| This research mainly divided into three parts,the first part is the literature review,the second part is a clinical study,which explores the correlation between the systemic bone metabolism level of femoral head necrosis with phlegm and blood stasis accumulation and local lesions,and the third part is the discussion content.Objective:To explore the systemic bone metabolism levels in patients with phlegm and blood stasis accumulating femoral head necrosis in different stages of necrosis,to study the pathological characteristics of the femoral head in patients with phlegm and blood stasis accumulating femoral head necrosis,and to explore the systemic bone metabolism and femoral head in patients with femoral head necrosis correlation of pathology.Methods:The patients with femoral head necrosis admitted to the Department of Orthopedics of our hospital from December 2016 to December 2020 were retrospectively analyzed.294 patients with phlegm and stasis type femoral head necrosis were selected as the experimental group,and 211 patients hospitalized for other diseases(knee cruciate ligament injury and meniscus injury)were selected as the control group.Patients in the trial group were divided into middle aged group(18-49 years old)and middle aged group(50-69 years old)according to their age.According to the ARCO stages of femoral head necrosis,the patients were divided into ARCO stage II group,ARCO stage III group and ARCO stage IV group.According to daily alcohol intake,the patients were divided into heavy drinking group,moderate drinking group and light drinking group.The basic information,gender,age,pain time,type and duration of alcohol consumption,and the amount of alcohol consumed each time were collected from all patients who met the standards of sodium and alcohol intake.Serum bone metabolism indexes of the patients in the two groups were detected.Including former type I collagen n-terminal propeptide(PINP),type I collagen peptide beta special sequence of carboxyl end(β-CTX),osteocalcin n-terminal molecular fragment(N-MID),25-hydroxy vitamin D(25-OH Vit D),serum uric acid(UA),calcium(Ca),inorganic phosphorus(P),alkaline phosphatase(ALP),serum magnesium(Mg),iron(Fe),serum total cholesterol(TC),triglyceride(TG),apolipoprotein A1(Apo A1),apolipoprotein B(Apo B),high-density lipoprotein(HDL),low density lipoprotein(LDL),MRI imaging data of the experimental group were collected to calculate the necrosis range of the femoral head.SPSS24.0 software was used to compare the two groups of data and intra-group data.Results:A total of 294 patients in the experimental group were included in this study,all male patients aged 18-69 years,with an average age of 42.56±11.30.They were divided into two ages of 18-49/50-69,with 211 cases and 83 cases respectively.The mean time of hip pain was 15.65±30.97 months.63,174 and57 patients with stage II,III and IV were enrolled according to ARCO stage.In the control group,211 patients were male,aged 18-69 years,with an average age of 42.95±13.15 years.There was no statistical significance in age between the two groups(P>0.05).In the experimental group,220 cases(74.8%)of the patients drank high-alcohol liquor,11 cases(3.7%)of low-alcohol liquor,5 cases(1.7%)of red wine,7 cases(2.4%)of rice wine,and 51 cases(17.4%)of beer.In the experimental group,126 patients were heavy drinkers,accounting for 42.9% of the total number,78 patients were moderate drinkers,accounting for 26.5% of the total number,and 90 patients were light drinkers,accounting for 30.6% of the total number.The mean value of P1 NP in the experimental group was 75.25±37.30 ng/ml,and that in the control group was48.54±32.16 ng/ml.The mean value of β-CTX was 0.59±0.29 ng/ml in the experimental group and 0.42±0.24 ng/ml in the control group.The mean value of N-MID in the experimental group was 19.52±7.84 ng/ml,and that in the control group was 16.43±8.90 ng/ml.The mean value of 25-OH Vit D in the experimental group was 32.40±12.92 ng/ m L and that in the control group was28.64±9.54 ng/ m L.Among other bone metabolisation-related indexes in experimental groups and control groups,serum calcium,uric acid,alkaline phosphatase and serum phosphorus in experimental groups were higher than those in control group,with statistical significance(P < 0.05),while high-density lipoprotein in experimental groups was lower than that in control group,with statistical significance(P < 0.05).There were no significant differences in serum magnesium,serum iron,total cholesterol,triglyceride,apolipoprotein A1,apolipoprotein B and low density lipoprotein between the two groups(P >0.05).In the experimental group,the P1 NP of patients with ARCO stage II was lower than that of patients with ARCO stage III,and the P1 NP of patients with ARCO stage III was lower than that of patients with ARCO stage IV,and the differences were statistically significant(P < 0.05).There were no statistically significant differences in β-CTX,N-Mid and 25-OH Vit D among different stages(P > 0.05).The β-CTX of heavy drinking patients was lower than that of light and moderate drinking patients,and the 25-OH Vit D of heavy drinking patients was higher than that of light drinking patients,the difference was statistically significant(P < 0.05).There were no statistically significant differences in P1 NP and N-MID between the three groups(P > 0.05).The β-CTX of the middle-aged group was higher than that of the middle-aged group,and the 25-OH Vit D of the middle-aged group was lower than that of the middle-aged group,the difference was statistically significant(P < 0.05).There was no significant difference in P1 NP and N-MID between the two groups(P > 0.05).Group within bone markers associated with other four indicators to analyze correlation between,negative correlation between alcohol intake and β-CTX(r = 0.183),and negatively correlated with N-MID(r = 0.165),and positively correlated between 25-OH Vit D(r = 0.125),drinking a negative correlation between length and β-CTX(r = 0.173),serum calcium,uric acid,serum phosphorus,magnesium,serum iron,apolipoprotein A1,apolipoprotein B,high-density lipoprotein cholesterol(HDL)and bone markers had no obvious correlation between the four.There was a positive correlation between alkaline phosphatase and P1NP(r=0.289),but no significant correlation between alkaline phosphatase and β-CTX,N-MID and25-OH Vit D,a negative correlation between total cholesterol and β-CTX(r=-0.143),and no significant correlation between P1 NP,N-MID and 25-OH Vit D,and a negative correlation between triglyceride and β-CTX(r=-0.126),and no significant correlation between P1 NP,N-MID and 25-OH Vit D.There was a negative correlation between LDL and 25-OH Vit D(r=-0.129),but no significant correlation between LDL and P1 NP,β-CTX and N-MID.There was a positive correlation between the range of femoral head necrosis and P1NP(r=0.507),β-CTX(r=0.600),and N-MID(r=0.389),but no significant correlation between the range of femoral head necrosis and 25-OH Vit D.Conclusions:The levels of P1 NP,β-CTX,N-MID and 25-OH Vit D in patients with phlegm-stasis type femoral head necrosis were significantly higher than those in the control group,and the levels of β-CTX and PINP were significantly higher than the clinical normal reference values.The bone metabolism level of patients with phlegm-stasis type femoral head necrosis was in a high transition state.The level of P1 NP in ARCO stage II and III was lower than that in ARCO stage IV.The bone metabolism level of femoral head necrosis patients with phlegm and blood stasis was positively correlated with the necrosis range of femoral head. |
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