Chinese medicine with the treatment of femoral head necrosis of clinical and experimental studies of core decompression
|School||Beijing University of Traditional Chinese Medicine|
|Course||Chinese and Western medicine combined with orthopedic|
|Keywords||Steroid-induced Avascular Necrosis of the Femoral Head Traditional Chinese medicine Marrow core reduced pressure technique Composite treatment|
Steroid-induced Avascular Necrosis of the Femoral Head（SANFH）is a kind of refractoriness disease,whose attack rate and mutilation rate are very high,which seriously affect patient’s living quality.But the exact nosogenesis of SANFH is not fully understanded.Which restrict the development of prophylaxis and cure method.Operation is the basic method and premise,but operation is also local.Traditional Chinese medicine has notable superiority to cure SANFH,it’s curative effect is content.But cure method only by TCM also has it’s insufficiency. To study how to combine operation and TCM,seek a combined therapy which has certain curative effect,low cost and few side effect,is important to raise cure effect of SANFH, economics burden of patient and society lessen.1 ObjectiveBy literature analysis,empirical study and clinical observation,to study the cure SANFH method by combining site of modern and TCM,expect to found the guide principle of cure SANFH,provide new method for clinical select suitable treatment plan and rational use.2 Method2.1 Theory researchBy method of bibliography and logic analysis,explain and analysis each recognition to etiological and pathogeny,cure status quo of SANFH and prophase experiment result,provide think method and way to cure SANFH by combination of TCM with Western medicine,and study the combining site.2.2 clinical research（1）overall thinking route:SANFH treatment has been the medical arena difficulty,surgery is the essential method and premise contains the SANFH advancement and prevents the collapse, but has its own limitation.Chinese medicine has the bidirectional control action to SANFH treat, but the pure Chinese medicine treatment also has the insufficiency.This research subject had already carried on the comprehensive solid preliminary exploring foundation and the clinical research work in the osteonecrosis cooperation of Chinese and Western medicine treatment domain.From 2003,has carried on the Core Decompression technique to the Steroid-induced Avascular Necrosis of the Femoral Head patient,simultaneously coordinated the Mu Dou leaf and the Chinese medicine recovery treatment,has obtained the good treatment result.This research through carring on the review analysis to the recent years composite treatment Steroid-induced Avascular Necrosis of the Femoral Head’s medical record,completed the traditional Chinese medicine coordination Core Decompression technique to treat SANFH the curative effect appraisal,based on this and summarized the treatment experience and the rule, instructed further clinical practice and research..（2）common material:Take the Steroid-induced Avascular Necrosis of the Femoral Head patient as the object of observation,according to the diagnosis standard,integrates the standard and the elimination standard,chose 2003-2006 Steroid-induced Avascular Necrosis of the Femoral Head patient altogether 58 examples of the Dongzhimen hospital.（3）investigates the target:Generally the project including the patient name,the sex,the age, the occupation,is hospitalized to be clear about the diagnosis,the therapeutic schedule and so on.Investigation project including kidney function target,biochemistry target,effect target, phantom study target and synthesis clinical curative effect deliberated index（4）statistical method:Carries on the T-test and the single factor variance analysis using the SPSS 13.0 analysis software.2.3 Experimental studies: （1）General layout:This experimental study mainly take establishes with human SANFH has the similarity and the commeasurability,conforms to the human SANFH pathological change’s objective law,the economical feasible animal model as a breakthrough point,has chosen takes the research with Steroid-induced Avascular Necrosis of the Femoral Head close related VEGF and the correlation cell factor the object.Around the observation under the hormone impact, observes the target（organization shape,VEGF,BMP-2）change that before and after using different treat law,and has carried on the comparative analysis to its relevance.（2）Animal experimental:Health New Zealand big ear rabbit,male gender,4 week age,body weight 0.60±0.11kg.New Zealand big ear rabbit will be post specially made cage,the natural illumination,the freedom absorbs the drinking water,room temperature raising.Refers to He’s making mold law,intermuscular injection acetic acid Prednisone dragon 8mg/kg/time,two times every week,injects 8w continuously.After making the mold success,after the phantom study inspection,reference international the ARCO standard carries on by stages by stages. After stochastic grouping,carries on the traditional Chinese medicine,the surgery and the complex therapy.3)Examination method:The histo-pathology inspection,utilizes the light microscope,the electron microscope observation;VEGF determination,utilization immunity group reduction; Blood serum BMP-2 determination,utilization emission immunization technology.（4）Analysis method:All data by?±SE the expression,the group difference carry on the ANOVA examination that using the SPSS13.0 statistics software package,The difference has the significance by P＜0.05.The variable relations use the straight line correlation analysis.3.Result:3.1 Fundamental research resultSteroid-induced Avascular Necrosis of the Femoral Head is clinical difficult to be treated disease, the disease incidence rate and crippling rate is very high,serious influence people’s life quality. But the Steroid-induced Avascular Necrosis of the Femoral Head accurate pathogenesis was not yet clear,this limit the clinical prevention and the treatment work development.Surgery is contains the h Steroid-induced Avascular Necrosis of the Femoral Head advancement and prevents the collapse the essential method and the premise,but has its own limitation.Chinese medicine treatment Steroid-induced Avascular Necrosis of the Femoral Head has the remarkable superiority,but the pure Chinese medicine treatment also has the insufficiency.The unique guiding principle treatment Steroid-induced Avascular Necrosis of the Femoral Head’s must be establish,the key treat Must establish’s combining site determination in the doctor practicing between Chinese medicine and western medicine.Through doctor western medicine’s method practicing,Creation advantageous that perhaps is the local environment which organizes to be repaired,in addition Chinese medicine promoter action,can achieve the twice result with half the effort effect.The animal model to explores the successful treatment pattern is essential,the new method of treatment’s exploration because of lacks receives with the annual bonus bone necrosis consistent animal model hinders.How to make conforms to the animal model which human Must establish develops,is a question which urgent needs to be solved.3.2 Clinical research results:3.2.1 Harris grading changes prior-treatment and post-treatmentThe Harris grading to demonstrate:The traditional Chinese medicine group clinical cures 9 hips,excellent results 2 hips,effective 4 hips,invalid 7 hips;The surgery group clinical cures 3 hips,excellent results 3 hips,effective 9 hips,invalid 5 hips;The comprehensive group clinical cures 11 hips,excellent results 5 hips,effective 4 hips,invalid 5 hips. 3.2.2 Three group of imaging study curative effects compare the phantom study target: The traditional Chinese medicine group shows results 8 hips,effective 8 hips,invalid 6 hips; The surgery group phantom study target shows results 10 hips,effective 4 hips,invalid 6 hips; The comprehensive group phantom study target shows results 13 hips,effective 6 hips,invalid 3 hips.3.2.3Three groups of total curative effects compare demonstrate:The traditional Chinese medicine group shows results 8 hips,effective 8 hips,invalid 6 hips, total effectiveness 72.72%;The surgery group shows results 6 hips,effective 9 hips,invalid 5 hips.Total effectiveness 75.00%;the synthesis group shows results 11 hips,effective 11 hips, invalid 3 hips.Total effectiveness 88.00%.3.3 Experimental study result3.3.1 VEGF expression level:Model group VEGF expression level compares the blank group elevate after the second week,but the fourth,eighth week VEGF expression level reduces gradually,lower the blank group obviously.3.3.2 BMP-2 content:The model group blood serum BMP-2 content compares the blank group to reduce,its difference has the significance（P＜0.01）.3.3.3 Traditional Chinese medicine groups,the surgery group and the synthesis group BMP-2 water elevate mean difference to model group,has the significance difference（P＜0.01）. Explained that three can through elevate the BMP-2 level to treat hormone nature INFH;the comprehensive group BMP-2 level elevates obviously,compares with other two groups has the significance difference.The traditional Chinese medicine group BMP-2 level is higher than the surgery group slightly,but the two compare,its difference non-statistics significance.4 Conclusion:4.1 Hormone make avascular necrosis of the femoral head’s blood vessel has no way to regenerate might by restraint VEGF express,reduce blood supply,result in osteocyte death,and continue make avascular necrosis of the femoral head.4.2 BMP-2 level cut down might be one of the factors of SANFH.4.3 Traditional Chinese medicine coordination Core Decompression technique to treat SANFH is the best method to treat Steroid-induced Avascular Necrosis of the Femoral Head.