【摘要】 目的探讨“Y”形软骨损伤后骨骺早闭对髋关节发育的影响。方法选用10只4~5周龄大白兔,切除、破坏右侧髋臼部分“Y”形软骨,左侧髋关节不行处理,作为对照。X线动态观察双侧髋关节发育状况,术后12周处死动物,进行形态学及组织学观察。结果手术侧术后3周“Y”形软骨均出现骨骺早闭,髋臼内壁增厚、髋臼变浅;术后6~9周髋臼浅且形态不规则,4例出现半脱位;术后12周全部出现关节发育不良,50%的髋关节发生半脱位。形态学观察见髋臼变浅,内壁厚度增加,股骨头增大、变扁,关节软骨失去光泽,部分缺失。HE染色见髋臼及股骨头软骨层变薄,软骨细胞排列紊乱,骺板扭曲、变薄。对照侧各髋关节形态结构正常。手术侧各期臼头指数、相对髋臼指数及臼壁厚度与对照侧相比差异均有显著性意义(P<0.05)。手术侧术后12周臼头指数及相对髋臼指数与术后第2d相比差异有非常显著性意义(P<0.01)。结论“Y”形软骨损伤可导致骨桥形成、骨骺早闭,使髋臼内壁增厚、髋臼变浅,继而引发髋关节发育不良和半脱位。更多还原

【Abstract】 Objective To study the effect of premature physeal fusion of t ri radiate cartilage on hip development. Methods Ten rabbits aged 4 to 5 weeks were used by partial excision of triradiate physeal cartilage on the right hip of ea ch rabbit, and the opposite untreated hip served as control. Postoperative analy sis consisted of radiographic and histological studies. Radiographs of both hips were taken at 2 days and 3, 6, 9 and 12 weeks after surgery to evaluate the dev elopment and stability of hips. All rabbits were sacrificed at 12 weeks postoper atively. The gross and microscopic histological changes of the hip joints were s ubsequently assessed. The statistic analysis was performed by paired student’s t test worked out by SPSS software. Results On the operated hips, bone bridge fo rmed 3 weeks after operation at the site of triradiate cartilage. The medial ace tabular walls became thick, and the acetabula were shallow. At 6 and 9 weeks pos toperatively, the thickness of acetabular walls increased gradually, and irregul ar sclerosis appeared on the acetabular roof. The density of femoral head increa sed in 6 of 10 rabbits. At 12 weeks postoperatively, the acetabular cavity was m ore shallow, and the femoral head appeared flat. Subluxation of hip was observed in 5 rabbits. There was significant difference in approximate acetabular index (AAI), acetabular head index (AHI) and the thickness of acetabular wall between the operated and control hips. The mean value of AAI and AHI on the operated hip s at 12 weeks significantly decreased as compared to that at 2 days. Gross inspe ction confirmed that the acetabular cavity on the operated hips was characterist ically shallow with a marked increase thickness of medial wall. The femoral head became flattened, and the cartilage of both acetabulum and femoral head were th inned. Histological study showed thinning and partial loss of the joint cartilag e layer and irregularity of cartilage cells on the operated hip joints. There we re increased amounts of fibrovascular cells deep to the cartilaginous layer. In addition, the femoral head exhibited a zone of necrosis in its superior pole wit h thinning of the epiphyseal plate. On the control hips, structure of acetabulum and femoral head appeared normal congruity. Conclusion Acetabular triradiate ca rtilage injury might result in bony bar formation and premature fusion of physis . Its main pathologic changes are widening of the acetabular medial wall, shallo wness of the acetabular cavity, and subsequent hip dysplasia and dislocation.更多还原