Objective： To study the mechanism of Huogu I Formula （活骨I方） in treating osteonecrosis of femoral head. Methods： Forty-eight healthy female Leghorn chickens were randomly divided into control group, model group and Huogu I group, and each group consisted of 16 chickens. At the meantime of model establishment, chickens of the Huogu I group were administrated with decoction, while the model and control group with distilled water by gavage. At the 8th and 16th week after medication, blood samples were obtained for blood lipid detection while both sides of femoral head were harvested for the rest of examinations. Specifically, expressions of bone morphogenetic protein-2 （BMP2）, transforming growth factor beta1 （TGFβ1）, Smad4 and Smad7 were evaluated by immunohistochemistry, while expression of osteoprotegerin/receptor activator of nuclear factor kappaB ligand （OPG/RANKL） mRNA was detected by in situ hybridization. Results： Compared with the control group, serum levels of total cholesterol （TG）, triglyceride （TG） and low-density lipoprotein cholesterol （LDL-C） in the model group rose significantly. Positive cell counting of BMP2, TGF 131, Smad4 and OPG in femoral head of the model group dropped prominently. Positive cell counting of Smad7 and RANKL increased dramatically. In contrast with the model group, levels of TC, TG and LDL-C in Huogu I group reduced significantly. Positive cell counting of BMP2, TGFβ1, Smad4 and OPG in femoral head of the Huogu I group increased prominently. Indices of Smad7 and RANKL both decreased significantly. Especially at the 8th week, these variations were more significant. Conclusion： Huogu I Formula is effective in promoting repair of necrotic femoral head by regulating the expressions of BMP2, TGFβ1, Smads and OPG/RANKL of osteoclast in femoral head.
[目的]探讨髋关节骨髓水肿(bone marrow edema,BME)严重程度与股骨头坏死(osteonecrosis of the femoral head,ONFH)塌陷及Harris评分的相关性,为临床对股骨头坏死病情的了解和预后的判断起到指导作用。[方法]根据患者X线和MRI检查,58例(94髋)ONFH未伴有股骨头塌陷的患者,随访16～28个月,平均18个月,回顾性研究其BME严重程度与随访后股骨头塌陷与否以及Harris评分的相关性。[结果]骨髓水肿程度与塌陷相关性结果:Ⅰ级水肿塌陷率为4.5%,Ⅱ级水肿塌陷率为11.8%,Ⅲ级水肿塌陷率为66.7%,Ⅳ级水肿塌陷率为90%:骨髓水肿程度与Harris评分相关性结果:Ⅰ级水肿评分为93.0±5.41分,Ⅱ级水肿评分为84.1±5.42分,III级水肿评分为76.4±4.22分,Ⅳ级水肿评分为66.3±7.46分。[结论](1)骨髓水肿是ONFH一种继发征象;(2)通过骨髓水肿可以预测股骨头塌陷的趋势;(3)骨髓水肿分级与Harris评分呈负相关关系,即骨髓水肿范围越人,Harris评分越低。
目的探讨髋关节骨髓水肿(Bone Marrow Edema,BME)严重程度与股骨头坏死(Osteonecrosis of the Femoral Head,ONFH)中医证候的相关性。方法根据患者X线和MRI检查,对69例(121髋)确诊为ONFH且伴有BME的患者,回顾性研究其BME分级ONFH与中医三期四型分型的关系。结果ONFH早期气滞血瘀型和痰瘀阻络型,伴随BME较轻以Ⅰ、Ⅱ级水肿为主,中期经脉痹阻型较重以Ⅳ级水肿为主,晚期肝肾亏虚型以Ⅰ、Ⅱ级水肿为主。结论BME是ONFH一种继发征象;早、中期股骨头未塌陷前,BME随着病情的加重而加重;晚期随着股骨头的塌陷、骨性关节炎的形成,BME又逐渐消散;BME的严重程度,可作为中医辨证论治ONFH依据之一。
