隨著醫療進步使得皮質類固醇(corticosteroid)已被廣泛運用在器官移植、急性發炎及免疫系統相關疾病的臨床治療上。現今美國有超過三千萬人的治療方案中需使用糖化皮質類固醇(glucocorticoid) [1]。儘管皮質類固醇在臨床治療上有非凡貢獻，但卻使患者暴露在罹患股骨頭壞死的風險下。學者Koo指出，長期服用類固醇患者約有5% ~ 40%會形成不同程度的股骨頭壞死 [2]。在台灣約有47%人工髖關節置換手術的主診斷為股骨頭壞死 [3]，而造成每年高達8.5億台幣的花費。現今股骨頭壞死的治療方式以手術的核心減壓術最為常見且妥當，但僅對於股骨頭壞死初期具有療效。而非手術的治療方式尚無較合適且具有療效的方法，因此發展使用物理性刺激達到預防或早期治療股骨頭壞死將成為趨勢。在尚未形成股骨頭壞死之前，其主要原因可能與類固醇誘發股骨頭骨質改變有關。因此本研究目的為探討物理性刺激於類固醇誘發股骨頭骨質改變之效應。本實驗之特定目標為應用類固醇誘發股骨頭骨質改變之大白鼠動物模型，探討電磁場刺激及高壓氧治療對於股骨頭骨質改變之影響。

本實驗使用48隻十六週大白鼠，分為控制組、跑步組、誘發組、高壓氧治療組、電磁場刺激組及合併治療組。健康大白鼠隨機分配為控制組及跑步組；利用注射糖皮質類固醇及負重訓練誘發股骨頭骨質改變之大白鼠，分別應用高壓氧治療、單一脈衝式電磁場及電磁場合併高壓氧治療三種方式，分別命名為高壓氧治療組、電磁場刺激組及合併治療組。在八週結束後犧牲大白鼠，並使用微電腦斷層(micro-CT)及蘇木紫與伊紅染色(H&E stain)獲取股骨頭之骨骺及幹骺端之骨形態學與組織學參數，以探討兩種不同的物理性刺激對於類固醇誘發股骨頭骨質改變之影響。骨型態學參數包含骨體積百分比、骨小樑厚度、骨小樑數量、骨小樑間隙及極慣性矩；組織學參數包括骨細胞死亡情況及脂肪細胞數量與體積大小。
組織學切片結果顯示：藉由類固醇注射及負重訓練的方式大白鼠之骨骺處脂肪細胞有明顯體積增大與數量增加的趨勢，儘管沒有骨細胞死亡之組織學特徵，但幹骺端的骨小樑數量也有減少之趨勢。高壓氧治療有助於避免骨骺處及幹骺端之脂肪細胞增生及肥大。電磁場刺激則是有助於增加幹骺端之骨小樑厚度及數量之趨勢，但對於抑制脂肪細胞肥大和增生卻無正面療效。

骨骺處之骨型態學結果顯示：誘發組之骨骺處骨小樑厚度小於控制組，並達統計差異 (p<0.05)。經過八週的類固醇注射及負重訓練使得大白鼠股骨頭骨骺處的骨質產生改變。高壓氧治療組在骨骺處之骨小樑厚度明顯小於控制組，達到統計差異 (p<0.05)。因此高壓氧治療對於類固醇誘發股骨頭骨質改變的大白鼠動物模型並沒有正面的療效。電磁場刺激組在骨骺處之骨組織百分比及骨小樑數量較誘發組高，且有統計上的差異 (p<0.05)。

幹骺端之骨型態學結果顯示：誘發組之幹骺端骨組織百分比與骨小樑厚度和控制組之間相差無異，但骨小樑數量高於控制組，並達統計差異 (p<0.05)。高壓氧治療組之幹骺端骨組織百分比、骨小樑數量及骨小樑間隙和誘發組無統計差異 (p>0.05)，但骨小樑厚度則高於誘發組，並具統計差異 (p<0.05)。電磁場刺激組之幹骺端骨小樑厚度高於誘發組，並具統計差異 (p<0.05)，儘管骨小樑數量及骨組織百分比高於誘發組但無差異。

高壓氧治療對於類固醇誘發股骨頭骨質改變之大白鼠的骨骺處無明顯改善骨質之效果，但卻有提高幹骺端之骨小樑厚度及避免脂肪細胞肥大與增生的效果。單一脈衝式電磁場刺激對於類固醇誘發股骨頭骨質改變之大白鼠確實達到改善骨質之效果，使得骨骺及幹骺端之骨小樑數量均有明顯的增加，並達統計上差異 (p<0.05)。單一脈衝式電磁場未來具有發展成為較佳的預防或治療初期股骨頭壞死之非手術治療方法。

The corticosteroid has been widely used in organ transplantation, acute inflammation and immune system related diseases. Currently, more than 30 million Americans require glucocorticoid (GC) drugs as part of their treatment regime [1]. The corticosteroid in clinical treatment has extraordinary contributions, but patients exposed to the risk of osteonecrosis. Osteonecrosis of the femoral head occurs in 5 – 40% of patients treated with long-term steroids [2]. About 47% total hip replacement patient were caused by osteonecrosis in Taiwan [3], and cost NT 85 million for total hip replacement .
One of the treatments of osteonecrosis was core decompression surgery, and that was most common and appropriate. Core decompression surgery only has effect for early osteonecrosis patients. There is no appropriately treatment for non-surgical treatments. Using physical stimulation to prevent osteonecrosis that are will be future. The femoral head trabecular architecture was changed before osteonecrosis. Purpose of this study is investigating the effect of physical stimulation on steroid-induced femoral head trabecular architecture. Specific aim is investigating the effect of high magnetic single pulsed electromagnetic field (SPEMF) and hyperbaric oxygen therapy (HBO) on steroid-induced femoral head trabecular architecture using animal model.

16-weeks-old S.D. rats were randomly assigned 6 groups including control group (C), treadmill group (T), positive control group (P), HBO group (H), SPEMF group (S) and HBO&SPEMF group (M). There are 8 normal rats in C group; 8 normal rats with treadmill training in T group. 32 rats was treat steroids and treadmill training was gave four treatments (no treatment, HBO, SPEMF and HBO&SPEMF). After 8 weeks, the rats were sacrificed and femur were took out for micro-CT scanning epiphysis and metaphysis to measure percent of bone volume, trabecular thickness, trabecular separation, and trabecular number. And on the other hand, using biopsy and H&E stain to observe epiphysis and metaphysis of the femoral head.

Results of histology show that rats treat steroids and treadmill training make hypertrophy and hyperplasia of fat cells on epiphysis, but osteocyte was still alive. HBO therapy was prevent hypertrophy and hyperplasia of fat cells on epiphysis and SPEMF made trabecular thickness and number increase.

Results of morphology on epiphysis show that P group was less than C group in trabecular thickness on epiphysis; H group was less than C group in trabecular thickness on epiphysis; percent of bone volume and trabecular number of SPEMF group were large than P group.

Results of morphology on metaphysis show that percent of bone volume and trabecular thickness of P group was similar C group, but trabecular number of P group was higher than C group; the percent of bone volume, trabecular number and trabecular separation of HBO group was similar C group, but trabecular thickness of HBO group was higher than P group; trabecular thickness of SPEMF group was higher than P group.

HBO therapy was no effect on steroid-induced femoral head trabecular architecture, but HBO therapy was prevent that hypertrophy and hyperplasia of fat cells. SPEMF stimulation make trabecular thickness higher on epiphysis and metaphysis. SPEMF was one of non-surgical treatments in the future.

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