to observe after HE staining.We observed themorphological and quantitative on chondrocytes number,empty lacunae rate,trabecular bone areas,the largest diameter of fat cells.The experimental dateapplied SPSS13.0statistical software for statistical analysis and the measurement data used mean±standard deviation(x±s).Setα=0.05,there wasstatistical significance if P <0.05for the difference.Results:1General observation:①control group: specimens were divided into twoparts: Ⅰw eight-bearing area of cartilage layer: Integrity, smooth, wear-free,without osteophyte formation,cartilage and subchondral tissue isolated,white;Ⅱ s ubchondral area:femoral head bone was uniform,without necrosis,cystic degeneration,and no granulation-like tissue,the upper part of the colorwas yellow,the lower was bright red.②experimental group:specimens weredivided into four parts: Ⅰw eight-bearing area of cartilage layer:incomplete,broken,cartilage and subchondral tissue was isolated the surface washyperplasia,the color was slightly pale. Ⅱnecrotic area:cystic degeneration,appear hardening zone,yellow-white;Ⅲ repair area:appear granulationtissue,slightly whitish color,soft; Ⅳnormal area:femoral head bone wasuniform,without necrosis,cystic degeneration,but the color was slightly palecompared with femoral neck fracture group.2Microscopy observation:①control group;the structure of chondrocytes andtrabecular bone structure were normal;the number of empty osteocytelacunae was small;no obvious aggregation of inflammatory cells; thestructure of fat cells was normal,without hypertrophy and hyperplasia.②experimental group:Ⅰ weight-bearing area of cartilage layer:the number ofchondrocytes was decreased and the number of empty osteocyte lacunae wasincreased, accompanied by the hyperplasia of fibrous tissue.Ⅱ necrotic area:the subchondral bone trabecular was fracture,marrow cavity appeared,and thehyperplasia of fibrous tissue was appeared in the junction of cartilage andsubchondral; fat cells were hypertrophy and hyperplasia, disordered, part ofthe cells fused into larger vacuoles,others were necrosis and absorbed.Besides that, the bone marrow was necrosis and the marrow cavityappeared;bone cells were reduced, the number of empty lacunae wasincreased. Ⅲr epair area:the bone marrow was necrosis and the marrowcavity appeared,with the invasion of granulation tissue; many inflammatory cells were aggregated, with the appearance of neovascularization.Thetrabecular bones were composed of normal trabecular bone, necrotic bonetrabeculae and newly formed bone trabeculae.Ⅳ normal area: the structure ofbone trabecular and fat cells was normal；the number of empty lacunae wassmall; the structure of fat cells was normal, without hypertrophy andhyperplasia.3Statistical data: The chondrocytes number of control group was17.9±1.4(n),experimental group was8.15±1.7, F=1.96,P>0.1，population variances wereequal，using the method of equal population variance t-test) t=16.8，P<0.001,the difference between the two groups were significant. The trabecular boneareas of control group was24504.9±2848.4(μm2),experimental group was16716.85±2297.1(μm2),F=1.537,P>0.1，using the method of equal populationvariance t-test,t=8.08,P<0.001,the difference between the two groups weresignificant.The empty bone lacunae rate of control group was8.6±4.2(%),theother group was47.7±5.9(%),(F=1.97,P>0.1, population variances wereequal，using the method of equal population variance t-test)t=8.90,P<0.001,thedifference between the two groups were significant. The largest diameter of fatcells of control group was54.1±9.8(μm),the other group was67.45±11.7,(F=1.425,P>0.1,population variances were equal,using the methodof equal population variance t-test)t=3.10,P<0.005, the difference between thetwo groups were significant.Conclusion:1The chondrocytes number of non-traumatic avascular necrosis of femoralhead is decreased, accompanied by the hyperplasia of fibrous tissue.2The subchondral bone trabecular of non-traumatic avascular necrosis offemoral head is fracture, marrow cavity appeared.The bone marrow is necrosisand the number of empty bone lacunae is increased.3Many inflammatory cells are aggregated in non-traumatic avascular necrosisof femoral head,with the invasion of granulation tissue. The fat cells arehypertrophy and hyperplasia, disordered, part of the cells fused into largervacuoles, others are necrosis and absorbed. |
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