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Chinese Medical Journal 2012年第1期125卷 134-139页

作者： TAN Gang KANG Peng-de PEI Fu-xing Department of Orthopedic Surgery West China HospitalSichuan UniversityChengduSichuan 610041China

Objective To review the recent developments in the mechanisms of glucocorticoids induced osteonecrosis of femoral head （ONFH） and introduce a new theory of *** sources Both Chinese- and English-language literatures were searched using MEDLINE （1997-2011）,Pubmed （1997-2011 ） and the Index of Chinese-language Literature （1997-2011 ）.Study selection Data from published articles about mechanisms of glucocorticoids induced ONFH in recent domestic and foreign literature were *** extraction Data were mainly extracted from 61 articles which are listed in the reference section of this *** Glucocorticoids are steroid hormones secreted by the adrenal cortex that play a pivotal role in the regulation of a variety of developmental,metabolic and immune ***,high dose of exogenous glucocorticoids usage is the most common non-traumatic cause of ON *** can affect the metabolisms of osteoblasts,osteoclasts,bone marrow stromal cells and adipocytes which decrease osteoblasts formation but increase adipocytes formation and cause ONFH *** Glucocorticoids affect the differentiation of mesenchymal stem cells,through activating or inhibiting the related transcript regulators of osteogenesis and *** last,the size and volume of mesenchymal stem cells derived adipocytes will increase amazingly,but the osteoblasts will be decreased *** the meantime,the activity of the osteoclasts will be ***,these mechanisms work together and lead to ONFH.

关键词： glucocorticoids osteonecrosis of femoral head peroxisome proliferator-activated receptor-y Runx2 Dickkopf-1 bone marrow stromal cells

Corticosteroid-induced osteonecrosis of the femoral head:Detection,Diagnosis,and Treatment in Earlier Stages

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Chinese Medical Journal 2017年第21期130卷 2601-2607页

作者： Li-Hua Liu Qing-Yu Zhang Wei Sun Zi-Rong Li Fu-Qiang Gao Peking Union Medical Col ege China-Japan Friendship Institute of Clinical MedicineBeijing 100029China Department of Orthopaedic Surgery Centre for Osteonecrosis and Joint Preserving and ReconstructionChina-Japan Friendship HospitalBeijing 100029China

Objective： This review aimed to provide a current recommendation to multidisciplinary physicians for early detection, diagnosis, and treatment of corticosteroid-induced osteonecrosis of the femoral head （ONFH） based on a comprehensive analysis of the clinical literature. Data Sources： For the purpose of collecting potentially eligible articles, we searched for articles in the PubMed, Cochrane Library, Embase, and CNKI databases up to February 2017, using the following key words：＆quot;corticosteroid＆quot;, ＆quot;osteonecrosis of the femoral head＆quot;,＆quot;risk factors＆quot;, ＆quot;diagnosis＆quot;, ＆quot;prognosis＆quot;, and ＆quot;treatment＆quot;. Study Selection： Articles on relationships between corticosteroid and ONFH were selected for this review. Articles on the diagnosis, prognosis, and intervention of earlier-stage ONFH were also reviewed. Results： The incidence of corticosteroid-induced ONFH was associated with high doses of corticosteroids, and underlying diseases in certain predisposed individuals mainly occurred in the first 3 months of corticosteroid prescription. The enhanced awareness and minimized exposure to the established risk factors and earlier definitive diagnosis are essential for the success of joint preservation. When following up patients with ONFH, treatment should be started if necessary. Surgical treatment yielded better results than conservative therapy in earlier-stage ONFH. The ideal purpose of earlier intervention and treatment is permanent preservation of the femoral head without physical restrictions in daily living. Conclusions： Clinicians should enhance their precaution awareness of corticosteroid-induced ONFH. For high-risk patients, regular follow-up is very important in the 1st year after high-dose prescription of corticosteroids. Patients with suspected ONFH should be referred to orthopedists for diagnosis and treatment in its earlier stage to preserve the joint.

关键词： Corticosteroid Diagnosis osteonecrosis of femoral head Prognosis Risk Factors Treatment

A modified technique of bone grafting pedicled with femoral quadratus for alcohol-induced osteonecrosis of the femoral head

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Chinese Medical Journal 2010年第20期123卷 2847-2852页

作者： WANG Yi-sheng ZHANG Yi LI Jun-wei YANG Guo-hui LI Jin-feng YANG Jie YANG Guang-hui Department of Orthopedic Surgery First Affiliated Hospital of Zhengzhou UniversityZhengzhouHenan 450052China

Background Quadratus femoris pedicled bone grafting has yielded satisfactory long-term clinical outcome for osteonecrosis of the femoral head （ONFH） in pre-collapse ONFH without extensive lesion. However, for pre-collapse ONFH with extensive necrotic area, it is still challenging to preserve the femoral head. The current study aimed to introduce a new technique of deliquesce strut with titanium mesh containing bone grafting pedicled with the femoral quadratus and to evaluate its short-term *** From January 2008 to December 2008, 10 ONFH patients （12 hips） underwent operations by a new technique of deliquesce strut with titanium mesh containing bone grafting pedicled with the femoral quadratus （group A）.According to the ARCO classification system, there were two hips in stage Ⅱ B and 10 hips in stage Ⅱ C. Also in the same period, 12 ONFH patients （16 hips） underwent operations by the conventional procedure of quadratus femoris pedicled bone grafting （group B）. There were 6 hips in stage Ⅱ B and 10 hips in stage Ⅱ C. All patients were males and suffered from alcohol induced ONFH. For the new technique, the necrotic area was evaluated, and a titanium mesh piece of the same size （range from 2.5 cm×2.8 cm to 2.8 cm×3.4 cm） was obtained and shaped to match the contour of the head. The cancellous bone was first placed underneath the subchondral bone and was densely impacted （about 1 to 2 mm thick）.Then the titanium mesh piece was inserted. The length of the decompressive trough was measured. A titanium cylinder mesh cage with a diameter of 1.6 cm of the same length was obtained, with a ＂U＂ shaped window in the wall being created to make room for the muscle pedicle. The muscle pedicle bone was inserted into the titanium mesh cage to form a bone graft-titanium cage complex and, then the complex was inserted. The hundred percent score method was used for outcome evaluation. Clinical and radiographic outcomes were compared between group A and group *** The a

关键词： osteonecrosis of femoral head titanium mesh pedicled with quadratus femoris strut bone grafting deliquesce prop

Effects of individual shock wave therapy vs celecoxib on hip pain caused by femoral head necrosis

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World Journal of Clinical Cases 2023年第9期11卷 1974-1984页

作者： Jun-Yu Zhu Jun Yan Jian Xiao Hai-Guang Jia Hao-Jun Liang Geng-Yan Xing Orthopedic Department The Third Medical Center of Chinese People’s Liberation Army General HospitalThe Armed Police Clinical CollegeAnhui Medical UniversityHefei 230022Anhui ProvinceChina Orthopedic Department The Third Medical Center of Chinese People’s Liberation Army General HospitalBeijing 100039China

BACKGROUND Celecoxib has been used to treat hip discomfort and functional difficulties associated with osteonecrosis of the femoral head(ONFH),although significant adverse reactions often follow long-term *** shock wave therapy(ESWT)can delay the progression of ONFH,alleviate the pain and functional limitations it causes,and avoid the adverse effects of *** To investigate the effects of individual ESWT,a treatment alternative to the use of celecoxib,in alleviating pain and dysfunction caused by *** This was a randomized,controlled,double-blinded,non-inferiority *** examined 80 patients for eligibility in this study;8 patients were excluded based on inclusion and exclusion criteria.A total of 72 subjects with ONFH were randomly assigned to group A(n=36;celecoxib+alendronate+sham-placebo shock wave)or group B(n=36;individual focused shock wave[ESWT based on magnetic resonance imaging three-dimensional(MRI-3D)reconstruction]+alendronate).The outcomes were assessed at baseline,at the end of treatment,and at an 8-wk *** primary outcome measure was treatment efficiency after 2 wk of intervention using the Harris hip score(HHS)(improvement of 10 points or more from the baseline was deemed sufficient).Secondary outcome measures were post-treatment HHS,visual analog scale(VAS),and Western Ontario and McMaster Universities Osteoarthritis Index(WOMAC)*** After treatment,the pain treatment efficiency of group B was greater than that of group A(69%vs 51%;95%CI:4.56%to 40.56%),with non-inferiority thresholds of-4.56%and-10%,***,the HHS,WOMAC,and VAS scores in group B dramatically improved during the follow-up period as compared to those in group A(P<0.001).After therapy,the VAS and WOMAC in group A were significantly improved from the 2nd to 8th wk(P<0.001),although HHS was only significantly altered at the 2 wk point(P<0.001).On the 1st d and 2nd wk after treatment,HHS and VAS scores were different

关键词： Extracorporeal shockwave therapy osteonecrosis of femoral head Pain Magnetic resonance imaging three-dimensional reconstruction Celecoxib

Effects of HuoguⅠFormula(活骨Ⅰ方) on Correlated Factors of Bone Regeneration in Chickens with Steroid-Induced Necrosis of femoral head

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Chinese Journal of Integrative Medicine 2012年第5期18卷 378-384页

作者：陈卫衡孔祥英万蓉肖春生李莉王智耀林娜王和鸣 Fujian University of Traditional Chinese Medicine Wangjing Hospital of China Academy of Chinese Medical Sciences Institute of Chinese Materia Medica China Academy of Chinese Medical Sciences

Objective： To study the mechanism of Huogu I Formula （活骨I方） in treating osteonecrosis of femoral head. Methods： Forty-eight healthy female Leghorn chickens were randomly divided into control group, model group and Huogu I group, and each group consisted of 16 chickens. At the meantime of model establishment, chickens of the Huogu I group were administrated with decoction, while the model and control group with distilled water by gavage. At the 8th and 16th week after medication, blood samples were obtained for blood lipid detection while both sides of femoral head were harvested for the rest of examinations. Specifically, expressions of bone morphogenetic protein-2 （BMP2）, transforming growth factor beta1 （TGFβ1）, Smad4 and Smad7 were evaluated by immunohistochemistry, while expression of osteoprotegerin/receptor activator of nuclear factor kappaB ligand （OPG/RANKL） mRNA was detected by in situ hybridization. Results： Compared with the control group, serum levels of total cholesterol （TG）, triglyceride （TG） and low-density lipoprotein cholesterol （LDL-C） in the model group rose significantly. Positive cell counting of BMP2, TGF 131, Smad4 and OPG in femoral head of the model group dropped prominently. Positive cell counting of Smad7 and RANKL increased dramatically. In contrast with the model group, levels of TC, TG and LDL-C in Huogu I group reduced significantly. Positive cell counting of BMP2, TGFβ1, Smad4 and OPG in femoral head of the Huogu I group increased prominently. Indices of Smad7 and RANKL both decreased significantly. Especially at the 8th week, these variations were more significant. Conclusion： Huogu I Formula is effective in promoting repair of necrotic femoral head by regulating the expressions of BMP2, TGFβ1, Smads and OPG/RANKL of osteoclast in femoral head.

关键词： osteonecrosis of femoral head bone morphogenetic protein-2 transforming growth factor beta1 osteoprotegerin receptor activator of nuclear factor kappaB Smads

EXPERIMENTAL　STUDY　ON　FREE　VASCULARIZED　FIBULA　GRAFTING　IN　REVASCULARIZING　femoral　　　head

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Journal of Pharmaceutical Analysis 1996年第2期10卷 123-128,154页

作者：王坤正王春生杨万石李旭东杨筱凤

laterals or femoral head and neck of 18 mature healthy male domestic dogs were divided into two groups by the principle or *** osteonecrosis of femoral head(ONFH)and old femoral neck fracture(FNF)were made *** vascularized fibula grafting was performed 2 weeks *** operation, X-ray,histopathological,electron microscopic,tetracycline fluorescence labelling and99mTc-methylene diphosphorate scanning were carried out *** result indicated that free vascularized fibula grarting could provide new blood supply system to injured femoral head and participate in the repairing process of avascular uecrosis of femoral head.

关键词： fibula graft osteonecrosis of femoral head fracture

Three-dimensional finite element analysis on the treatment of adult femoral head necrosis using different graft

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Journal of Nanjing Medical University 2006年第1期20卷 55-58页

作者： Wen Xue Kunzheng Wang Wei Ling Deptment of Orthopaedics Second Hospital Affiliated of Xi＇an Jiaotong University Xi＇an 710004 China

Objective： To study the alternation of distribution of the stress in the necrotic femoral head with different kinds of grafting materials by using three-dimensional element methods and find out the most optimal one with sound biomechanical principles before clinical application. Methods： We prepared a three dimension finite element model of central femoral head necrosis with surface modeling technique （spiral ct）and calculated the peak stress index of necrotic portion in three situations：core drilling in 14 mm diameter and grafting with titanium, fibula, polylactide. Results： The peak stress index of normal femoral head was 0.05, but in osteonecrotic femoral head, the peak stress index was 13 times of the normal （0.67）. The value of necrotic portion with big shallow angle （0.67） was larger than the one with small deep angle （0.49）. Core drilling in 14 mm diameter and grafting with titanium, fibula and polyactide could diminish the bad stress in the necrotic portion respectirdy. The decrease volume in small necrotic area （90°） is marked（38% ）, while in big necrotic area （150°） it was indistinctive（ 10% ）. In the same necrotic portion,the decrease volume with titanium was（38% ） larger than with the fibula （37%）, and also larger than with the polyactide（29% ）. Conclusion： In necrotic portion of femoral head, the badshess could produce 13 times of the normal one. Grafting with titanium, fibula and polyactide could reduce the bad stress respectively. The effect of titanium is most marked, second is fibula and polyactide is indistinctive. The effect was in big necrotic portion is bad, the best effect was in small necrotic portion.

关键词： mechanics: graft osteonecrosis of femoral head

Research Progress of Tonifying Kidney and Promoting Blood Circulation in the Treatment of Steroid-induced Necrosis of femoral head

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Journal of Advances in Medicine Science 2022年第1期5卷 36-41页

作者： Yongcai Wang Yanmin Li Yingang Li Shaanxi University of traditional Chinese Medicine XianyangShaanxi712000China Affiliated Hospital of Shaanxi University of traditional Chinese Medicine XianyangShaanxi712000China

osteonecrosis of the femoral head is a common disability disease of the hip joint in China,and osteonecrosis of the femoral head caused by hormone factors is the most common,which is related to the gradual increase in the utilization rate of glucocorticoids in recent *** is a refractory disease in orthopaedics with a poor *** this disease,the treatment of traditional Chinese medicine has certain *** view of this,the author reads,analyzes and summarizes its materials by searching China Journal full-text Database and Wanfang *** paper reviews the mechanism and clinical research progress of tonifying kidney and activating blood circulation in the prevention and treatment of steroid-induced osteonecrosis of the femoral head,hoping to provide help for the clinical treatment of hormone-related osteonecrosis of the femoral head.

关键词： Glucocorticoid osteonecrosis of femoral head Tonifying kidney and activating blood circulation Review