| Objective To explore the change of osteoid contents in human femoral head with avascular necrosis, and explore the change and the significance of vascular endothelial growth factor(VEGF) and core binding factor alpha 1(Cbfα1)expression. Further to study the internal connections among osteoid contents, VEGF and Cbfα1. To discuss the significance of osteoporosis for avascular necrosis of femoral head and to study how VEGF and Cbfα1 play a fundamental effects on rehabilitation and reconstruction of bone, and to provide basis for clinical gene therapy.Methods Collect 74 samples from clinical patients who have taken total articular replacement arthroplasty. 29 of these samples were collected from patients who suffered traumatic femoral head necrosis, 25 of these samples were collected from patients who suffered non-traumatic femoral head necrosis(NONFH), and the other 20 samples were collected from patients who suffered from femoral neck fracture, as a control group.Split these samples in coronal plane and make them into microtome section after immobility and decalcification process. Further observation of pathological changes and bone repair by using HE staining under optical microscope; bone density analysis by the x-ray absorptiometry; further detection of VEGF and Cbfα1 expression by using in situ hybridization technique; and further analysis of VEGF and Cbfα1 by several photo software. The statistical data was obtained by analysis of variance.Results(1) The bone structure in experimental group was disorganized and cracked,some bone trabecula showed empty lacuna, which were also thin and non-intact. An increased forming of fibrous connective tissues and decreased osteoblasts were found under the optical microscope. It was also found more osteoclasts and bone marrow necrosis, more thrombosis in interstitial capillaries, poor bone reparation and regeneration, and more hypertrophic fat cells in the medullary space of necrotic femoral head. In the control group, the situation is reversed, with organized bone trabecula,normal osteoblasts and interstitial capillaries and connective tissues. Few osteoclasts were found.(2) The experimental groups, A and B, had less value of osteoid density than the control group C. Group A had the value of 21.66±4.86, Group B had the value of 14.38±5.17, and the control Group C had the value of 30.47±5.45. Thus there were statistical difference between the experimental groups and control group(P<0.05); and statistical difference between Group A and B also exists(P <0.05) since the osteoid density of Group A was higher than Group B.(3) Both the expressions of VEGF and Cbfα1 were positive. In Group A, the value of area percentage for VEGF and Cbfα1were 8.99±2.13 and 11.30±3.59 respectively, and the AOD were 0.171±0.063 and0.193±0.047 respectively. In Group B, the value of area percentage for VEGF and Cbfα1 were 6.05±2.45 and 6.84±2.04 respectively, and the AOD were 0.140±0.058 and0.137±0.037 respectively. In control group C, the value of area percentage for VEGF and Cbfα1 were 22.83±6.71 and 26.23±5.76 respectively, and the AOD were0.244±0.069 and 0.277±0.064 respectively. Compared with Group C, both experimental groups, A and B, were lower, with significant statistical difference(P<0.05). So both the expression of VEGF and Cbfα1 in experimental group was lower than the control group.(4) All three groups had positive correlation(P<0.05) with staining areas, AOD and osteoid density.Conclusion The osteoid density decreased in both traumatic and non-traumatic femoral head necrosis, which resulted in poor bone reconstruction and regeneration, and osteoporosis occurred in process of necrosis of the femoral head. Traumatic femoral head necrosis was a little better as for osteoid density, so the ability to reconstruction was better. The expression of VEGF and Cbfα1 decreased in necrosis group, which may have a relationship with bad bone reconstruction and blood supply recovery. Therefore,it would be much better for bone recovery with increasing expression of VEGF and Cbfα1, and the osteoporosis would be improved. However, the mechanisms and synergistic effects of the factors should be study further and deeper. |
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