Chinese Medicine Preventive Study Of Femoral Head Necrosis

The objective of this article is to investigate the effect of the prevention of Steroid-induced Avascular Necrosis of the Femoral Head(SANFH)by Traditional Chinese Medicine(TCM).The first part is a summarize reviewing the TCM studies about SANFH.It reveals that there are lots of advantages in treating and preventing SANFH with TCM.The second part is a case-control study.Objective:To investigate the risk factors of SANFH in patients with systemic lupus erythematosus(SLE). Methods:The consecutive 461 SLE patients who underwent inpatient care in China-Japan Friendship Hospital were reviewed,the clinical data of 32 cases complicated with ANFH and 64 without ANFH as control was studied and multivariate conditional logistic step-wise regression was applied to analyze those different factors.Results:The incidence of ANFH in 461 SLE patients was 6.94%.65.63%of the ANFH was diagnosed within the first 3 years of SLE.It was found that the occurrence of ANFH was positively associated with the existence of vasculitis,high level of blood platelet,serum LDL-C and fibrinogen(P＜0.05).The ANFH initial glucocorticoid dosage and accumulative dosage of glucocorticoid within the first month or six months were significantly higher in patients with ANFH than that in SLE patients without ANFH(P＜0.05).There were no significant differences between two groups in sex,age,duration of SLE,dental ulcer,Raynaud's phenomenon,hypocalcemia, renal diseases and positive anticardiolipin antibodies(P＞0.05).Multivariate analysis showed that the existence of vasculitis and accumulative dosage of glucocorticoid within the six months were independent risk factors associated with ANFH(P＜0.05).Conclusion:The incidence of ANFH in patients with SLE is relatively high within the first 3 years of SLE.The patients with vasculitis and exposed to high-dose glucocorticoid therapy are more likely to develop ANFH.High level of blood platelet,serum LDL-C and fibrinogen which could be caused by high-dose glucocorticoid are important risk factors inducing ANFH. The third part is a clinical study.Objective:To evaluate the the clinical effect and safety of the prevention of SANFH by taking "xianlinggubao" capsule.Methods:A randomized,double-blind controlled clinical trial was carried out in patients who would be given a high-dose glucocorticoid.The subjects were randomly assigned into experimental and control groups and orally given a single dose of"xianlinggubao" capsule or placebo respectively. The clinical data of two groups was studied.Results:The total 25 cases were eligible for final analysis,16 from experimental group and 9 from control group.There were no significant differences between two groups in sex and age(P＞0.05).Harris score of all hips were above 90 and no osteonecrosis was detected by MRI in all patients.It was found that the level of fibrinogen in 12 week and 24 week was significantly lower in patients in experimental group than that in control group(P＜0.05).No evident side effects were detected. Conclusions:"Xianlinggubao" Capsule may have a positive effect in preventing SANFH by depressing the level of fibrinogen.There are no evident side effects in taking "xianlinggubao" capsule.