A Comparative Study Of Hemodynamics And BMP-2 Levels In Nontraumatic Femoral Head Necrosis

Objective: To compare the levels of bone morphogenetic protein-2(BMP-2)in serum of patients with alcoholic femoral head necrosis and steroid-induced femoral head necrosis by ELISA.Hemodynamic differences between the necrotic regions of alcoholic femoral head necrosis and steroid-induced femoral head necrosis detected by nuclide bone imaging provide potential reference value for personalized treatment of femoral head necrosis(ONFH)caused by different clinical factors.Methods: From January 2018 to December 2019,30 patients with alcoholic osteonecrosis of the femoral head and 30 patients with steroid-induced osteonecrosis of the femoral head diagnosed by DR,CT and MRI in the affiliated Hospital of Qinghai University were selected as the experimental group,including alcohol group ARCO III stage(n = 14),ARCO IV stage(n = 16)and hormone group ARCO III stage(n = 17),ARCO IV stage(n = 13).Thirty patients with fresh femoral neck fracture without other diseases were selected as the control group.Fasting peripheral blood samples were collected from patients in the experimental group and the control group.The level of serum BMP-2 was detected by enzyme-linked immunosorbent assay(ELISA).30 patients with osteonecrosis of the femoral head in the alcohol group and 30 patients in the hormone group were examined by radionuclide bone triphasic imaging and analyzed by software after radionuclide bone imaging examination.The ratio of radioactivity count in the necrotic area of the femoral head to 1/3 of the ipsilateral femoral shaft in the blood pool phase was calculated to reflect the blood distribution and neovascularization in the necrotic area.The experimental and examination data were statistically analyzed and compared.Results: The average level of serum BMP-2 in steroid-induced femoral head necrosis group was lower than that in alcoholic femoral head necrosis group,and the average serum BMP-2 level in both groups was lower than that in normal femoral neck fracture group(p<0.05).There was no significant difference in serum BMP-2 levels between hormone group and alcohol group(p>0.05).The radioactivity ratio of femoral head and shaft in hormone group was higher than that in alcohol group,and the difference was statistically significant(p < 0.05).The radioactivity ratio of femoral head to femoral shaft in the hormone group and alcohol group in the fourth stage was higher than that in the third stage,and the difference was statistically significant(p <0.05).Conclusion: 1.The expression level of BMP-2 in serum of patients with ONFH caused by different factors is different.Properly increasing the level of BMP-2 in blood or local area of patients may promote the repair of osteonecrosis of femoral head.2.The blood flow and neovascularization in the late necrotic area of steroidinduced and alcoholic osteonecrosis of the femoral head increased to a certain extent,and the blood flow and neovascularization in the late stage of steroid-induced osteonecrosis were more than those in alcoholic osteonecrosis.