Study On Series Of Femoral Head Necrosis Treated By Retention Of Hip Joint

BackgroundOsteonecrosis of femoral head (ONFH) occurs in young adults is a difficult disease for common orthopedic disability higher,the cause of many.Traumatic:hip fracture,non-traumatic:corticosteroids,alcoholism,decompressionsickness,hyperlipide mia, congenital acetabular dysplasia,sickle-cell anemia, idiopathic and so on. More common in middle-aged,average 38 years old, with bilateral involvement of more than 80%.If does not for treatment,most patients condition will for sexual development,eventually leading to severe hip osteoarthritis,joint replacement is often inevitable,but young patients line full hip replacement still exists with many problem,long-term effects are not ideal.Therefore,the disease should be early diagnosis and early treatment. On the basis of improvement in symptoms,how to prevent femoral head necrosis,and how we can delay the time of the artificial joint replacement,or even to avoid artificial joint replacement to retain their own femoral head,has become the focus of the study of avascular necrosis treatment.Current main treatment methods for retention of necrosis of femoral head avascular necrosis of femoral head by core decompression and bone marrow stromal stem cells transplantation,various bone grafts,each of the various treatments are inadequate,so how to prevent necrosis of the femoral head,search for effective treatment is currently outstanding issues.In recent years, with in-depth study of the bone cartilage injury and repair,some growth factors have become an increasing concern. IGF -1 is of concern,is a relative molecular mass of 7600 single- chain polypeptide of the non- sugar,insulin-like growth factor (IGF) IGF -1 and IGF -2 .IGF-1 with cartilage receptors on the cell membrane also works in a paracrine and autocrine fashion. IGF-1 could strongly stimulate synthesis of type collagen? and proteoglycan of cartilage cells, the IGF-1 can stimulate cartilage cells colony formation and cell proliferation, IGF-1 can promote the epiphyseal growth in vivo. Currently through the use of growth factors and biological means, regulate differentiation of pluripotent stem cells to form a normal physiological function of hyaline cartilage cell.Research Objective1 .Through two hollow compression screw internal fixation with the ascending branch of lateral circumflex femoral artery of iliac bone flap versus three hollow compression screw internal fixation in treatment of femoral neck fracture . observation of hip function and how to prevent the femoral head necrosis after operation of femoral neck fracture.2.Through the artery superselective digital subtraction angiography (DSA) of femoral head blood supply to explre the hip treatment and hemodynamic changes of young adults ischemic necrosis of the femoral head (ONFH) ARCO phase ii. Identify the clinical applications of superselective digital subtraction angiography (DSA) in the blood supply changes of different necrosis of femoral head .3.By establishing the carrier which can express human insulin-like growth factor adenovirus containing (Ad-hIGF-1),study on the expression of human insulin-like growth factor adenovirus containing (Ad-hIGF-1) transfection in the treatment of canine femoral head reconstruct cartilaginous metaplasia, the transformation rules of aponeurosis and periosteal fibers on the surface of greater trochanter bone flap,and IGF-1 play an biological role in articular cartilage metaplasia.Research significance1.Through the comparative study of treatment of femoral neck fracture in young,raised both internal fixation with AO solid points, but also provide fracture and femoral head blood supply, promoting fracture healing and preventing the occurrence of necrosis of the femoral head, provides an effective microsurgery method for femoral neck fractures of young people .2.By observing the clinical results of necrosis of femoral head in young adults(ARCO ?),verify that the value of clinical application of DSA in ONFH.3 .It validate that the vascularized great trochanter bone flap can reconstruct the femoral head with biological functions, while research on IGF-1 cytokines in cartilage tissue plays a role in the process of transformation,the result reveals a new pattern metaplasia of cartilage and bone transplantation of autologous blood formation and transport technology of a new biological functions .it provides the treatment ofischemic necrosis of the femoral head and cartilaginous metaplasia an experimental base.Research methods1.Uses two hollow compression screw internal fixation combined the iliac bone flap with the ascending branch of lateral circumflex femoral artery and three hollow compression screw internal fixation in treatment of femoral neck fracture in young adults, compared the function of hip joint and the incidence of necrosis of femoral head after operation.2.Through the artery superselective digital subtraction angiography (DSA) to explore the hemodynamic changes and hip treatment of ischemic necrosis of the femoral head (ONFH) ARCO? of young adults.3.first construct the carrier which can express the human insulin-like growth factor adenovirus containing (Ad-hIGF-1),then manufacture model of femoral head necrosis in dogs, selecting different group and different treatment, by pathological observation of the periosteal and Aponeurosis on surface of greater trochanter bone flap pedicled transformation to articular cartilage and tissue healing surroundings. Take Collagen? Immunohistochemical detect the expression of Ad-hIGF-1,Western blotting and RT-PCR detect the changing levels of protein and mRNA.Main research achievements1.1 Two hollow compression screws fixed and iliac flap transplanted with the ascending limb of lateral femoral circumflex to treat prime's femoral neck fracture:After operation, hip function(Harris score) and the rate of femoral head necrosis were obviously superior to three hollow compression screws fixed.1.2 The iliac flap with the ascending limb of lateral femoral circumflex are good area for bone graft for femoral head necrosis, as they are rich in blood and bone,their vesselpedicles are longer,and drawn convenience. And after operation,the DSA suggested blood supply were transplanted into the femoral head.2.1 As to prime patients in the ONFH ARCO? period, can choose operation method follow the super selective DSA before operation:The patients with artery ischemia chose greater trochanter bone flap with double blood vessels, and the patients with venous stasis chose core compression and bone marrow stromal stem cell transplantation, they all made a more satisfactory curative effect.2.2 Greater trochanter bone flap with double blood vessels are good area for bone graft for femoral head necrosis, as they are rich in blood, and drawn convenience.2.3 Taking all the marrow blood culture BMSCs can get a great number of high purity and high activity BMSCs. The method of extraction, separation, culture are simple, and they have strength augmentation differentiation ability. If they are receipted into body, they will be good seed cells for repairing femoral head.3. 1 Histopathology observationMasson and HE dying: At postoperative 3 weeks, it began to appear a large number of proliferative childish chondrocytes and less matrix in bone disc area, and the cells, without typical lacuna sample structure around, had smaller types and arranged disorderly. At postoperative 6 weeks, there were more chondrocytes and matrix in repaired tissue, and cartilage lacuna were seen easilier, and the cells were unevenly distributed. At postoperative 12 weeks, chondrocytes and matrix further increased, and their types were smaller than normal, and arranged disorderly. At postoperative 18,24 weeks, the repaired cartilage tissue and surrounding cartilage were basically connected into a expanse, and the chondrocytes' types,differentiation and arrangement were the same as normal.3.2 Collagen ? immunohistochemistryCollagen ? of tissue expressed in different periods in each group:Took cytoplasm and matrix yellow dye, determined the rate of fai degrees value expressed by computer image system. In the same week time, the rate of Collagen ?'s fai degrees value expressed in group B's right side was higher than group A's,and the two group's right side was higher than left side, and these have statistical differences.3.3 RT-PCRmRNA's level testingThe expression of transfection chondrocytes' hIGF-1mRNA:The test Results of RT-PCR's method in group B's right side suggested, the hIGF-1 gene expressed positive in transfection chondrocytes, and expressed the strongest in the third week,and weakened in turn in the sixth, the twelfth, the eighteenth, the twenty-fourth week.3.4 Western blotting technique detected proteinQuantitative analysis:Determined each purpose strip's integral grey value by molecular biology image analysis system , and their results were as to the grey value's rate of purpose strip dividing actin strip. In the same week time, the rate of fai degrees value expressed in group B's right side was higher than group A's, and the two group's right side was higher than left side, and these have statistical differences.Conclusion1.Two hollow compression screws fixed and iliac flap transplanted with the ascending limb of lateral femoral circumflex treated prime's femoral neck fracture,can greatly recover the hip function and the rate of femoral head necrosis were obviously superior to three hollow compression screws fixed.2.1 The pathogenesis prime's ONFH are not a single,and it's hemodynamic changes are complex. Different pathogenesis of femoral head with blood disorder need to choose different surgical therapy treatment. Following the DSA,choosing a Operation method can made a more curative effect.2.2 Greater trochanter bone flap with double blood vessels are good area for bone.2.3 Taking all the marrow blood culture BMSCs can get a great number of high purity and high activity BMSCs. The method of extraction,separation,culture are simple, and they have strength augmentation differentiation ability. If they are receipted into body, they will be good seed cells for repairing femoral head.3.1 Greater trochanter bone flap with transversalbranch blood vessels treating ONFH can reconstruct a biomechanical femoral head.3.2 The periosteum,fascia and etc. on the surface of greater trochanter bone flap transplanted can be transformed to articular cartilage.3.3 Ad-IGF-1 expressed positively on the surface of greater trochanter, can promote the periosteum,fascia and etc. on the surface of greater trochanter bone flap transplanted transform to articular cartilage.