Enoxaparin Prevents Steroid-Related Avascular Necrosis of the Femoral Head
Enoxaparin Prevents Steroid-Related Avascular Necrosis of the Femoral Head
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DOI：
10.1155/2014/347813
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发表时间：
2014-01-01
影响因子：
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通讯作者：
Drescher, Andwolf
中科院分区：
文献类型：
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作者：
Beckmann, Rainer;Shaheen, Hayfaa;Drescher, Andwolf
非外伤性股骨头坏死在骨科手术中仍然是一个具有挑战性的问题。在美国50万例髋关节置换手术中，有10%是髋关节置换手术，尤其影响相对年轻、活跃的患者。非外伤性骨坏死的主要原因是糖皮质激素的使用、酗酒、血栓形成和低纤溶（Glueck等，1997；north和anagnostoakos， 2013）。类固醇诱导的骨坏死的一种病理机制被认为是由于血栓形成和血管收缩增加而导致股骨头血流受损。以雄性新西兰大白兔为研究对象，探讨依诺肝素对激素相关性骨坏死的预防作用。甲基强的松龙注射液（1 × 20mg/kg体重）诱导骨坏死。对照动物用磷酸盐缓冲盐水处理。治疗包括每天注射11.7mg/kg体重的依诺肝素（Clexane）以及甲基强的松龙。注射甲基强的松龙4周后处死。进行组织学检查（苏木精-伊红和Ladewig染色），定量观察空腔隙和骨坏死的组织学征象。组织形态学测量显示，与糖皮质激素和clexane治疗的动物和对照组相比，糖皮质激素治疗的动物的空腔隙和坏死改变的骨细胞显著增加。糖皮质激素组和Clexane组与对照组无显著差异。这一发现表明，与依诺肝素联合治疗有可能预防类固醇相关性骨坏死。
Nontraumatic osteonecrosis of the femoral head is still a challenging problem in orthopedic surgery. It is responsible for 10% of the 500,000 hip replacement surgeries in the USA and affects relatively young, active patients in particular. Main reasons for nontraumatic osteonecrosis are glucocorticoid use, alcoholism, thrombophilia, and hypofibrinolysis (Glueck et al., 1997; Orth and Anagnostakos, 2013). One pathomechanism of steroid-induced osteonecrosis is thought to be impaired blood flow to the femoral head caused by increased thrombus formation and vasoconstriction. To investigate the preventive effect of enoxaparin on steroid-related osteonecrosis, we used male New Zealand white rabbits. Osteonecrosis was induced by methylprednisolone-injection (1 x 20mg/kg body weight). Control animals were treated with phosphate-buffered saline. Treatment consisted of an injection of 11.7mg/kg body weight of enoxaparin per day (Clexane) in addition to methylprednisolone. Four weeks after methylprednisolone-injection the animals were sacrificed. Histology (hematoxylin-eosin and Ladewig staining) was performed, and empty lacunae and histological signs of osteonecrosis were quantified. Histomorphometry revealed a significant increase in empty lacunae and necrotic changed osteocytes in glucocorticoid-treated animals as compared with the glucocorticoid-and Clexane-treated animals and with the control group. No significant difference was detected between the glucocorticoid and Clexane group and the control group. This finding suggests that cotreatment with enoxaparin has the potential to prevent steroid-associated osteonecrosis.