【摘要】 目的 探讨髓芯减压联合胶原基骨修复材料、血管内皮生长因子（VEGF）对股骨头坏死（ONFH）家兔模型的股骨头骨密度及生物力学的影响。方法 30只家兔股骨头内注射无水乙醇建立ONFH模型，随机分为健康对照组（A组）、模型组（B组）、髓芯减压联合自体松质骨组（C组）、髓芯减压联合胶原基骨修复材料组（D组）及髓芯减压联合胶原基骨修复材料和VEGF组（E组），每组6只。治疗8周后，分别检测各组家兔股骨头的骨密度和生物力学参数（最大应力、弹性模量、刚度、最大载荷和能量吸收），HE染色观察股骨头形态。qRT-PCR检测各组家兔的股骨头组织中骨保护素（OPG）、血管内皮生长因子164(VEGF164)、血管内皮生长因子受体2(VEGFR2)、核因子κB受体活化因子配体（RANKL）和核因子κB受体活化因子（RANK）的mRNA水平。结果 B组的骨密度较A组显著降低（P<0.05）,E组的骨密度显著高于B组、C组和D组（P<0.05）。与A组相比，B组的空骨陷窝比率显著增高（P<0.05）；与B组相比，C组、D组和E组的空骨陷窝比率均降低，以E组最低（P<0.05）。与A组相比，B组的股骨头生物力学参数显著降低（P<0.05）；与B组相比，C组、D组和E组的股骨头生物力学参数均升高，以E组最高（P<0.05）。与B组、C组和D组相比，E组股骨头组织中OPG、VEGF164和VEGFR2的mRNA水平均升高（P<0.05）,RANKL和RANK的mRNA水平均降低（P<0.05）。结论 髓芯减压联合胶原基骨修复材料、VEGF可有效提高ONFH家兔股骨头的骨密度和强度，促进损伤区域的骨形成和血管生成，促进坏死性股骨头的修复。更多还原

【Abstract】 Objective To investigate the effects of core decompression combined with collagen-based bone repair material and vascular endothelial growth factor(VEGF) on bone mineral density and biomechanics of the femoral head in rabbit model of osteonecrosis of femoral head(ONFH).Methods The ONFH model was established by injecting absolute ethanol into the femoral head of 30 rabbits. Then the rabbits were randomly divided into the healthy control group(group A), the model group(group B), the core decompression combined with autologous cancellous bone group(group C),the core decompression combined with collagen-based bone repair material group(group D) and the core decompression combined with collagen-based bone repair material and VEGF group(group E), with 6 rabbits in each group. After 8 weeks of treatment, the bone mineral density and biomechanical parameters(maximum stress, elastic modulus, stiffness, maximum load and energy absorption) of the femoral head of rabbits in each group were detected respectively, and the morphology of the femoral head was observed by HE staining. The mRNA levels of osteoprotegerin(OPG), vascular endothelial growth factor 164(VEGF164), vascular endothelial growth factor receptor 2(VEGFR2), receptor activator of nuclear factor-κB ligand(RANKL) and receptor activator of nuclear factor-κB(RANK) in the femoral head tissue of rabbits in each group were detected by qRT-PCR.Results The bone mineral density of group B was significantly lower than that of group A(P<0. 05), and the bone mineral density of group E was significantly higher than those of group B, group C and group D(P<0. 05). Compared with group A, the ratio of empty bone lacunae in group B was significantly higher(P<0. 05). Compared with group B, the ratios of empty bone lacunae in group C, group D and group E were decreased, and group E was the lowest(P<0. 05). Compared with group A, the biomechanical parameters of the femoral head in group B were significantly decreased(P<0. 05). Compared with group B, the biomechanical parameters of the femoral head in group C, group D and group E were increased, and group E was the highest(P<0. 05). Compared with group B, group C and group D, the mRNA levels of OPG, VEGF164 and VEGFR2 in the femoral head tissue of group E were increased(P<0. 05), while the mRNA levels of RANKL and RANK were decreased(P<0. 05).Conclusion Core decompression combined with collagen-based bone repair material and VEGF can effectively improve the bone mineral density and strength of the femoral head of ONFH rabbits, promote bone formation and angiogenesis in the injured area, and promote the repair of necrotic femoral head.更多还原