Study on the fibrinolytic system of the femoral head in aseptic osteonecrosis.

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In order to elucidate whether the fibrinolytic system is involved in the pathogenesis of osteonecrosis, the author examined the fibrinolytic activity of human femoral heads suffering from aseptic osteonecrosis. The animal experiment was also carried out by giving high dose of steroid hormone to adult dogs every day of 3 to 13 weeks duration and the fibrinolytic activity of femoral heads was also examined for the study of the hormonal effect.Results: 1) The fibrinolytic activity in bone marrow of a femoral head can definitely be inhibited by t-AMCHA. Hence the related fibrinolytic enzymes are at least plasminogen and its activators. 2) In case of an aseptic necrosis of a femoral head, there is a significant difference of fibrinolytic activity in and out of the necrotic zone. However in case of rheumatoid arthritis and osteoarthritis the fibrinolytic activity is not significantly different in and out of the weight bearing zone. 3) Low fibrinolytic activity in the subchondral and central necrotic areas in the necrotic zone may suggest poor vascularization and far advanced necrosis in these areas, while relatively strong activity in either side of the necrotic zone near the sclerotic boundary may indicate higher vascularization and active repair process in these areas. 4) Animal experiment with dogs showed no significant difference in the fibrinolytic activity of the femoral head between the steroid treated and the control group. 5) From this study no definite evidence was obtained, that the fibrinolytic system is related to initiate the process of osteonecrosis, but it definitely participates in the repair process of osteonecrosis.
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