| Objective:To explore the incidence characteristic of osteonecrosis of the femoral head, laws of syndromes elements combination, evidence-based distribution and mechanism of prevention and treatment of traditional Chinese medicine, to provide preventive treatment based on differentiation and theoretical basis for osteonecrosis of the femoral head.Methods:(1) through the ancient literature, as well as nearly 15 years hospitals in China Digital Library, a database of Chinese VIP femoral head necrosis on the status and evidence of research literature syndromes elements study of the treatment of osteonecrosis of the femoral head, to understand the advantages and problems of TCM treatment, as well as syndromes elements principle of evidence and its scientific significance.(2) Refer to the etiology of osteonecrosis of the femoral head, the incidence characteristics, National Drug Food Inspection Agency to amend the "new Chinese medicine as the guiding principles of clinical research" and "modern clinical diagnostics",develop the clinical investigation scale of osteonecrosis of the femoral head, to investigate patients who with a clear diagnosis inclusion criteria of with symptoms, signs, etiology, pathogenesis-related factors. Using the method of composition analyse the incidence of osteonecrosis of the femoral head characteristics; using frequency analyse femoral head necrosis in patients with symptoms and signs of distribution;using WF-wen-feng-ⅢChinese medicine clinics assisted differentiation software to explore the combination of the laws of syndromes elements; Using cluster analysis methods in patients with osteonecrosis of the femoral head of the cluster, using the method of principal component to analyse each type of cluster in patients with syndrome, and combined with traditional Chinese medicine theory to establish TCM syndrome; In accordance with etiology, disease period to explore evidence of osteonecrosis of the femoral head-type distribution(3) Frozen in liquid nitrogen method used to copy the animal model of femoral head necrosis, HE staining to observe morphological changes of the femoral head; detected by radioimmunoassay in blood levels of osteocalcin; using enzymatic detecte triglycerides and total cholesterol, using precipitation method measure high-density lipoprotein cholesterol,and low-density lipoprotein cholesterol; using in situ hybridization measure tissues of the femoral head bone morphogenetic protein-2mRNA expression; using enzyme-linked immunosorbent assay morphogenetic protein-2 content in blood of bone; using immunohistochemical detecte the femoral head of vascular endothelin growth factor protein expression; using BrdU mark newborn cells, using immunohistochemical detecte femoral head newborn cells organizations. Analyse the traditional Chinese medicine impact on the indicators, from the blood rheology, blood lipids, bone metabolism, bone formation, angiogenesis and other aspects to explore traditional Chinese medicine treatment of osteonecrosis of the femoral head mechanism.Results:(1) literatureThe results showed that the pathogenesis of osteonecrosis of the femoral head has not yet completely clear, is not satisfied with the clinical efficacy; Chinese medicine treatment of osteonecrosis of the femoral head has some advantages, but Syndrome Differentiation non-uniform.(2)Study incidence Characteristics and Differentiation of femoral head necrosisIncidence of features:the proportion of steroid-top in the cause; male to female ratio was 2.5:1; mainly concentrated in the age of 20 years of age-52years old;disease stages,Ⅱperiod is the highest,43.34%;the proportion of peasants, workers, cadres respectively is 22.40%,17.53%, 14.94%.Syndrome distribution and the laws of evidence:frequency of occurrence of the syndrome more than 40% is hip pain, limp, joint activities in a negative, knee pain, constant pain, pain after move, slippery and string pulse.Laws of syndromes elements combination:location of syndromes elements bones disease, kidney, liver, spleen often, there were the frequency of 92.64%,64.50%,21.64%,18.61%;comorhidity of syndromes elements (wet), and blood stasis (qi),Yang and Han,Qi-deficiency,yin deficiency found, there were the frequency of 69.69%,62.77%,54.12%, 41.12%,32.47%,22.49%.Clustering the results of syndrone:Yang deficiency, kidney, cold, phlegm, qi deficiency, spleen, wetlands clustered together; Qi stagnation, blood stasis clustered together; blood deficiency for a class; heart, lung, yin deficiency for the a class; liver, heat (fire), sperm losses clustered together.Evidence-based distribution:evidence-based can be summarized IV, eight subtypes, namely, blood stasis syndrome (bones cards of Qi stagnation, blood stasis, bones and blood stasis and Yang deficiency, bones Blood of Kidney-Yang Deficiency and Spleen), sputum blood evidence (bones of phlegm and blood stasis and spleen deficiency, bones of phlegm and blood stasis and Qi deficiency), dampness permit (Permit dampness bones, spleen dampness bones kidney-yang deficiency syndrome), liver and kidney deficiency syndrome; early for blood stasis, phlegm and blood stasis are mostly medium-term certificates,dampness cards, post-card for the liver and kidney deficiency.(3) Chinese intervention in the experimental study of femoral head necrosisHistopathology:blank group trabecular clear and tidy;bone cells clearly visible, occasionally empty bone lacuna; cartilage rich vascular,structure clear; with a rich marrow hematopoietic cells, a relatively small fat cells,the normal form; number of osteoblasts along the trabecular.2 and 4 weeks both see an increase in empty lacunae of bone, fat cell hyperplasia and hypertrophy.Model group there is sparse trabecular bone, thinning, structural disorders, occasionally debris; bone necrosis, nuclear pyknosis is obvious and bone lacuna increased; the amount of vascular in subchondral apparent reduction, wall structure of the destruction and elastic fibers break crack. Fat cell size in Marrow is increased, and some integration into a bubble, the number of hematopoietic cells reduced; cells into the edge of trabecular bone relative the blank group is reduced, in the number of multinuclear osteoclasts increased; the performance of the above-mentioned pathological four weeks more obvious than 2 weeks.Treatment group, chondrocytes were arranged regularly; yet with the rules of trabecular bone, dense, the edge of bone can be seen a large number of osteoblasts, there is a small number of osteoclasts; trabecular bone with a small amount of empty lacunae, empty lacunae of bone less than the model group, close to the blank group; marrow with a rich hematopoietic cells, fat cells and fat vacuoles less than the model group, close to the blank group. Pathological changes in the above-mentioned four weeks more evident than two weeksHemorheology:the model group at two weeks of whole blood viscosity, plasma viscosity, hematocrit were higher than blank group (P <0.05), platelet aggregation, fibrinogen have increased, but the difference was not statistically significant (P>0.05); the treatment group in whole blood viscosity, plasma viscosity, hematocrit, platelet aggregation and fibrinogen were lower than model group (P<0.05). Model group at 4 weeks of whole blood viscosity, plasma viscosity, hematocrit, platelet aggregation and fibrinogen were higher than blank group (P＜0.05 or P＜0.01); the treatment group in whole blood viscosity, plasma viscosity, hematocrit plot, platelet aggregation and fibrinogen were lower than model group (P＜0.05 or P＜0.01).Lipids:the model group at two weeks of TC, TG, LDL-C were compared with blank control group increased, but there was no significant difference (P>0.05); TG treatment group lower than in model group (P＜0.05), TC, LDL-C lowering, but there was no significant difference (P>0.05), HDL-C have a higher trend, but the difference was not statistically significant (P>0.05).4 weeks treatment group TG, TC, LDL-C were lower than model group (P＜0.05), HDL-C have a higher trend, but the difference was not statistically significant (P>0.05).Serum osteocalcin:2 weeks, BGP model group higher than the blank group (P＜0.05), treatment group was higher than model group (P＜0.05), higher than the blank group (P<0.01). Model group at 4 weeks of serum osteocalcin with the blank group was no significant difference between the treatment group, treatment group was significantly higher than the model group (P＜0.01).Bone morphogenetic protein:serum protein in bone formation, the model group at 2 weeks in serum bone morphogenetic protein group increased relative gaps, but there was no significant difference (P>0.05), treatment group was higher than model group (P＜0.05), higher than the blank group (P＜0.05). Treatment group at 4 weeks was significantly higher than the model group (P<0.01), higher than the blank group (P＜0.05).Organization of the femoral head bone morphogenetic protein in 2 weeks,the model group was higher than the blank group(P＜0.05),4 weeks,less than the blank group (P＜0.05); the treatment group at two weeks, four weeks were higher than the model group (P＜0.05, P<0.01)Vascular perfusion marker ink:blank control group blood vessels in the subchondral bone marrow trabecular bone formed within the vascular network, blood vessel network of inter-connected, the bone marrow significantly less blood vessels, vascular patterns is normal, no extravasation of intravascular ink. Model under the same conditions, ink can not be fully in the bone marrow infusion, but still transparent liquid perfusion same, there is a phenomenon of ink leakage. Treatment group, the formation of vascular network of bone marrow, small blood vessels clearly visible. Vascular distribution of epiphyseal vascular network formation of normal capillaries and branches can be seen.BrdU new cell markers:two weeks, the number of BrdU-positive cells marked in the model group relative in the blank group increased, but between the two groups was no significant difference (P>0.05), lower than the treatment group (P＜0.05); 4 weeks, the number of BrdU-positive cells marked in treatment group higher than the blank group (P＜0.05), higher than the model group (P＜0.01).Vascular endothelial growth factor:2 weeks,VEGF protein expression in model group higher than the control group (P<0.05), 4-weeks,model group lower than in the blank model group (P<0.05); the treatment group two weeks, four weeks were higher than the model group (P<0.05 or P<0.01).Conclusion:(1) Chinese medicine treat osteonecrosis of the femoral head is a vast range of prospects, but the research evidence remains to be standardized.(2) hormone has become the main incentive for femoral head necrosis, the incidence of age on the 20-year-old-52 years old.(3) osteonecrosis of the femoral head of patients mainly syndromes elements are bones, kidney, liver, spleen and sputum (wet), and more in blood stasis (qi), Han, Yang deficiency. Osteonecrosis of the femoral head of the card type can be summarized as four types and eight subtypes, early for blood stasis, phlegm and blood stasis type, dampness type, for the medium-term, the latter type for the liver and kidney deficiency.(4) syndromes elements have broad application of dialectical and scientific.(5) Chinese medicine treatment of osteonecrosis of the femoral head is through a variety of work, related to improve the state of blood, regulating blood lipids, regulation of bone metabolism to promote bone formation and promotion of angiogenesis. |
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