Experimental Study On Regulating Microenvironment Of The Necrotic Area To Promote Repair Of Osteonecrosis Of Femoral Head

Objective: To investigate the expression and significance of inflammatory cytokines in the intraosseous microenvironment of the necrotic area,and improve the understanding of the pathogenesis of ONFH.Methods: Patients with ARCO stage II and ARCO stage III non-traumatic ONFH who went to the Orthopedics Department of Chinese PLA General Hospital for treatment were recruited.Ten samples of intraosseous washing fluid were collected by surgery,five samples from the necrotic area and the other four samples from the normal area.The expression levels of inflammatory cytokines of the samples in the two groups were determined by multiplex immunoassay technology(Luminex).Results: Compared with the bone washing fluid of the normal area,IL-12 in that of the necrotic area was increased,while Eotaxin,IL-17 and PDGF-bb were decreased.The results were statistically significant(P<0.05).Conclusion: Bone washing fluid was analyzed for inflammatory cytokines for the first time,to reflect the expression levels of inflammatory cytokines in the microenvironment of different areas of osteonecrosis.The regional distribution of inflammatory factors in the necrotic femoral head suggested that the removal of inflammatory factors that were not conducive to bone regeneration might promote bone repair.Objective: To explore the effect of different concentrations of zoledronic acid in the treatment of early traumatic femoral head necrosis in rats,in order to find the recommended concentration of local injection.Methods: In this study,the rat model of traumatic femoral head necrosis was induced,and local injection of different concentrations of zoledronic acid(1μM,10μM,and 100μM)was performed in the early stage,and all experimental animals were sacrificed after 4 weeks.Efficacy evaluation was performed using histological and histological methods.Results: The shape of the femoral head in the NS group was deformed,and the surface cartilage was rough and damaged.The surface cartilage of the femoral head after treatment with different concentrations of zoledronic acid in the three groups was pale,but relatively smooth and intact without damage,and still maintained the hemispherical shape.The imaging results showed that the epiphysis and metaphyseal trabeculae of the femoral head treated with different concentrations of zoledronic acid in the three groups were more complete than those in the NS group,but the bone density in the 1μM group was uneven.The bone parameters of the femoral head were better in the 10μM group compared to the 1μM and 100μM groups.Histological results showed that the bone structure of the 1μM group was not as complete as that of the 10μM group and the 100μM group,and part of the bone trabeculae was destroyed and absorbed.Conclusion: Zoledronic acid at concentrations of 1μM,10μM and 100μM could effectively improve bone structure and maintain the shape of femoral head.Zoledronic acid at the concentration of 10μM is superior to the concentration of1μM and 100μM in improving bone mineral density and trabecular thickness.Therefore,we recommend the local use of zoledronic acid at the concentration of 10 μM for the treatment of femoral head necrosis.