| The necrosis of femoral head results from destroying the femoral head' s blood supply by many kind of reason. Except the reason of wound, hormone cause more and more iatrogenic necrosis of femoral head, and it has several features as short morbility, fast progress, easy collapse, bad prognosis. And most patients once fall ill, they will follow the development rule of IDEM effect-necrosis-collapse-osteoarthritis, and the morbility progress may be from several months to several years. Many patients become disabled, loss work and living ability. Therefore, it becomes the grave question of orthopedics. Epidemiologic survey disclose that it is the morbility peak after using of hormone three to five months; by taking hormone long-term the disease incidenceof femoral head necrosis is ten to thirty percent.The outbreak mechanism of femoral head necrosis is very complicated, and the academic circles exists various theories currently. But investigate its essence, all is a blood circulation obstacle with partial femoral head, the nourishment materials and oxygens supply decrease, the metabolism outcome can't in time clearance, the bone organization, the cell lack of oxygen, and so as time passes the bone cells become denaturation and necrosis, but inside the necrosis organization of the femoral head, blood vessels reactivate and new bone form attenuated obviously. Therefore that adopting the valid means to promote b ad area blood vessel reactivate and new the bone form is the key of conservative treatment on femoral head necrosis, especially for the earlier period of femoral head necrosis. In the earlier period of femoral head necrosis, the pathological changes is slightly, if we adopt the valid treatment early, then it can cut off the progress of osteonecrosis, recover the bone organization structure. Currently, there is a lot of kinds conservative treatments on femoral head necrosis, but the research concerning of the nerve block therapy is less. My tutor make use of the Chinese herbal medicine Mailuoning injection, mixed with 2% lidocaine, 5% sodii bicarbonas (called Mailuoning compound, MC) block femoral articulation branches nerve of the obturator nerve to treat the earlier period of femoral head necrosis, and she obtains the satisfied curative effect. Therefore, we carry out this preliminary animal experiment. Mailuoning, the compound of Chinese traditional medicine, is composed of achyranthis,figwort,ophiopogonis,honeysuckble,dendrobium. It can activate blood circulation,increase yin and provide blood, heat-clearing and detoxicating. The main purpose of this topic is examine the curative effect of femoral head necrosis strictly, by using the Mailuoning compound blocking the femoral articulation branches nerve of the obturator nerve, and investigate the mechanism of action preliminary, and establish theory foundation for clinical treat. For this, this topic draws up to learn from the organization appearance, the immunity organization chemistry, blood fat three aspects to carry on the research.1．The empirical study on histomorphology of Mailuoning compound curing rat' s hormonic earlier necrosis of femoral head1．1 ObjectiveThe method that applied HE dye, from the histomorphology, observe the pathology appearance on rat' s earlier hormone necrosis of femoral head, check the therapeutic effect of Mailuoning compound blocking femoral articulation branches nerve of the obturator nerve.1．2 Material and methodsThere were 30 Wistar rats involved, 24 out of them were modeled in hormone necrosis of femoral head (Vena caudalis injection endotoxin 10μg/kg for once.After 24 hours, peritoneal injection prednisolone acetate 20mg/kg. d for 3 days.) and then divided into two sections, 12 for model group, 12 for treatment group. On the 4 day , to healing group, we began to block the femoral articulation branches nerve of the obturator nerve by injecting MC, 2ml/kg, 3times/week, 8weeks altogether. Model team and vacant team rats are raised for routine. All rats are drawed the materials on the first day of the 9th week: peritoneal injection pentobarbital sodiumlml/100g, and then take down rat' s right head of femur, 4% paraform (0．01MPBS preparing, PH7．2～7．4) retained, staying check. We prepare the paraffin sections, dye in HE, and observe the variation of femoral head pathology tissue necrosis. Also using image analysator, we quantitative analysis the vacuity bone lacuna ratio,bone lacuna areas bone,trabecula areas. Carry on mono-factor square analysis to the income data.1．3 Results and conclusions1．3．1 Results(1) Model group show by HE dyeing: bone trabecula raritas,long and thin, architectonic derangemen; part osteocyte neorobiosis, vacuitybone lacuna growing in number; camera pulpi intracavity axungia vacuole increasing obviously; osteoplast growing downwards; camera pulpi intracavity multinucleated osteoclast growing in number. Mc healing group show: bone trabecula coarsen, amount increasing, structure clear on the whole; most osteocytes are normal in bone trabecula, vacuity bone lacuna grow downwards obviously ; camera pulpi intracavitary axungia vacuole growing downwards, hematopoietic cell population growing in number; osteoblast increasing, multinucleated osteoclast decreasing obviously。(2) Image analysator quantitative analysis: bone trabecula area in area group and healing group decrease to common group, difference is significant (P<0．05) ; vacuity bone lacuna ratio,bone lacuna area increase to common group (P<0．05) . Healing group' s bone trabecula areais high to model group in bone trabecula area, lower to model group in bone lacuna area. Difference is not significant (P>0．05) .1．3．2 Conclusions(1) Endotoxin and flushing dose hormone can cause femoral head necrosis.(2) Applying MC block articulatio coxae nerve, to healing femoral head necrosis,can increase bone trabecula amount,osteoblast hematopoietic cell population, decrease necrosis osteocyte,vacuity bone lacuna,multinucleated osteoclastamount, relieve osteonecrosis degree obviously.2．Empirical study of MC healing rats' hormonic earlier femoral head necrosisby nerve block on immunohistochemistry2．1 ObjectiveUsing immunohistochemical approach, observe the difference of growth factors in different groups' femoral head effecting bone growth and prosth, check the therapeutic effect of Mailuoning compound blocking femoral articulation branches nerve of the obturator nerve. And further approach molecular biology foundation of pathology appearance of femoral head necrosis.2．21．2 Material and methodsThere were 30 Wistar rats involved, 24 out of them were modeled in hormone necrosis of femoral head (Vena caudalis injection endotoxin 10μg/kg for once. After 24 hours, peritoneal injection prednisolone acetate 20mg/kg.d for 3 days.) and then divided into two sections, 12 for model team, 12 for treatment team. On the 4 day , we began to block the femoral articulation branches nerve of the obturator nerve by injecting MC, 2ml/kg, 3times per week, 8weeks altogether. Model team and vacant team rats are raised for routine. All rats are drawed the materials on the first day of the 9th week: peritoneal injection pentobarbital sodiumlml/100g, and then take down rat' s right head of femur, 4% paraform (0．01MPBS preparing, PH7．2～7．4) retained, staying check. Paraffin sections are prepared, dye immunohistochemistry stain: Vessel endothelial cell growth factor (VEGF),Bone morphogenetic proteins (BMPs),Transforming growth factor-β(TGF-β),Ⅷfactor fos-related antigen(ⅧFRA). Also using image analysator, we quantitative analysis the masccline area,masccline cell population ratio. Carry on mono-factor square analysis to the income data.2．3 Conclusions(1) Hormone can restrain the express of growth factors (GF) in femoral head such as VEGF,BMPs,TGF-β1,ⅧFRA. (2) After using MC, the express of growth factors(GF) such as VEGF,BMPs,TGF-β1,ⅧFRA are up-regulation. Then we can say MC promote the production of capillary vessel,cartilage cell, and then promote the production of new bone.3．Empirical study of MC healing rats' hormonic earlier femoral head necrosis by nerve block on blood fat3．1 ObjectiveThrough contents contrast of TC and TG in rats' blood serum, and analyze the mechanism of action of MC healing rats' earlier hormone femoral head necrosis.3．2 Material and methodsThere were 30 Wistar rats involved, 24 out of them were modeled in hormone necrosis of femoral head (Vena caudalis injection endotoxin 10μg/kg for once. After 24 hours, peritoneal injection prednisolone acetate 20mg/kg. d for 3 days.) and then divided into two sections, 12 for model team, 12 for treatment team. On the 4th day , we began to block the femoral articulation branches nerve of the obturator nerve by injecting MC, 2ml/kg, 3times/week, 8weeks altogether. Model team and vacant team rats are raised for routine. All rats are drawed the materials on the first day of the 9th week: peritoneal injection pentobarbital sodiumlml/100g,and then split abdominal cavity, get blood 5ml, put in tubes differently. Centrifugate 3500rpm for 15min at 4℃, separate blood serum, chest freezer in chest freezer at 4℃. Send blood serum to biochemistry laboratory of Wangjing hospital to determin cholesterol total (TC),triglyceride(TG). Carry on mono-factor square analysis to the income data.3．3 Conclusions(1) After we make use of flushing dose hormone, cholesterol total and triglyceride in rats' blood serum step up obviously, and phenomenon of hyperlipemia appearance in organism. (2) After we take measures of promoting blood flow,increasing yin and provide blood, heat-clearing and detoxicating by injecting MC, cholesterol total and triglyceride in rats' blood serum cut down in quantity. Then we can say MC can improve rats' hyperlipemia state, rebound rats' lipid metabolism balance.Conclusion1．Endotoxin and flushing dose hormone can cause femoral head necrosis.2．That applying MC block articulatio coxae nerve, to healing femoral head necrosis, can increase bone trabecula amount,osteoblast hematopoietic cell population, decrease necrosis osteocyte,vacuity bone lacuna,multinucleated osteoclast amount, relieve osteonecrosis degree obviously.3．After applying MC block articulatio coxae nerve, to healing femoral head necrosis, the express of growth factors (GF) such as VEGF,BMPs,TGF-β1,ⅧFRA are up-regulation.4．After applying MC block articulatio coxae nerve, MC can protect osteocytes, restrain the development of necrosis effectively, minish the area of femoral head necrosis.5．That applying MC block articulatio coxae nerve, to healing femoral head necrosis, can promote the production of capillary vessel,cartilage cell, and then promote the production of new bone.6．That applying MC block articulatio coxae nerve, to healing, can improve rats' hyperlipemia state caused of hormone femoral head necrosis, rebound rats' lipid metabolism balance.7．Mailuoning, the compound of Chinese traditional medicine, is composed of achyranthis,figwort,ophiopogonis,honeysuckble,dendrobium. It can promoting blood flow,increase yin and provide blood, heat-clearing and detoxicating. So the results of this study shows that Mailuoning compounding with lidocaine and baking soda, adopted nerve block, has much potential for treating earlier hormone femoral head necrosis. |
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