BACKGROUND Femoral head necrosis(FHN)can significantly affect patients'psychological well-being and functional outcomes.However,the long-term relationship between postoperative depression,anxiety,and functional re...BACKGROUND Femoral head necrosis(FHN)can significantly affect patients'psychological well-being and functional outcomes.However,the long-term relationship between postoperative depression,anxiety,and functional recovery in patients with FHN remains unclear.AIM To investigate the dynamic changes in postoperative depression and anxiety and their relationship with functional recovery in patients with FHN for 3 years.METHODS Ninety-three patients with FHN who underwent surgical treatment in March 2020 to 2023 were enrolled in this longitudinal study.Depression and anxiety status were assessed using the hospital anxiety and depression scale(HADS)at baseline,6 months,1,2,and 3 years postoperatively.Functional recovery was evaluated using the Harris hip score(HHS).The dynamic changes in HADS and HHS were analyzed using repeated measures ANOVA;the relationship between depre-ssion/anxiety status and functional recovery was examined using Pearson’s correlation analysis.RESULTS The mean HADS-depression(HADS-D)and HADS-anxiety(HADS-A)scores significantly improved over time(P<0.001).The prevalence of depression and anxiety decreased from 36.6%and 41.9%at baseline to 10.8%and 12.9%,respectively,at 3 years postoperatively.The mean HHS increased sig-nificantly from 52.3±10.5 at baseline to 88.1±7.2 at 3 years postoperatively(P<0.001).Significant negative correl-ations were found between HADS-D/HADS-A scores and HHS at all time points(P<0.05).CONCLUSION The severity of depression and anxiety negatively correlated with functional recovery,highlighting the importance of psychological interventions in the management of patients with FHN.展开更多
Objective:To explore the repair and treatment effect of Quan Du Zhong capsule on necrosis of femoral head in dogs.Methods:Totally 12 beagles were randomly divided into normal group,model group,Quan Du Zhong capsule gr...Objective:To explore the repair and treatment effect of Quan Du Zhong capsule on necrosis of femoral head in dogs.Methods:Totally 12 beagles were randomly divided into normal group,model group,Quan Du Zhong capsule group and Xianlinggubao capsule group,with three in each group.In addition to the normal group,the other groups established the femoral head necrosis model by liquid nitrogen alternative freezing.The normal group and the model group did not have any intervention during the modeling period,and the Quan Du Zhong group began to receive the Quan Du Zhong by gavage on the day of modeling;Xianlinggubao capsule group was given Xianlinggubao capsule by gavage once a day for 12 consecutive weeks on the day of modeling.The levels of VEGF and bFGF in the blood vessels of each group at the 12th week were compared,and the ratios of BMD,BS/BV,BV/TV,Tb.Th,Tb.N were measured by Micro CT,and the expressions of Bcl-2,Bax,Caspase-3 proteins were detected by immune reaction.Results:1.Compared with the normal group,the level of serum VEGF and bFGF in the model group decreased after 12 weeks of modeling(P<0.05);Compared with the model group,the levels of serum VEGF and bFGF water in the Xianlinggubao capsule group and the Quan Du Zhong capsule group increased on average at the 12th week of modeling,with statistical difference(P<0.05).The level of the Quan Du Zhong capsule group was the highest,followed by the Xianlinggubao capsule group.2.Compared with the normal group,BMD,BS/BV,BV/TV,Tb.Th and Tb.N in the model group were lower,and Tb.SP were higher,the results were statistically significant(P<0.05).Compared with the model group,the BMD,BV/TV,Tb.Th and Tb.N of Xianlinggubao capsule group and the total eucommia capsule group increased,while the BS/BV and Tb.SP decreased(P<0.05).3.The Quan Du Zhong capsule group and Xianlinggubao capsule group could significantly increase the expression of bcl-2 protein in the femoral head of dogs,which was significantly different from the model group(P<0.05).The expression of bax protein in the femoral head of dogs in the Quan Du Zhong capsule group and the Xianlinggubao capsule group was significantly reduced compared with the model group(P<0.05).The expression of caspase-3 protein in the femoral head of dogs was significantly reduced in the Quan Du Zhong capsule group and Xianlinggubao capsule group,which was significantly different from the model group(P<0.05).Conclusion:Quan Du Zhong capsule can increase the expression of VEGF and bFGF in serum,increase the expression of bcl-2,inhibit the expression of bax,and reduce the expression of caspase-3,which plays a synergistic role in the treatment of avascular necrosis of the femoral head,and has potential targets.展开更多
The purpose of this study was to investigate biomechanical behavior changes of femoral head necrosis(FHN)by increasing lower extremity abduction(LEA)angle,offering scientific basis on choosing the LEA procedure for th...The purpose of this study was to investigate biomechanical behavior changes of femoral head necrosis(FHN)by increasing lower extremity abduction(LEA)angle,offering scientific basis on choosing the LEA procedure for the exact classifications.Methods:Thirty computational models were constructed and used to simulate six different abducent angles with five different progresses of FHN.The initial model was validated by the bony density distribution in X-rays images and the photograph of the cadaver bone in cross-section.The stress transfer path(STP)of each model was analyzed and the contact stresses were assessed.Results:During the midstance phase,STP of type A showed strong similarities with the healthy level;STP distribution was from the top of the femoral head to the calcar;the damage area of STP of type B was approximately 25%of the healthy.While STPs in both type C1 and C2 were broken off.As the increase of the abduction angle,STP of type B transformed into type A,STP of type C1 transformed into type B.STP of type C2 transformed into type C1.There was no significant difference in contact stress between the four settings of FHN and normal femoral head.Conclusions:We found computational biomechanical technique to be a sensitive and useful method for distinguishing the biomechanical difference of FHN during abduction gait.These results showed that LEA motion could effectively reduce collapse risk and interrupt the disease pathway of FHN deteriorated into osteoarthritis.Furthermore,our findings indicated that the LEA procedure was suitable for type A,B and C1,while type C2 of FHN involved surgical intervention might get a better clinical outcome.展开更多
For the treatment of an intertrochanteric fracture combined with femoral head necrosis in middle-age patients,it has been controversial whether to perform fracture reduction and fixation first then total hip replaceme...For the treatment of an intertrochanteric fracture combined with femoral head necrosis in middle-age patients,it has been controversial whether to perform fracture reduction and fixation first then total hip replacement,or direct total hip replacement.We present a rare case of 53-year-old male patient suffered from bilateral intertrochanteric fracture caused by a road traffic injury.The patient had a history of femoral head necrosis for eight years,and the Harris score was 30.We performed total hip replacement with prolonged biologic shank prostheses for primary repair.One year after the surgery,nearly full range of motion was achieved without instability(active flexion angle of 110°,extension angle of 20°,adduction angle of 40°,abduction angle of 40°,internal rotation angle of 25°,and external rotation angle of 40°).The Harris score was 85.For the middle-aged patient with unstable intertrochanteric fractures and osteonecrosis of the femoral head,we can choose primary repair for concurrent bilateral intertrochanteric fracture and femoral head necrosis with prolonged shank biologic total hip replacement.展开更多
The publication of"Evidence-based Chinese Medicine"and the establishment of the Chinese Traditional Medicine Evidence-based Medicine Center mark that evidentiary-based Chinese medicine has stood in front of ...The publication of"Evidence-based Chinese Medicine"and the establishment of the Chinese Traditional Medicine Evidence-based Medicine Center mark that evidentiary-based Chinese medicine has stood in front of all Chinese medicine practices in the form of new disciplines,greatly promoting the modernization of Chinese medicine.It will always give Chinese medicine a powerful impetus to the world.Femoral head necrosis is the dominant disease in the treatment of TCM.Chinese medicine practices should seize the optionality to active learn the content of evidentiary-based Chinese medicine and apply it to clinical and scientific research practice.This article review the development status of femoral head necrosis treatment by TCM medicine from the perspective of event-based Chinese medicine.It provides a reference for the event-based development of Chinese medicine in the treatment of femoral head necrosis,and continues to develop advantages and make up for the shortcomings.展开更多
BACKGROUND Osteonecrosis of the femoral head(ONFH)is a prevalent orthopedic issue,leading to the collapse and fragmentation of the femoral head in its advanced stages,which can severely impair patients'quality of ...BACKGROUND Osteonecrosis of the femoral head(ONFH)is a prevalent orthopedic issue,leading to the collapse and fragmentation of the femoral head in its advanced stages,which can severely impair patients'quality of life.Total hip arthroplasty(THA)is a clinical intervention frequently used to alleviate ONFH symptoms and reinstate hip functionality.The conventional surgical technique is invasive and comes with an extended recuperation period,posing significant challenges for patients.With the progression of medical technology,the use of the mini-incision technique in minimally invasive THA(MITHA)has become more prevalent.However,comparative studies examining the effectiveness of these two surgical procedures in treating ONFH remain scarce.Furthermore,understanding patients'psychological well-being is crucial given its profound influence on postoperative recuperation.AIM To evaluate the impact of mini-incision MITHA on ONFH treatment and to identify the risk factors associated with postoperative anxiety and depression.METHODS A retrospective study was conducted on 125 patients treated for ONFH at Xi’an Hong Hui Hospital between February 2020 and January 2022,with the term"consecutive"indicating that these patients were treated in an unbroken sequence without any selection.Among these,60 patients(control group)underwent traditional THA,while 65 patients(observation group)were treated with miniincision MITHA.Variations in the visual analog scale(VAS)score and the Harris hip score were monitored.Additionally,shifts in pre-and posttreatment Hamilton anxiety(HAMA)and Hamilton depression(HAMD)scale scores were recorded.Patients with both postoperative HAMA and HAMD scores of≥8 were identified as those experiencing negative emotions.Logistic regression was utilized to analyze the determinants influencing these negative emotional outcomes.Comparative analyses of surgical and postoperative metrics between the two groups were also conducted.RESULTS Posttreatment results indicated a significantly higher VAS score in the control group than in the observation group,while the Harris score was considerably lower(P<0.0001).The observation group benefited from a notably shorter operation duration,reduced blood loss,diminished incision size,and a decreased postoperative drainage time(P<0.0001),accompanied by a reduced hospital stay and lower treatment costs(P<0.0001).The control group had elevated posttreatment HAMA and HAMD scores in comparison to the observation group(P<0.0001).Multivariate logistic regression revealed that being female[odds ratio(OR):4.394,95%CI:1.689-11.433,P=0.002],having a higher postoperative VAS score(OR:5.533,95%CI:2.210-13.848,P<0.0001),and having higher treatment costs(OR:7.306,95%CI:2.801-19.057,P<0.0001)were significant independent determinants influencing postoperative mood disturbances.CONCLUSION Compared to conventional THA,mini-incision MITHA offers advantages such as reduced operation time,minimal bleeding,and a shorter incision in ONFH patients.Moreover,factors such as sex,postoperative pain(reflected in the VAS score),and treatment costs significantly impact postoperative anxiety and depression.展开更多
Objective: To investigate the effect of Yang-warming and Kidney-tonifying Prescription (YKP) on the treatment of steroid-induced avascular necrosis of the femoral head (SANFH) in rabbits. And to further explore whethe...Objective: To investigate the effect of Yang-warming and Kidney-tonifying Prescription (YKP) on the treatment of steroid-induced avascular necrosis of the femoral head (SANFH) in rabbits. And to further explore whether its therapeutic mechanism is related to the expression of HIF-1α and VEGF (angiogenic factors), BMP2 and Osterix (osteogenic factor), CD31 (type H vascular marker) and MMP13 (bone destruction-related factor). Methods: Twenty-seven healthy male New Zealand white rabbits were divided into a normal group, model group, traditional Chinese medcine (TCM) group (clinical equivalent dose group of YKP), miR-130a inhibitor group and TCM + inhibitor group. The SANFH model was established by combining horse serum with methylprednisolone. After the model is successfully established, TCM group was given 6.44 g/kg·d YKP by gavage, and the miR-130a gene inhibitor group was intraperitoneally injected with 25 mg/kg miR-130a inhibitor, locked nucleic acid (LNA)-anti-miR-130a. TCM + inhibitor group was treated with YKP intragastrically and miR-130a inhibitor intraperitoneally. The rabbits in the normal group and the model group were intragastrically administered with normal saline 10 ml/d. Once a day for 4 weeks. The avascular necrosis was detected by HE staining. The contents of HIF-1α, VEGF, BMP2 and Osterix in rabbit tissues were detected by qRT-PCR kit, and the expression of CD31 and MMP13 was detected by immunofluorescence staining. Results: In the normal group, the surface of the cartilage layer of the femoral head was smooth, the bone trabeculae were intact and densely arranged, the cells of each layer were neatly arranged, the morphology of the bone cells, the chondrocytes and the adipocytes were normal. In the model group, cartilage surfaces of the femoral head showed exfoliative cracks. The bone trabecular structure was loose and incomplete, chondrocytes, osteoblasts and bone marrow cells were significantly reduced, and the number of empty bone traps was significantly increased. In the TCM-treated group, more chondrocytes, thicker cartilage layer, and more regular bone trabeculae were detected as compared to model rabbits. In contrast, the cartilage layer was thinner, the destruction and fracture of bone trabeculae was more serious, chondrocytes and osteocytes were decreased as compared to model group. The expression of HIF-1α, VEGF, BMP2, and Osterix in the model group decreased significantly as compared to the normal group (P Conclusion: YKP can regulate the expression of angiogenic-related factors (VEGF and HIF-α), osteogenic-related factors (BMP2 and Osterix), and H-type vascular marker CD31, resulting in increased expressions of VEGF, HIF-α, BMP2, and Osterix, which promote intra-femoral head revascularization. Meanwhile, YKP decreased the expression of bone-destruction-related factor MMP13, thus enhancing the ability of bone tissue to repair itself. Regulation of these molecules’ expression may be one of the mechanisms of YKP in the treatment of hormonal femoral head necrosis.展开更多
Objective: To explore the pathogenesis of avascular necrosis of femoral head(ANFH) and search an effective method for clinical practice. Methods: Twenty-four Japanese rabbitswere divided into 2 groups of models and co...Objective: To explore the pathogenesis of avascular necrosis of femoral head(ANFH) and search an effective method for clinical practice. Methods: Twenty-four Japanese rabbitswere divided into 2 groups of models and controls. ANFH models were produced byintramuscular-injection of large dosage of steroid to rabbits for 8 weeks. From the 4th, 8th and12th week after production of models, 2 rabbits of each group were sacrificed to observe thestructure of femoral head through light microscope and scanning electron microscope. The contents ofNitric Oxide (NO), tissue-type plasminogen activator (t-PA) and -plasminogen activator inhibitor(PAI) in plasma of the 4 rabbits in each group were estimated at the same time. Results: Comparedwith control group, the rabbits of model group exhibited many differences: such as osteoporosis offemoral head, the presence of more bone lacuna and fat cell through light microscope observing; thebroken and sunk bone trabecula, the loosen and broken collagen fibers on the surface of bone matrixthrough scanning electron microscope observing. Compared with control group, the Concentration ofNO and t-PA in plasma of the model rabbits decreased obviously, but the Concentration of the PAIincreased obviously. Conclusion: The steroid-induced ANFH might be related to the lower level of NOand the descent of fibrinolytic activity.展开更多
In this article,the biodegradation process and bone formation of a mineralized collagen reconstruction rod embedding in necrosis of human femoral head were investigated by imageological and histological methods.Comput...In this article,the biodegradation process and bone formation of a mineralized collagen reconstruction rod embedding in necrosis of human femoral head were investigated by imageological and histological methods.Computed radiography(CR)computerized tomography(CT),common pathological section and hard tissue section analysis were used to evaluated the dynamics of imageological and histopathological changes of femoral head,interface between the host bone and implant and the bone reconstruction process.The results showed that the density of rods increased closed to that of host bones after 1 year implanting,and the interface between them turns to blurring.Hard tissue grinding sections analysis showed osteocytes appearing in sparse bone trabecular and bone pit region,as well as a few vessels in the degraded dye powder matrix were noticed,indicating the new bone forming between the implants and host bones.Regular decalcified sections analysis showed scattered osteoclasts,multinucleated giant cells and fibrosis components existing in the degraded rod and the host bone trabecular.Degraded debris was endocytosed by giant cells,and vascular network formed around the boundaries of the implanted rod.The good osteointegration has been expressed by the interface between the implanted rod and the host bone becoming blurred.Histological results indicated that the implanted rod degradation process and new bones regeneration simultaneously occurred around the boundaries of embedding rod.New bone and host bone were hinged and co-existed.展开更多
Objective： To assess the curative effect and investigate the indications of total hip arthroplasty for treatment of comminuted intertrochanteric fractures. Methods： Total hip arthroplasty was carried out in 9 cases ...Objective： To assess the curative effect and investigate the indications of total hip arthroplasty for treatment of comminuted intertrochanteric fractures. Methods： Total hip arthroplasty was carried out in 9 cases of severe intertrochanteric fracture. The patients included two men and seven women. The average age of the patients was 68 years （48-75 years）. The period from fracture to operation was 5 days （2-10 days）. The mean follow- up period lasted for 11 months （3 months-2 years）. There was one patient with comminuted intertrochanteric fracture accompanied by femoral head necrosis and 2 patients with intertrochanteric fracture and stroke. Other 6 patients had severe osteoporosis. The Harris score before operation was 63 points （45-71 points）.Results： At the last follow-up, the patients gained 86points （70-100 points） according to the Harris score. The effects of the 8 cases were good. The Harris score of all patients improved after treatment. Only two hemiplegia patients needed sticks to walk. The others could walk without hip pain. No radiographic evidence of acetabular wear and prosthesis dislocation or other major complications happened during the follow-up. Conclusions： Prosthetic replacements can well treat unstable intertrochanteric fracture if operative indication is correctly selected. It is suitable for elderly patients and the operation should be performed by experienced surgeons.展开更多
Objective： To observe the regulation of Youguiyin （YGY, 右归钦） on the gene expression profile of the rat with steroid-induced femoral head necrosis （sFHN）, for the sake of investigating its molecular mechanism o...Objective： To observe the regulation of Youguiyin （YGY, 右归钦） on the gene expression profile of the rat with steroid-induced femoral head necrosis （sFHN）, for the sake of investigating its molecular mechanism of sFHN prevention and treatment. Methods： All the 30 rats were randomly divided into three groups, the normal control group （A）, the model control group （B）, and the YGY treated group （C）, 10 in each group. After rats in Groups B and C were being made into FHN models with steroid injection, they received a daily intragastdc administration of saline and YGY respectively in equal volume for a total of 6 weeks, while to the unmodeled normal rats in Group A, saline was administered instead. The rats were sacrificed at the terminal of administration; their mRNA from femoral head tissue was extracted and prepared to cDNA probe through inverse transcription for detecting gene expression profile by microarray, outcomes of which was passing fluorescence quantitative PCR verification, and the differential expressed genes were analyzed adopting gene ontology （GO） method. Results： Compared with Group A, the numbers of differential genes found in Groups B and C were 190 and 92, respectively, but the changing trend in the two groups was opposite, mainly manifested as down-regulating in Group B/Group A （GB/GA） and up-regulating in Group C/Group B （GC/GB）. The analysis showed that these differential genes were mainly assigned to cell apoptosis, signal transduction, metabolism, cell proliferation and differentiation, cell cycle, blood coagulation, antioxidant activity, etc. Conclusions： sFHN was regulated by various genes; the regulation of YGY on expressions of these genes and the intra]extra-cellular signaling processes was possibly the molecular mechanism of YGY for preventing/treating sFHN. This study gave an explanation to the effectiveness of Chinese medicine in preventing/treating FHN from aspects of gene expression and enriched the Chinese medicine theory of ＂Kidney （Shen） governing bones＂.展开更多
Objective: To explore the pathogenesis of avascular necrosis of femoral head (ANFH), the early diagnosis index and the treatment effective index of ANFH in clinical practice. Methods: Twenty-four Japanese rabbits were...Objective: To explore the pathogenesis of avascular necrosis of femoral head (ANFH), the early diagnosis index and the treatment effective index of ANFH in clinical practice. Methods: Twenty-four Japanese rabbits were divided into 2 groups: model group and control group. ANFH models were produced by intramuscular injection of large dosage of steroid to rabbits for 8 weeks. On the 4 th, 8 th week after the injection, two rabbits each time from each group were taken to observe the structure of femoral head by light microscope and scanning electron microscope. Four other stomach-empty rabbits from each group were also used to test the contents of Nitric Oxide (NO), contents of the hemorheology indexes. Results: Compared with the control group, the rabbits in the model group exhibited osteoporosis of femoral head and more bone lacuna and more fat cells through light microscope. Through scanning electron microscope observation bone trabecula were broken and sunk, and collagen fibers on the surface of bone matrix became loosen and broken, more osteocyte had pyknosis, adipocyte in the medullary cavity were enlarged and subchondral arterioles and capillaries of the femoral head were pressed by adipocyte. Compared with the control group, the model rabbits contained less NO and obvious increase of the plasma viscosity (PV), low blood viscosity (LBV), erythrocyte hematocrit (HCT), indices of erythrocyte rigidity (TK) and indices of erythrocyte aggregation (AI), plasma fibrin level (PFL) (P<0. 01) and an increase of erythrocyte electrophoresis rate (ERT) (P< 0.05). High blood viscosity (HBV), and erythrocyte sedimentation rate (ESR) were unchanged. Conclusion: The steroid-induced ANFH might be related to less NO and the abnormal hemorheology; and NO and hemorheology should be considered as an early diagnosis index for ANFH in clinical practice.展开更多
Objective:This study is to investigate the nisk factors of femoral head contracture after total hip arthroplasty(THA)in patients with avascular necrosis of femoral head.Methods:Retrospective analysis was perfomed in 3...Objective:This study is to investigate the nisk factors of femoral head contracture after total hip arthroplasty(THA)in patients with avascular necrosis of femoral head.Methods:Retrospective analysis was perfomed in 361 cases of femoral head necrosis patients taking THA fom September 2016 to December 2017.A total of 179 patents with no significant preoperative adductor muscle contraction were finally enrolled in this study.These 179 patients were further divided into two groups:contracture group(64 cases)and noncompaction group(115 cases).The chi-square test was used to compare the differences between the two groups.Risk factors were identifed by logistic regession analysis.Results:of the patients included,64 patients (35.75%)developed into end adductor muscle contracture.There were signuificant differences in limb shortening.surgical history,whether taction,surgical approach,surgical methods,and fumctional training between the two goups(P<0.05).Logistic regression analysis showed that shortness of extremity,sugical approach,effective taction,surgical history,and etiology were the factors affecting femoral head contracture after THA in patients with avascular necrosis of femoral head.Conclusions:Preoperative traction therapy,surgical methods,and postoperative functional training are the factors that affect the adductor muscle contraction after THA.展开更多
To explore the relationship between preoperative traction and osteonecrosis of femoral head(ONFH)in patients with stable femoral neck fractures.Data from medical charts for 115 patients admitted to our institution wit...To explore the relationship between preoperative traction and osteonecrosis of femoral head(ONFH)in patients with stable femoral neck fractures.Data from medical charts for 115 patients admitted to our institution with Garden II femoral neck fracture operated from January 2012 to December 2013 were extracted.Seven-year retrospective comparative study in the first affiliated hospital of Soochow University.Patients were divided into two groups by preoperative treatment:a preoperative traction group(group I)and a T-shaped shoe fixation group(group II).There were 14 patients lost to follow-up.101 patients with Garden II femoral neck fracture followed until July 2016 were available for complete analysis.Intervention:patients received skeletal traction or T-shaped shoe fixation preoperatively.All patients accepted internal fixation with multiple annulated screws.Main outcome measurements:the incidence of osteonecrosis of femoral head was analyzed based on preoperative traction,gender and implant removal.The average follow-up of these patients was 35 months(range,24-48 months).There was no implant failure or nonunion in our study.Nine patients(8.91%)had avascular necrosis.8(15.38%)patients in group I had osteonecrosis of femoral head,whereas only onepatient(2.04%)in group II had osteonecrosis of femoral head.Patients with preoperative traction had significantly higher incidence of osteonecrosis of femoral head compared with T shaped shoe fixation(P=0.032).No significant difference was found between the incidence of osteonecrosis of femoral head based on gender,age,injury-to-surgery interval time,implant removal or weight-bearing time.In patients with femoral neck fracture,preoperative traction may increase the incidence of osteonecrosis.Preoperative traction may not benefit patients with Garden II femoral neck fracture.The weight of traction may be a risk factor to osteonecrosis of femoral head.展开更多
Objective To establish an experimental model of early stage avascular necrosis of the femoral head （ANFH） caused by corticosteroid in adult rabbits and to observe the pathological changes with various imaging techni...Objective To establish an experimental model of early stage avascular necrosis of the femoral head （ANFH） caused by corticosteroid in adult rabbits and to observe the pathological changes with various imaging techniques. Methods ANFH was induced by a combination of hypersensitivity vasculitis caused by injection of horse serum and subsequent administration of a high dose of corticosteroid. The pathological changes were detected with digital radiography （DR）, computed tomography （CT）, magnetic resonance imaging （MRI）, ink artery infusion angiography, hematoxylin-eosin staining, and immunohistochemistry. Results The imageological and pathological changes corresponded to the clinical characteristics of early stage ANFH. DR showed bilaterally increased bone density, an unclear epiphyseal line, and blurred texture of cancellous bone. CT showed spot-like low-density imaging of cancellous bone, thinner cortical bone, osteoporosis, and an unclear epiphyseal line. MR! showed bone marrow edema and spot-like high signals in T2-weighted imaging in cancellous bone. Ink artery infusion angiography showed fewer obstructed blood vessels in the femoral head. HE staining of pathological sections showed fewer trabeculae and thin bone, an increased proportion of empty osteocyte lacunae, decreased hematopoiesis, thrombosis, and fat cell hypertrophy. Immunohistochemistry showed attenuated expression of vascular endothelial growth factor in osteoblasts and chondrocytes, and on the inner membrane of blood vessels. Conclusion Experimental rabbit model of early stage ANFH caused by corticosteroid can be successfully established and provide the foundation for developing effective methods to treat early stage ANFH.展开更多
Objective:To probe into the relation between magnetic resonance imaging(MRI) signal classifications and TCM syndromes in femoral head necrosis patients,so as to provide reference for TCM diagnosis of this disease.Meth...Objective:To probe into the relation between magnetic resonance imaging(MRI) signal classifications and TCM syndromes in femoral head necrosis patients,so as to provide reference for TCM diagnosis of this disease.Methods:Refering to the criteria for TCM syndrome types of necrosis of the femoral head described in "The Guiding Principles of Clinical Studies of New Chinese Drugs" and Shimizu and Mitchell's MRI signal classifications,MRI signal classifications between different TCM syndrome types were compared.Results:The Shimizu signal classification of different TCM syndrome types had statistically significant difference(P=0.04);Both T2WI+fs and Mitchell signal classifications of different TCM syndrome types had no statistical by significant differences(P=0.42 or P=0.15).Conclusion:There is a certain correlativity of TCM syndrome types of necrosis of the femoral head with T1WI signal classification of MRI.MRI signal classification may contribute to objectivity in TCM syndrome typing of this disease.展开更多
To explore a new method for the therapy of the avascular necrosis of the femoral head, the recombinant plasmid pCD-hVEGF 165 was mixed with collagen and was implanted in the necrotic femoral head The expression...To explore a new method for the therapy of the avascular necrosis of the femoral head, the recombinant plasmid pCD-hVEGF 165 was mixed with collagen and was implanted in the necrotic femoral head The expression of vascular endothelial growth factor (VEGF) was detected by RNA dot hybridization and immunohistochemical method The repair of the femoral head was observed by histological method The results showed that the expression of VEGF was detectable in the femoral head treated with VEGF gene Angiogenesis in these femoral heads was more abundant than the control Bone repairing was augmented in the femoral head treated with VEGF gene The results suggest that angiogenesis in bone tissue could be augmented by gene transfection of VEGF and bone repairing would be accelerated accordingly展开更多
The aim of this study is to investigate microscopic structure and characterize cancellous bone of avascular necrosis of the femoral head （ANFH）. The rabbit model of the ANFH is established. The histopathologic featu...The aim of this study is to investigate microscopic structure and characterize cancellous bone of avascular necrosis of the femoral head （ANFH）. The rabbit model of the ANFH is established. The histopathologic features are studied successfully. The differences between the steroidinjection group （S.G.） and the controlled group （C.G.） are examined, including the weight of rabbits, the hematological examination and the three-dimensional stnactures. It is found that the plasma levels of cholesterol （CHO）, high-density lipoprotein （HDL） and low-density lipoprotein （LDL） in S.G. are lower than those in C.G. when the triglyceride （TG） increased in the S.G.; but the bone mineral content （BMC） and the structural model index （SMI） of the organ and tissue decreased significantly in S.G. Three-dimensional structures of the femoral head are obtained using micro-computed tomography （CT） scanning and the mechanical model is established to analyze the influences of these structural changes on the mechanical properties of the cancellous bone.展开更多
Objective: To investigate the value of transplantation of vascularized fibula in treating non-union femoral neck fractures and preventing ischemic necrosis of the femoral head. Methods : Vascularized heterotopic fibul...Objective: To investigate the value of transplantation of vascularized fibula in treating non-union femoral neck fractures and preventing ischemic necrosis of the femoral head. Methods : Vascularized heterotopic fibula was transplanted to the anterior-lateral part of the femoral neck. The fibula artery and vein were anastomosised with lateral circumflex artery and vein. Results : One hundred and twenty-nine cases of non-union femoral neck fracture were treated with vascularized fibula graft in our hospital from 1982 to 2002. Eighty-seven cases of them were followed up for 3 to 19 years with functional and X-ray examination. The percentage of fracture healing and effect were 94. 3 and 81. 6, respectively. Conclusion:The fibula with blood supply has a synergistic fixation impact on the non-union femoral neck fractures. The fibula is solid enough for supporting the femoral head and preventing it from collapse. The vascularized fibula grafting, by providing blood supply to the affected femoral head and neck, could promote the femoral head restoration and reconstruction. In addition, the periosteum of fibula plays a role in fracture healing.展开更多
Objective Glucocorticoid(GC)-induced adverse reactions(ARs)have been extensively studied due to their potential impact on patients’health.This study aimed to examine the potential correlation between two polymorphism...Objective Glucocorticoid(GC)-induced adverse reactions(ARs)have been extensively studied due to their potential impact on patients’health.This study aimed to examine the potential correlation between two polymorphisms[adenosine triphosphate-binding cassette B1(ABCB1)C3435T and plasminogen activator inhibitor-1(PAI-1)4G/5G]and various GC-induced ARs in nephrotic syndrome(NS)patients.Methods In this study,513 NS patients who underwent GC treatment were enrolled.Then,the patients were divided into two groups based on ABCB1 C3435T and PAI-14G/5G genotyping,and intergroup comparisons of clinicopathological data and GC-induced ARs were performed.Univariate and multivariate logistic analyses were subsequently conducted to identify potential risk factors for GC-induced ARs,and a nomogram was subsequently established and validated via the area under the ROC curve(AUC),calibration curve and decision curve analysis(DCA).Results We identified ABCB1 C3435T as an independent risk factor for the development of steroid-associated avascular necrosis of the femoral head(SANFH)(OR:2.191,95%CI:1.258–3.813,P=0.006)but not as a risk factor for the occurrence of steroid diabetes mellitus(S-DM).On the other hand,PAI-14G/5G was identified as an independent risk factor for the development of both SANFH(OR:2.198,95%CI:1.267–3.812,P=0.005)and S-DM(OR:2.080,95%CI:1.166–3.711,P=0.013).Notably,no significant correlation was found between the two gene polymorphisms and other GC-induced ARs.In addition,two nomograms were established and validated to demonstrate strong calibration capability and clinical utility.Conclusion Assessing ABCB1 C3435T and PAI-14G/5G before steroid treatment in NS patients could be useful for identifying patients at a high risk of developing SANFH and S-DM.展开更多
基金Supported by Baoshan District Key Specialized Class A,Clinical Medical Center for Integrated Traditional Chinese and Western Medicine Treatment of Neck,Shoulder,Lumbar and Leg Pain,No.BSZK-2023-Z07.
文摘BACKGROUND Femoral head necrosis(FHN)can significantly affect patients'psychological well-being and functional outcomes.However,the long-term relationship between postoperative depression,anxiety,and functional recovery in patients with FHN remains unclear.AIM To investigate the dynamic changes in postoperative depression and anxiety and their relationship with functional recovery in patients with FHN for 3 years.METHODS Ninety-three patients with FHN who underwent surgical treatment in March 2020 to 2023 were enrolled in this longitudinal study.Depression and anxiety status were assessed using the hospital anxiety and depression scale(HADS)at baseline,6 months,1,2,and 3 years postoperatively.Functional recovery was evaluated using the Harris hip score(HHS).The dynamic changes in HADS and HHS were analyzed using repeated measures ANOVA;the relationship between depre-ssion/anxiety status and functional recovery was examined using Pearson’s correlation analysis.RESULTS The mean HADS-depression(HADS-D)and HADS-anxiety(HADS-A)scores significantly improved over time(P<0.001).The prevalence of depression and anxiety decreased from 36.6%and 41.9%at baseline to 10.8%and 12.9%,respectively,at 3 years postoperatively.The mean HHS increased sig-nificantly from 52.3±10.5 at baseline to 88.1±7.2 at 3 years postoperatively(P<0.001).Significant negative correl-ations were found between HADS-D/HADS-A scores and HHS at all time points(P<0.05).CONCLUSION The severity of depression and anxiety negatively correlated with functional recovery,highlighting the importance of psychological interventions in the management of patients with FHN.
基金Liaoning Provincial Science and Technology Plan Project(No.2017225043)。
文摘Objective:To explore the repair and treatment effect of Quan Du Zhong capsule on necrosis of femoral head in dogs.Methods:Totally 12 beagles were randomly divided into normal group,model group,Quan Du Zhong capsule group and Xianlinggubao capsule group,with three in each group.In addition to the normal group,the other groups established the femoral head necrosis model by liquid nitrogen alternative freezing.The normal group and the model group did not have any intervention during the modeling period,and the Quan Du Zhong group began to receive the Quan Du Zhong by gavage on the day of modeling;Xianlinggubao capsule group was given Xianlinggubao capsule by gavage once a day for 12 consecutive weeks on the day of modeling.The levels of VEGF and bFGF in the blood vessels of each group at the 12th week were compared,and the ratios of BMD,BS/BV,BV/TV,Tb.Th,Tb.N were measured by Micro CT,and the expressions of Bcl-2,Bax,Caspase-3 proteins were detected by immune reaction.Results:1.Compared with the normal group,the level of serum VEGF and bFGF in the model group decreased after 12 weeks of modeling(P<0.05);Compared with the model group,the levels of serum VEGF and bFGF water in the Xianlinggubao capsule group and the Quan Du Zhong capsule group increased on average at the 12th week of modeling,with statistical difference(P<0.05).The level of the Quan Du Zhong capsule group was the highest,followed by the Xianlinggubao capsule group.2.Compared with the normal group,BMD,BS/BV,BV/TV,Tb.Th and Tb.N in the model group were lower,and Tb.SP were higher,the results were statistically significant(P<0.05).Compared with the model group,the BMD,BV/TV,Tb.Th and Tb.N of Xianlinggubao capsule group and the total eucommia capsule group increased,while the BS/BV and Tb.SP decreased(P<0.05).3.The Quan Du Zhong capsule group and Xianlinggubao capsule group could significantly increase the expression of bcl-2 protein in the femoral head of dogs,which was significantly different from the model group(P<0.05).The expression of bax protein in the femoral head of dogs in the Quan Du Zhong capsule group and the Xianlinggubao capsule group was significantly reduced compared with the model group(P<0.05).The expression of caspase-3 protein in the femoral head of dogs was significantly reduced in the Quan Du Zhong capsule group and Xianlinggubao capsule group,which was significantly different from the model group(P<0.05).Conclusion:Quan Du Zhong capsule can increase the expression of VEGF and bFGF in serum,increase the expression of bcl-2,inhibit the expression of bax,and reduce the expression of caspase-3,which plays a synergistic role in the treatment of avascular necrosis of the femoral head,and has potential targets.
基金The authors received grants from Natural Science Foundation of Guangdong Province(2014A030310214),Science and Technology Project of Guangdong Province(2014A020221041),and the Medical Science and Technology Foundation of Guangdong Province(A2015039).
文摘The purpose of this study was to investigate biomechanical behavior changes of femoral head necrosis(FHN)by increasing lower extremity abduction(LEA)angle,offering scientific basis on choosing the LEA procedure for the exact classifications.Methods:Thirty computational models were constructed and used to simulate six different abducent angles with five different progresses of FHN.The initial model was validated by the bony density distribution in X-rays images and the photograph of the cadaver bone in cross-section.The stress transfer path(STP)of each model was analyzed and the contact stresses were assessed.Results:During the midstance phase,STP of type A showed strong similarities with the healthy level;STP distribution was from the top of the femoral head to the calcar;the damage area of STP of type B was approximately 25%of the healthy.While STPs in both type C1 and C2 were broken off.As the increase of the abduction angle,STP of type B transformed into type A,STP of type C1 transformed into type B.STP of type C2 transformed into type C1.There was no significant difference in contact stress between the four settings of FHN and normal femoral head.Conclusions:We found computational biomechanical technique to be a sensitive and useful method for distinguishing the biomechanical difference of FHN during abduction gait.These results showed that LEA motion could effectively reduce collapse risk and interrupt the disease pathway of FHN deteriorated into osteoarthritis.Furthermore,our findings indicated that the LEA procedure was suitable for type A,B and C1,while type C2 of FHN involved surgical intervention might get a better clinical outcome.
文摘For the treatment of an intertrochanteric fracture combined with femoral head necrosis in middle-age patients,it has been controversial whether to perform fracture reduction and fixation first then total hip replacement,or direct total hip replacement.We present a rare case of 53-year-old male patient suffered from bilateral intertrochanteric fracture caused by a road traffic injury.The patient had a history of femoral head necrosis for eight years,and the Harris score was 30.We performed total hip replacement with prolonged biologic shank prostheses for primary repair.One year after the surgery,nearly full range of motion was achieved without instability(active flexion angle of 110°,extension angle of 20°,adduction angle of 40°,abduction angle of 40°,internal rotation angle of 25°,and external rotation angle of 40°).The Harris score was 85.For the middle-aged patient with unstable intertrochanteric fractures and osteonecrosis of the femoral head,we can choose primary repair for concurrent bilateral intertrochanteric fracture and femoral head necrosis with prolonged shank biologic total hip replacement.
文摘The publication of"Evidence-based Chinese Medicine"and the establishment of the Chinese Traditional Medicine Evidence-based Medicine Center mark that evidentiary-based Chinese medicine has stood in front of all Chinese medicine practices in the form of new disciplines,greatly promoting the modernization of Chinese medicine.It will always give Chinese medicine a powerful impetus to the world.Femoral head necrosis is the dominant disease in the treatment of TCM.Chinese medicine practices should seize the optionality to active learn the content of evidentiary-based Chinese medicine and apply it to clinical and scientific research practice.This article review the development status of femoral head necrosis treatment by TCM medicine from the perspective of event-based Chinese medicine.It provides a reference for the event-based development of Chinese medicine in the treatment of femoral head necrosis,and continues to develop advantages and make up for the shortcomings.
基金Supported by the Shaanxi Provincial Key R&D Plan Project Contract(Task)Letter,No.2022SF-491.
文摘BACKGROUND Osteonecrosis of the femoral head(ONFH)is a prevalent orthopedic issue,leading to the collapse and fragmentation of the femoral head in its advanced stages,which can severely impair patients'quality of life.Total hip arthroplasty(THA)is a clinical intervention frequently used to alleviate ONFH symptoms and reinstate hip functionality.The conventional surgical technique is invasive and comes with an extended recuperation period,posing significant challenges for patients.With the progression of medical technology,the use of the mini-incision technique in minimally invasive THA(MITHA)has become more prevalent.However,comparative studies examining the effectiveness of these two surgical procedures in treating ONFH remain scarce.Furthermore,understanding patients'psychological well-being is crucial given its profound influence on postoperative recuperation.AIM To evaluate the impact of mini-incision MITHA on ONFH treatment and to identify the risk factors associated with postoperative anxiety and depression.METHODS A retrospective study was conducted on 125 patients treated for ONFH at Xi’an Hong Hui Hospital between February 2020 and January 2022,with the term"consecutive"indicating that these patients were treated in an unbroken sequence without any selection.Among these,60 patients(control group)underwent traditional THA,while 65 patients(observation group)were treated with miniincision MITHA.Variations in the visual analog scale(VAS)score and the Harris hip score were monitored.Additionally,shifts in pre-and posttreatment Hamilton anxiety(HAMA)and Hamilton depression(HAMD)scale scores were recorded.Patients with both postoperative HAMA and HAMD scores of≥8 were identified as those experiencing negative emotions.Logistic regression was utilized to analyze the determinants influencing these negative emotional outcomes.Comparative analyses of surgical and postoperative metrics between the two groups were also conducted.RESULTS Posttreatment results indicated a significantly higher VAS score in the control group than in the observation group,while the Harris score was considerably lower(P<0.0001).The observation group benefited from a notably shorter operation duration,reduced blood loss,diminished incision size,and a decreased postoperative drainage time(P<0.0001),accompanied by a reduced hospital stay and lower treatment costs(P<0.0001).The control group had elevated posttreatment HAMA and HAMD scores in comparison to the observation group(P<0.0001).Multivariate logistic regression revealed that being female[odds ratio(OR):4.394,95%CI:1.689-11.433,P=0.002],having a higher postoperative VAS score(OR:5.533,95%CI:2.210-13.848,P<0.0001),and having higher treatment costs(OR:7.306,95%CI:2.801-19.057,P<0.0001)were significant independent determinants influencing postoperative mood disturbances.CONCLUSION Compared to conventional THA,mini-incision MITHA offers advantages such as reduced operation time,minimal bleeding,and a shorter incision in ONFH patients.Moreover,factors such as sex,postoperative pain(reflected in the VAS score),and treatment costs significantly impact postoperative anxiety and depression.
文摘Objective: To investigate the effect of Yang-warming and Kidney-tonifying Prescription (YKP) on the treatment of steroid-induced avascular necrosis of the femoral head (SANFH) in rabbits. And to further explore whether its therapeutic mechanism is related to the expression of HIF-1α and VEGF (angiogenic factors), BMP2 and Osterix (osteogenic factor), CD31 (type H vascular marker) and MMP13 (bone destruction-related factor). Methods: Twenty-seven healthy male New Zealand white rabbits were divided into a normal group, model group, traditional Chinese medcine (TCM) group (clinical equivalent dose group of YKP), miR-130a inhibitor group and TCM + inhibitor group. The SANFH model was established by combining horse serum with methylprednisolone. After the model is successfully established, TCM group was given 6.44 g/kg·d YKP by gavage, and the miR-130a gene inhibitor group was intraperitoneally injected with 25 mg/kg miR-130a inhibitor, locked nucleic acid (LNA)-anti-miR-130a. TCM + inhibitor group was treated with YKP intragastrically and miR-130a inhibitor intraperitoneally. The rabbits in the normal group and the model group were intragastrically administered with normal saline 10 ml/d. Once a day for 4 weeks. The avascular necrosis was detected by HE staining. The contents of HIF-1α, VEGF, BMP2 and Osterix in rabbit tissues were detected by qRT-PCR kit, and the expression of CD31 and MMP13 was detected by immunofluorescence staining. Results: In the normal group, the surface of the cartilage layer of the femoral head was smooth, the bone trabeculae were intact and densely arranged, the cells of each layer were neatly arranged, the morphology of the bone cells, the chondrocytes and the adipocytes were normal. In the model group, cartilage surfaces of the femoral head showed exfoliative cracks. The bone trabecular structure was loose and incomplete, chondrocytes, osteoblasts and bone marrow cells were significantly reduced, and the number of empty bone traps was significantly increased. In the TCM-treated group, more chondrocytes, thicker cartilage layer, and more regular bone trabeculae were detected as compared to model rabbits. In contrast, the cartilage layer was thinner, the destruction and fracture of bone trabeculae was more serious, chondrocytes and osteocytes were decreased as compared to model group. The expression of HIF-1α, VEGF, BMP2, and Osterix in the model group decreased significantly as compared to the normal group (P Conclusion: YKP can regulate the expression of angiogenic-related factors (VEGF and HIF-α), osteogenic-related factors (BMP2 and Osterix), and H-type vascular marker CD31, resulting in increased expressions of VEGF, HIF-α, BMP2, and Osterix, which promote intra-femoral head revascularization. Meanwhile, YKP decreased the expression of bone-destruction-related factor MMP13, thus enhancing the ability of bone tissue to repair itself. Regulation of these molecules’ expression may be one of the mechanisms of YKP in the treatment of hormonal femoral head necrosis.
文摘Objective: To explore the pathogenesis of avascular necrosis of femoral head(ANFH) and search an effective method for clinical practice. Methods: Twenty-four Japanese rabbitswere divided into 2 groups of models and controls. ANFH models were produced byintramuscular-injection of large dosage of steroid to rabbits for 8 weeks. From the 4th, 8th and12th week after production of models, 2 rabbits of each group were sacrificed to observe thestructure of femoral head through light microscope and scanning electron microscope. The contents ofNitric Oxide (NO), tissue-type plasminogen activator (t-PA) and -plasminogen activator inhibitor(PAI) in plasma of the 4 rabbits in each group were estimated at the same time. Results: Comparedwith control group, the rabbits of model group exhibited many differences: such as osteoporosis offemoral head, the presence of more bone lacuna and fat cell through light microscope observing; thebroken and sunk bone trabecula, the loosen and broken collagen fibers on the surface of bone matrixthrough scanning electron microscope observing. Compared with control group, the Concentration ofNO and t-PA in plasma of the model rabbits decreased obviously, but the Concentration of the PAIincreased obviously. Conclusion: The steroid-induced ANFH might be related to the lower level of NOand the descent of fibrinolytic activity.
基金This study was in part supported by the National Natural Science Foundation of China(21371106,51402167).
文摘In this article,the biodegradation process and bone formation of a mineralized collagen reconstruction rod embedding in necrosis of human femoral head were investigated by imageological and histological methods.Computed radiography(CR)computerized tomography(CT),common pathological section and hard tissue section analysis were used to evaluated the dynamics of imageological and histopathological changes of femoral head,interface between the host bone and implant and the bone reconstruction process.The results showed that the density of rods increased closed to that of host bones after 1 year implanting,and the interface between them turns to blurring.Hard tissue grinding sections analysis showed osteocytes appearing in sparse bone trabecular and bone pit region,as well as a few vessels in the degraded dye powder matrix were noticed,indicating the new bone forming between the implants and host bones.Regular decalcified sections analysis showed scattered osteoclasts,multinucleated giant cells and fibrosis components existing in the degraded rod and the host bone trabecular.Degraded debris was endocytosed by giant cells,and vascular network formed around the boundaries of the implanted rod.The good osteointegration has been expressed by the interface between the implanted rod and the host bone becoming blurred.Histological results indicated that the implanted rod degradation process and new bones regeneration simultaneously occurred around the boundaries of embedding rod.New bone and host bone were hinged and co-existed.
文摘Objective： To assess the curative effect and investigate the indications of total hip arthroplasty for treatment of comminuted intertrochanteric fractures. Methods： Total hip arthroplasty was carried out in 9 cases of severe intertrochanteric fracture. The patients included two men and seven women. The average age of the patients was 68 years （48-75 years）. The period from fracture to operation was 5 days （2-10 days）. The mean follow- up period lasted for 11 months （3 months-2 years）. There was one patient with comminuted intertrochanteric fracture accompanied by femoral head necrosis and 2 patients with intertrochanteric fracture and stroke. Other 6 patients had severe osteoporosis. The Harris score before operation was 63 points （45-71 points）.Results： At the last follow-up, the patients gained 86points （70-100 points） according to the Harris score. The effects of the 8 cases were good. The Harris score of all patients improved after treatment. Only two hemiplegia patients needed sticks to walk. The others could walk without hip pain. No radiographic evidence of acetabular wear and prosthesis dislocation or other major complications happened during the follow-up. Conclusions： Prosthetic replacements can well treat unstable intertrochanteric fracture if operative indication is correctly selected. It is suitable for elderly patients and the operation should be performed by experienced surgeons.
基金Supported by the National Natural Science Foundation of China (No.30672702,No.81072820 and No.30873276)Key Program of Traditional Chinese Medicine of Zhejiang Province (No.2005Z003)
文摘Objective： To observe the regulation of Youguiyin （YGY, 右归钦） on the gene expression profile of the rat with steroid-induced femoral head necrosis （sFHN）, for the sake of investigating its molecular mechanism of sFHN prevention and treatment. Methods： All the 30 rats were randomly divided into three groups, the normal control group （A）, the model control group （B）, and the YGY treated group （C）, 10 in each group. After rats in Groups B and C were being made into FHN models with steroid injection, they received a daily intragastdc administration of saline and YGY respectively in equal volume for a total of 6 weeks, while to the unmodeled normal rats in Group A, saline was administered instead. The rats were sacrificed at the terminal of administration; their mRNA from femoral head tissue was extracted and prepared to cDNA probe through inverse transcription for detecting gene expression profile by microarray, outcomes of which was passing fluorescence quantitative PCR verification, and the differential expressed genes were analyzed adopting gene ontology （GO） method. Results： Compared with Group A, the numbers of differential genes found in Groups B and C were 190 and 92, respectively, but the changing trend in the two groups was opposite, mainly manifested as down-regulating in Group B/Group A （GB/GA） and up-regulating in Group C/Group B （GC/GB）. The analysis showed that these differential genes were mainly assigned to cell apoptosis, signal transduction, metabolism, cell proliferation and differentiation, cell cycle, blood coagulation, antioxidant activity, etc. Conclusions： sFHN was regulated by various genes; the regulation of YGY on expressions of these genes and the intra]extra-cellular signaling processes was possibly the molecular mechanism of YGY for preventing/treating sFHN. This study gave an explanation to the effectiveness of Chinese medicine in preventing/treating FHN from aspects of gene expression and enriched the Chinese medicine theory of ＂Kidney （Shen） governing bones＂.
文摘Objective: To explore the pathogenesis of avascular necrosis of femoral head (ANFH), the early diagnosis index and the treatment effective index of ANFH in clinical practice. Methods: Twenty-four Japanese rabbits were divided into 2 groups: model group and control group. ANFH models were produced by intramuscular injection of large dosage of steroid to rabbits for 8 weeks. On the 4 th, 8 th week after the injection, two rabbits each time from each group were taken to observe the structure of femoral head by light microscope and scanning electron microscope. Four other stomach-empty rabbits from each group were also used to test the contents of Nitric Oxide (NO), contents of the hemorheology indexes. Results: Compared with the control group, the rabbits in the model group exhibited osteoporosis of femoral head and more bone lacuna and more fat cells through light microscope. Through scanning electron microscope observation bone trabecula were broken and sunk, and collagen fibers on the surface of bone matrix became loosen and broken, more osteocyte had pyknosis, adipocyte in the medullary cavity were enlarged and subchondral arterioles and capillaries of the femoral head were pressed by adipocyte. Compared with the control group, the model rabbits contained less NO and obvious increase of the plasma viscosity (PV), low blood viscosity (LBV), erythrocyte hematocrit (HCT), indices of erythrocyte rigidity (TK) and indices of erythrocyte aggregation (AI), plasma fibrin level (PFL) (P<0. 01) and an increase of erythrocyte electrophoresis rate (ERT) (P< 0.05). High blood viscosity (HBV), and erythrocyte sedimentation rate (ESR) were unchanged. Conclusion: The steroid-induced ANFH might be related to less NO and the abnormal hemorheology; and NO and hemorheology should be considered as an early diagnosis index for ANFH in clinical practice.
基金This study is supported by Guangxi Zhuang Traditional Chinese Medicine Self-financing Research Projects.
文摘Objective:This study is to investigate the nisk factors of femoral head contracture after total hip arthroplasty(THA)in patients with avascular necrosis of femoral head.Methods:Retrospective analysis was perfomed in 361 cases of femoral head necrosis patients taking THA fom September 2016 to December 2017.A total of 179 patents with no significant preoperative adductor muscle contraction were finally enrolled in this study.These 179 patients were further divided into two groups:contracture group(64 cases)and noncompaction group(115 cases).The chi-square test was used to compare the differences between the two groups.Risk factors were identifed by logistic regession analysis.Results:of the patients included,64 patients (35.75%)developed into end adductor muscle contracture.There were signuificant differences in limb shortening.surgical history,whether taction,surgical approach,surgical methods,and fumctional training between the two goups(P<0.05).Logistic regression analysis showed that shortness of extremity,sugical approach,effective taction,surgical history,and etiology were the factors affecting femoral head contracture after THA in patients with avascular necrosis of femoral head.Conclusions:Preoperative traction therapy,surgical methods,and postoperative functional training are the factors that affect the adductor muscle contraction after THA.
基金the National Natural Science Foundation of China(No.81871789,No.81802200)the Natural Science Foundation of Jiangsu Province(No.BK20180052)Gusu Health Talents Program(No.GSWS2020023).
文摘To explore the relationship between preoperative traction and osteonecrosis of femoral head(ONFH)in patients with stable femoral neck fractures.Data from medical charts for 115 patients admitted to our institution with Garden II femoral neck fracture operated from January 2012 to December 2013 were extracted.Seven-year retrospective comparative study in the first affiliated hospital of Soochow University.Patients were divided into two groups by preoperative treatment:a preoperative traction group(group I)and a T-shaped shoe fixation group(group II).There were 14 patients lost to follow-up.101 patients with Garden II femoral neck fracture followed until July 2016 were available for complete analysis.Intervention:patients received skeletal traction or T-shaped shoe fixation preoperatively.All patients accepted internal fixation with multiple annulated screws.Main outcome measurements:the incidence of osteonecrosis of femoral head was analyzed based on preoperative traction,gender and implant removal.The average follow-up of these patients was 35 months(range,24-48 months).There was no implant failure or nonunion in our study.Nine patients(8.91%)had avascular necrosis.8(15.38%)patients in group I had osteonecrosis of femoral head,whereas only onepatient(2.04%)in group II had osteonecrosis of femoral head.Patients with preoperative traction had significantly higher incidence of osteonecrosis of femoral head compared with T shaped shoe fixation(P=0.032).No significant difference was found between the incidence of osteonecrosis of femoral head based on gender,age,injury-to-surgery interval time,implant removal or weight-bearing time.In patients with femoral neck fracture,preoperative traction may increase the incidence of osteonecrosis.Preoperative traction may not benefit patients with Garden II femoral neck fracture.The weight of traction may be a risk factor to osteonecrosis of femoral head.
基金The National 863 Program (2007AA02Z458)Science and Technology Program of Guangdong Province (2005B34001004)+1 种基金Science and Technology Program of Guangzhou (2005Z3-E0151)Medical Science Research Fund of Guangdong Province (B2005083, B2007107)
文摘Objective To establish an experimental model of early stage avascular necrosis of the femoral head （ANFH） caused by corticosteroid in adult rabbits and to observe the pathological changes with various imaging techniques. Methods ANFH was induced by a combination of hypersensitivity vasculitis caused by injection of horse serum and subsequent administration of a high dose of corticosteroid. The pathological changes were detected with digital radiography （DR）, computed tomography （CT）, magnetic resonance imaging （MRI）, ink artery infusion angiography, hematoxylin-eosin staining, and immunohistochemistry. Results The imageological and pathological changes corresponded to the clinical characteristics of early stage ANFH. DR showed bilaterally increased bone density, an unclear epiphyseal line, and blurred texture of cancellous bone. CT showed spot-like low-density imaging of cancellous bone, thinner cortical bone, osteoporosis, and an unclear epiphyseal line. MR! showed bone marrow edema and spot-like high signals in T2-weighted imaging in cancellous bone. Ink artery infusion angiography showed fewer obstructed blood vessels in the femoral head. HE staining of pathological sections showed fewer trabeculae and thin bone, an increased proportion of empty osteocyte lacunae, decreased hematopoiesis, thrombosis, and fat cell hypertrophy. Immunohistochemistry showed attenuated expression of vascular endothelial growth factor in osteoblasts and chondrocytes, and on the inner membrane of blood vessels. Conclusion Experimental rabbit model of early stage ANFH caused by corticosteroid can be successfully established and provide the foundation for developing effective methods to treat early stage ANFH.
文摘Objective:To probe into the relation between magnetic resonance imaging(MRI) signal classifications and TCM syndromes in femoral head necrosis patients,so as to provide reference for TCM diagnosis of this disease.Methods:Refering to the criteria for TCM syndrome types of necrosis of the femoral head described in "The Guiding Principles of Clinical Studies of New Chinese Drugs" and Shimizu and Mitchell's MRI signal classifications,MRI signal classifications between different TCM syndrome types were compared.Results:The Shimizu signal classification of different TCM syndrome types had statistically significant difference(P=0.04);Both T2WI+fs and Mitchell signal classifications of different TCM syndrome types had no statistical by significant differences(P=0.42 or P=0.15).Conclusion:There is a certain correlativity of TCM syndrome types of necrosis of the femoral head with T1WI signal classification of MRI.MRI signal classification may contribute to objectivity in TCM syndrome typing of this disease.
基金ThisprojectwassupportedbyagrantfromNationalNaturalSciencesFoundationofChina (No 30 170 94 5 )
文摘To explore a new method for the therapy of the avascular necrosis of the femoral head, the recombinant plasmid pCD-hVEGF 165 was mixed with collagen and was implanted in the necrotic femoral head The expression of vascular endothelial growth factor (VEGF) was detected by RNA dot hybridization and immunohistochemical method The repair of the femoral head was observed by histological method The results showed that the expression of VEGF was detectable in the femoral head treated with VEGF gene Angiogenesis in these femoral heads was more abundant than the control Bone repairing was augmented in the femoral head treated with VEGF gene The results suggest that angiogenesis in bone tissue could be augmented by gene transfection of VEGF and bone repairing would be accelerated accordingly
基金supported by the National Natural Science Foundation of China(30470430 and 30400514)
文摘The aim of this study is to investigate microscopic structure and characterize cancellous bone of avascular necrosis of the femoral head （ANFH）. The rabbit model of the ANFH is established. The histopathologic features are studied successfully. The differences between the steroidinjection group （S.G.） and the controlled group （C.G.） are examined, including the weight of rabbits, the hematological examination and the three-dimensional stnactures. It is found that the plasma levels of cholesterol （CHO）, high-density lipoprotein （HDL） and low-density lipoprotein （LDL） in S.G. are lower than those in C.G. when the triglyceride （TG） increased in the S.G.; but the bone mineral content （BMC） and the structural model index （SMI） of the organ and tissue decreased significantly in S.G. Three-dimensional structures of the femoral head are obtained using micro-computed tomography （CT） scanning and the mechanical model is established to analyze the influences of these structural changes on the mechanical properties of the cancellous bone.
文摘Objective: To investigate the value of transplantation of vascularized fibula in treating non-union femoral neck fractures and preventing ischemic necrosis of the femoral head. Methods : Vascularized heterotopic fibula was transplanted to the anterior-lateral part of the femoral neck. The fibula artery and vein were anastomosised with lateral circumflex artery and vein. Results : One hundred and twenty-nine cases of non-union femoral neck fracture were treated with vascularized fibula graft in our hospital from 1982 to 2002. Eighty-seven cases of them were followed up for 3 to 19 years with functional and X-ray examination. The percentage of fracture healing and effect were 94. 3 and 81. 6, respectively. Conclusion:The fibula with blood supply has a synergistic fixation impact on the non-union femoral neck fractures. The fibula is solid enough for supporting the femoral head and preventing it from collapse. The vascularized fibula grafting, by providing blood supply to the affected femoral head and neck, could promote the femoral head restoration and reconstruction. In addition, the periosteum of fibula plays a role in fracture healing.
基金supported by the General Project of Henan Natural Science Foundation(No.232300420034)the National Natural Science Foundation of China for the Youth(No.81600555)the General Project of China Postdoctoral Science Foundation(No.2018M640684)。
文摘Objective Glucocorticoid(GC)-induced adverse reactions(ARs)have been extensively studied due to their potential impact on patients’health.This study aimed to examine the potential correlation between two polymorphisms[adenosine triphosphate-binding cassette B1(ABCB1)C3435T and plasminogen activator inhibitor-1(PAI-1)4G/5G]and various GC-induced ARs in nephrotic syndrome(NS)patients.Methods In this study,513 NS patients who underwent GC treatment were enrolled.Then,the patients were divided into two groups based on ABCB1 C3435T and PAI-14G/5G genotyping,and intergroup comparisons of clinicopathological data and GC-induced ARs were performed.Univariate and multivariate logistic analyses were subsequently conducted to identify potential risk factors for GC-induced ARs,and a nomogram was subsequently established and validated via the area under the ROC curve(AUC),calibration curve and decision curve analysis(DCA).Results We identified ABCB1 C3435T as an independent risk factor for the development of steroid-associated avascular necrosis of the femoral head(SANFH)(OR:2.191,95%CI:1.258–3.813,P=0.006)but not as a risk factor for the occurrence of steroid diabetes mellitus(S-DM).On the other hand,PAI-14G/5G was identified as an independent risk factor for the development of both SANFH(OR:2.198,95%CI:1.267–3.812,P=0.005)and S-DM(OR:2.080,95%CI:1.166–3.711,P=0.013).Notably,no significant correlation was found between the two gene polymorphisms and other GC-induced ARs.In addition,two nomograms were established and validated to demonstrate strong calibration capability and clinical utility.Conclusion Assessing ABCB1 C3435T and PAI-14G/5G before steroid treatment in NS patients could be useful for identifying patients at a high risk of developing SANFH and S-DM.
