The Clinical Observation Of Yougui Drink Combined With Fibula Grafting For Osteonecrosis Of The Femoral Head And The Experimental Study Of Yougui Drink

[Objective]1 To observe the clinical efficacy of Yougui drink combined with allograft fibula grafting in the treatment of early-and-mid-stage Glucocorticosteroid-associated necrosis of the femoral head(GA-ONFH),and to analyze the effect of Yougui Yin on early prognosis after hip preservation;2 Through animal experiments,the effects of Yougui drink on GA-ONFH and its mechanism of action were investigated.3 Based on metabolomics,the active ingredients of the treatment of GA-ONFH in Yougui drink were initially explored.Through the above studies,it provides early clinical efficacy evidence and modern scientific evidence for the treatment of GA-ONFH by Yougui drink.[Methods]1 A retrospective analysis of patients with GA-ONFH treated in Orthopedics Department from January 2015 to January 2017.All patients underwent ARCO stag:ing in stage IIB-IIIB.All patients underwent allograft fibula grafting and all cases were recorded.Demographic indicators,ARCO(the association research circulation osseous)staging,JIC classification,Harris score before and after treatment,post-treatment imaging scores,and statistical analysis.2 The rabbit model of early GA-ONFH was made by high-dose horse serum combined with dexamethasone.Twelve successful rabbit models were randomly divided into two groups:the Yougui drink group and the hormone control group.After 6 weeks intervention by intragastric Yougui drink,hematoxylin and eosin(HE)staining,tartrate-resistant acid phosphatase(TRAP)staining and vascular endothelial growth factor(VEGF)immunohistochemical analysis were performed on the cells in the femoral head of rabbits.To observe the intervention effect of Youguiyin on GA-ONFH in rabbits.3 Rabbits were used to model and intervene in animal experiments,and each rabbit venous blood sample was taken to prepare the serum metabolomics test specimens and standard control specimens of Yougui Yin.High performance liquid chromatography-four-bar time-of-flight mass spectrometry(HPLC-Q-TOF-MS)was used to identify the fingerprints of compound ingredients.[Result]1 This clinical study included a total of 49 cases of GA-ONFH in 55 hips.The follow-up time was 3 months,6 months,12 months,and 24 months.The final follow-up was successful in 42 cases of 47 hips.There were 20 cases of 22 hips in the drinking group(treatment group),and 22 cases of 25 hips in the simple humeral rod support group(control group).There were no significant differences in age,gender,BMI,preoperative Harris score,ARCO stage,and JIC classification between the two groups(P>0.05).At the end of follow-up,5 hips were performed in hip replacement group,including 2 hips in the treatment group and 3 hips in the control group.The success rate of hip preservation was 90.9%and 88.0%,respectively.The difference was not statistically significant(P>0.05).At the last follow-up,there was a statistically significant difference in Harris score in both the treatment group and the control group(treatment group:63.83±4.55 before operation,85.47±5.13 after operation;control group:61.94±4.05 before operation,83.22±4.08 after operation;P<0.05).There was no significant difference in the Harris score at the last follow-up between the groups(P>0.05).At the last follow-up,there was no significant difference in imaging scores between the treatment group and the control group(P>0.05).The score of bone repair imaging in the treatment group was higher than that in the control group at 3 months after surgery.The difference was statistically significant(treatment Group:9.25±1.83,control group:7.5±2.99,P<0.05).The hip survival success rate of the two groups with different ARCO staging and JIC classification was compared:ARCOⅡB>ARCOⅢA>ARCOⅡC>ARCOⅢB,B>C1>C2,the difference was not statistically significant(P>0.05).2 In the animal experiment,HE staining showed that the trabecular bone density of the Yougui drink group was significantly higher than that of the hormone control group(P<0.05).TRAP staining showed that the osteoclast activity was significantly lower in the Yougui drink group than in the hormone control group(P<0.05).VEGF immunohistochemistry showed that the number of angiogenesis in the Yougui group was higher than that in the hormone control group,and the difference was statistically significant(P<0.05).In the metabolomics study,mass spectrometry analysis of 33 potential active components of Yougui drink into the blood,including 13 hydrophilic components,20 hydrophobic components,mainly including volatile oils,lipids,glycosides,total flavonoids Classes,etc.The peak area distribution is 773.5～142405.25.Among the hydrophobic component and the hydrophilic component,the three components having the highest peak area are L-epi-catechin,β-D-glucopyranoside,longevity glycoside,and echinacoside,rutin,and quercetin.[Conclusion]1 The treatment of GA-ONFH in the early and middle stage is satisfactory.The combined application of Yougui drink is helpful for early postoperative bone repair,helping patients to recover their daily life with early weight-bearing,avoiding or delaying the progression of GA-ONFH.It is clinically significant.2 Yougui drink can significantly improve the angiogenesis ability of rabbit GA-ONFH model,promote osteogenesis and inhibit bone-breaking activity,reflecting the scientific basis of clinical use.3 Mass spectrometry analysis screened the potential active components of blood into 33.Through literature search,we found that echinacoside,rutin and quercetin have the functions of promoting angiogenesis,promoting osteogenesis and inhibiting bone destruction.The results of the experimental study are consistent,indicating that echinacoside,rutin and quercetin may have equivalent effects in the treatment of GA-ONFH.