The Collapse Research Of Nontraumatic Osteonecrosis Of Femoral Head And Therapeutic Evaluation Of Traditional Chinese Medicine Treatment By Hip-preserving

Objective:1.To review the cases of nontraumatic osteonecrosis of femoral head in the First Affiliated Hospital of Guangzhou University of Chinese Medicine, observe the progression of disease history and imaging data, discuss the influence between the collapse and the pain time, ARCO stage, JIC, necrotic areas and bone marrow edema, screen the high risk factor of collapse.2. To analyze the risk factors of collapse after femoral head necrosis, combined with clinical symptoms and imaging data, to get a good method to predict the collapse of ONFH.3. To evaluate the clinical effect of traditional Chinese medicine in the treatment of non traumatic femoral head necrosis.4. Femoral heads were taken from patients with nontraumatic femoral head necrosis after total hip arthroplasty. The necrotic areas, the hardening bands and healthy bones were taken from the femoral head. To explore the biological mechanism of collapse by experiments of molecular biology.Methods:1. The clinical researchTo review the disease history of asymptomatic nontraumatic ONFH progressed to symptomatic and eventually progressed to collapse,45 cases (45 hips) were diagnosed as nontraumatic ONFH in the First Affiliated Hospital of Guangzhou University of Chinese Medicine during September 2011 to December 2013, because of the contralateral hip pain or limitation of activity and then diagnosed as ONFH. To collect the X-ray film, MRI film, X-ray examination was taken in standard bilateral hip joint, MRI examination was taken in the sagittal and coronal T1WI, T2WI, T2WI fat suppression; observe the patients gender, age, weight, pain, ARCO stage, JIC, necrotic areas, bone marrow edema, analysis the influence between the collapse and the factors, screening high risk factors.To analyze the risk factors of the collapse of the femoral head, and to combine the clinical symptoms and imaging data, to predict the collapse of the femoral head according to the cumulative integral value, and to test the sensitivity and specificity by the ROC curve.To evaluate the clinical effect of traditional Chinese medicine in the treatment of non traumatic femoral head necrosis, according to the patient’s Harris hip function index and scoring standards and the image progress.2. The experimental researchTo get 6 femoral heads from the patients ware diagnosised as nontraumatic ONFH in the First Affiliated Hospital of Guangzhou University of Chinese Medicine during September to October 2015,4 Male patients,2 female patients, ARCO stage IV, total hip arthroplasty was performed After admission,, and the patient offered the femoral head voluntarily for experimental study.The necrotic areas, the hardening bands and healthy bones were taken from the femoral head. RT-PCR method was used to detect the mRNA expression of OPG and RANKL in the necrotic area, the hardening area and the healthy area.Results:1.The clinical researchthe 45 (45 hips) ware diagnosised as nontraumatic ONFH,37 male patients,8 female patients, the mean age is 46.7 years (19 to 73 years); 18 alcohol induced ONFH cases,17 glucocorticoid induced ONFH cases,10 idiopathic ONFH cases. The average weight is 62.8 kg (45 to 78 kg);If the femoral head collapsed, the clinical observation ended, the average follow-up time is 29 months (7 to 60 months), the patients were followed up for at least 2 years If the femoral head do not collapse, average follow-up time is 39.7 months (24 to 96 month). ARCO stage I 1 hip, stage II 44 hips; JIC:type A 5 hips, type B 5 hips, type Cl 16 hips, type C2 19 hips;Necrotic range:small area 18 hips, middle area 8 hips, large area 19 hips;MRI of bone marrow edema classification:level 0 8 hips, level 1 21 hips, level 2 11 hips, level 3 5 hip. there are 25 hips progressed to symptomatic ONFH,15 hips progressed to collapse.According to statistic analysis, there ware no statistical significance between gender, age, body weight and asymptomatic nontraumatic ONFH progressed to symptomatic and eventually progressed to collapse, P> 0.05, indicated that the gender, age, weight had no effect to asymptomatic nontraumatic ONFH progressed to symptomatic and eventually progressed to collapse.According to statistic analysis, there ware no statistical significance between different causes (alcohol, glucocorticoid, idiopathic induced) ONFH and asymptomatic nontraumatic ONFH progressed to symptomatic and eventually progressed to collapse, P>0.05, indicated that the different causes ONFH had no effect to asymptomatic nontraumatic ONFH progressed to symptomatic and eventually progressed to collapse.According to statistic analysis, there ware no statistical significance between different causes (alcohol, glucocorticoid, idiopathic induced) ONFH and the time of asymptomatic nontraumatic ONFH progressed to symptomatic and eventually progressed to collapse, P>0.05.According to statistic analysis,there ware no statistical significance between the necrotic lesions size and asymptomatic nontraumatic ONFH progressed to symptomatic and eventually progressed to collapse, P>0.05, indicated that the necrotic lesions size had no effect to asymptomatic nontraumatic ONFH progressed to symptomatic and eventually progressed to collapse.According to statistic analysis, there ware no statistical significance between JIC and asymptomatic nontraumatic ONFH progressed to symptomatic and eventually progressed to collapse, P> 0.05, indicated that JIC had no effect to asymptomatic nontraumatic ONFH progressed to symptomatic and eventually progressed to collapse.According to statistic analysis,there ware no statistical significance between bone marrow edema and asymptomatic nontraumatic ONFH progressed to symptomatic and eventually progressed to collapse, P>0.05, indicated that bone marrow edema had no effect to asymptomatic nontraumatic ONFH progressed to symptomatic and eventually progressed to collapse.According to two classification logistic regression analysis, the prediction accuracy rate is 60% for 15 collapse cases and is 90% for 30 not collapse cases, The overall accuracy rate is 80%. X1(JIC) and X3 (bone marrow edema) entered the regression equation, Logit P=-15.227 +2.863 X1+1.784 X3. Wherein XI (JIC) each added one grade, the risk of collapse occurred 17.521 times, Wherein X3 (BME) each added one grade, the risk of collapse occurred 5.951 times.According to the cumulative value of the high risk factors to predict the collapse, the best critical point of the cumulative value is 9, the sensitivity is 0.767, the specificity is 0.933.According to the necrosis size to predict the collapse, the best critical point of necrosis size is 43%, the sensitivity is 0.667, the specificity is 0.733.Chinese medicine for the treatment of femoral head necrosis, can ease symptoms, According to statistic analysis, the Harris scores, pain scores, and progress rate statistical significance between before and after treatment, different group ARCO stages, statistically significant2.The experimental researchRT-PCR results:OPG, RANKL gene expression difference of necrotic areas, the hardening bands and healthy bones was statistically significant (P<0.05), which can be considered the expression of OPG, RANKL gene is different, LSD-t test was used for pairwise comparison the results showed that all groups were statistically significant.Gonelusion1. according to the disease history of Nontraumatic asymptomatic ONFH, we found that most of the hip joints will progress to symptomatic osteonecrosis, even progress to collapse; risk factors closely related to disease progression are necrotic lesion size, JIC, pain, bone marrow edema grade.2. cumulative integral value of high risk factors can be used to predict the collapse of the femoral head, which has a certain clinical use value.3. Traditional Chinese medicine for the treatment of femoral head necrosis can relieve symptoms, in the early treatment of the disease, the treatment effect is good4. OPG, RANKL gene expression difference of necrotic areas, the hardening bands and healthy bones, there are differences of osteoblasts osteoclasts gene expression between the different areas,which may be related to the progression of collapse.