The Study Of Kidney Deficiency And Blood Stasis Type Of ONFH Clinical,Pathology And Imaging Studies

Objective1. From the change of the bone marrow microenvironment to explore the kidney and blood stasis type of ONFH (glucocorticoid-induced) possible pathogenesis. Detection of glucocorticoid-induced ONFH proximal marrow cavity between BMSCs of Runx2, catenin, LRP5, OSX, PPAR y, OCN, TAZ, LEF-1 mRNA expression differences compared to healthy subjects, Wnt/β-catenin signaling pathway in kidney and blood stasis type of ONFH(glucocorticoid-induced) express meaning, offer reference for clinical treatment.2. Collection of patients with nontraumatic ONFH and femoral neck fracture line joint replacement fresh specimens of femoral head, the time of hip pain and cartilage state relations, and the hormone ONFH specimens for micro-CT scan to detect differences in BMD and BMC, etc, from different parts of the observational study ONFH pathologic structural differences in different pathological area.3. Retrospective study data complete nontraumatic ARCO II options ONFH imaging natural progress, research the retention and collapse of the ONFH with the relationship between the progress, so as to the prognosis of patients with ONFH and provide reference for reasonable individualized treatment plan.Methods1. From November 2015 to February 2016, the line is protected from 6 patients with glucocorticoid-induced ONFH hip surgery or joint replacement(experimental group)and 5 cases with femoral neck fracture, acetabulum hypoplasia secondary hip arthritis or hip arthritis need surgery (control group) in patients with intraoperative extract bone marrow from proximal femur, separation, cultivate MSCs, bone marrow its phenotype identification, detection of differentiation of osteogenesis, into fat. The basic data record into the preoperative. RT-qPCR detection between groups of BMSCs in the Runx2, catenin, LRP5, OSX, PPARy, OCN, TAZ, LEF-1 mRNA expression differences.2. From March 2015 to February 2016, collected from the NONFH and fresh femoral neck fracture patients with THA and medical records, imaging studies data collection just surgery, interception of fresh femoral head specimens, the specimens respectively before, after the appearance and internal, external direction pictures, records of patients suffering from hip pain since the onset time, degree, observe the appearance of the femoral head, color, surface morphology,thickness and elastic cartilage, etc. X-ray, CT and MRI in 6 cases with complete data of fresh specimens of glucocorticoid-induced ONFH with a hard tissue slicing machine along the femoral head coronal weight-bearing area as the center to cut 5-8 mm spacing, observed the pathological area form in each section, choose close to middle of coronary line level Micro-CT scans, and necrosis area, hardening, normal area for 3d reconstruction after bone mineral density(BMD), bone mineral capacity(BMC), tissue volume(TV), bone volume(BV),bone volume fraction(BVF), surface area of bone and bone volume(BS/BV), the density of bone surface (BS/TV),bone trabecular thickness(Tb. Th), bone trabecular number(Tb. N), trabecular bone isolation (Tb. Sp) related parameters, such as analysis, according to the weight of the rest area cartilage, necrosis area, hardening area and normal area respectively based on row HE staining and masson staining detection, and other related, as compared with the femoral neck fracture group is empty bone pit rate of fat cells, cartilage cells number, maximum diameter,etc.3. Retrospective analysis between January 2009 and March 2009 in our hospital orthopaedic hospital treatment during the period of 87 patients (102 hips) image information is complete the MRI diagnosis of ARCO Ⅱ period of NONFH in patients with imaging natural progress. Double hip is a record and the frog on the oblique X-ray collapse on the number of hip and development time to collapse. According to the dead zone is located anterolateral femoral head part put forward the frog side (FLL).The breaststroke side and after ONFH described as center(I type), part of the anterolateral(Ⅱ type) and the anterolateral (Ⅲtype), respectively,25%,50% and 25% of the diameter of the femoral head. Observation and anterolateral femoral head necrosis collapse of weight-bearing area bone mass reserves situation, and based on the morphological analysis of femoral head cut after surgery. For femoral head breaststroke side a different classification of subsidence rate and femoral head collapse time summarized analysis and compared with the traditional is a parting.Results1. Extraction of BMSCs between the experimental group compared with control group, experimental preoperative blood analysis of average red blood cell volume(MCV), mean platelet volume(MPV), platelet distribution width(PDW),red blood cell distribution width(RDW-CV) were higher than the control group, but there was no statistically difference (P>0.05);Experimental group blood biochemical analysis of CHOL, TG, Al, apoB, HDL-C, LDL-C are lower than the control group, but there was no statistically difference (p>0.05). According to the clinical signs and symptoms can see, the combination of femoral head necrosis specification, clinical pathway of traditional Chinese medicine diagnosis and treatment can be according to the kidney and blood stasis type glucocorticoid-induced ONFH dialectical treatment.2. Successful cultivation BMSCs, cell’phenotype identification CD29, CD44, CD73, CD105 positive, CD34, CD45 negative, accord BMSCs phenotype. Oil red 0 staining and alizarin red staining identified the potential into fat, osteogenesis ability of differentiation.3. RT-qPCR results show that the experimental group(ONFH) BMSCs Runx2, catenin, LRP5, OSX mRNA expression is significantly lower than the control group, with statistical difference (p<0.05);PPARy, OCN, TAZ, LEF-1 is lower than the control group, but no statistical difference (P>0.05).4. Micro-CT detection compared to femoral head necrosis area and normal area, necrosis of BMD and BMC, BVF, Tb. N decreased significantly (P<0.05), hardening with the BMD, BMC, BVF, BS/BV, Tb. Th significantly higher (P<0.05), compared with the normal area, the necrotic area Tb. Sp increased significantly (P<0.05).Statistical results showed that the patients of hip pain, the longer the heavier cartilage damage degree. Suggested that hip surgery in no more than 6 months of hip pain is advisable. Experimental weight-bearing area number of cartilage cells, necrosis area empty pit rate, maximum diameter of fat and the control group have obvious difference.5. Retrospective analysis showed that ARCO II ONFH progress of X-ray image, and is a comparison of the X-ray, the frog side is significantly higher than the number of X-ray collapse is a collapse of X line number(P< 0.01). Breaststroke oblique X-ray collapse time is less than a X-ray collapse time(P>0.05). In accordance with the breaststroke side femoral head necrosis type, type Ⅲ ONFH subsidence rate is significantly higher than the type II ONFH (P<0.001). Type Ⅲ ONFH development time to collapse than shorter II type (P>0.05).Histopathological analysis confirmed that the subsidence in the anterolateral femoral head department.Conclusion1. Subsidence stage in patients with glucocorticoid-induced ONFH proximal marrow Wnt β-catenin signaling pathways may is restrained, resulting in a decline in osteogenesis ability within the femoral head and osteoclast resorption of bone cells to speed higher than that of osteoblast to generate new bone, weaker ability to repair, repair reactions lead to reduced bone strength, load bearing ability.2. Non traumatic ONFH of BMD and BMC, BVF, Tb. N than normal area decreased significantly, Tb. Sp. Necrosis after its internal space arrangement and the 3D structure change, lead to mechanical strength, the weight-bearing area bearing ability, the result of stress concentration, bone trabecular microfracture. Change in biology and biomechanics of femoral head, eventually lead to femoral head collapse.3. ONFH of anterolateral retain associated with collapse progress. Dead zone breaststroke side classification helps to reduce the subsidence of the missed diagnosis, to predict the possibility of a collapse of the femoral head necrosis and select the appropriate treatment plan to provide the reference. The frog on the X-ray, when the first anterolateral femoral head necrosis area involving, collapse risk, suggest that surgical intervention.