腎虛血瘀型股骨頭壞死臨床、病理及影像學(xué)相關(guān)研究
發(fā)布時間：2018-07-16 18:22
【摘要】：目的：1.從骨髓微環(huán)境的改變來探討激素性股骨頭壞死(腎虛血瘀型)可能的發(fā)病機制。檢測激素性股骨頭壞死股骨近端髓腔內(nèi)骨髓間充質(zhì)干細胞的Runx2、catenin、 LRP5、OSX、PPARγ、OCN、TAZ、LEF-1 mRNA相對于健康者的表達差異,初步探討Wnt/β-catenin信號通路在激素性股骨頭壞死(腎虛血瘀型)中的表達意義,為臨床治療方案提供參考。2.收集非創(chuàng)傷性股骨頭壞死患者和股骨頸骨折行關(guān)節(jié)置換者新鮮股骨頭標(biāo)本,研究患髖疼痛時間與軟骨狀態(tài)關(guān)系,并對激素性壞死股骨頭標(biāo)本進行micro-CT掃描檢測不同部位的BMD和BMC等差異,觀察研究壞死股骨頭內(nèi)不同病理區(qū)病理結(jié)構(gòu)差異。3.回顧性研究資料完整的非創(chuàng)傷性ARCOⅡ期股骨頭壞死的影像學(xué)自然進展,研究股骨頭壞死負重區(qū)的保留與塌陷進展之間的關(guān)系,以期為股骨頭壞死患者的預(yù)后及制定合理的個體化治療方案提供參考依據(jù)。方法：1.從2015年11月至2016年2月,從我院6例因激素性股骨頭壞死行保髖手術(shù)或關(guān)節(jié)置換術(shù)(實驗組)和5例因股骨頸骨折、髖臼發(fā)育不良繼發(fā)髖關(guān)節(jié)炎或髖關(guān)節(jié)炎需手術(shù)患者(對照組)術(shù)中從股骨近端抽取骨髓。每位患者術(shù)前均簽署知情同意書。記錄納入研究者術(shù)前各項檢查資料。分離培養(yǎng)骨髓間充質(zhì)干細胞,對其表型進行流式鑒定,油紅O染色鑒定成脂能力,茜素紅染色鑒定成骨能力。將細胞培養(yǎng)至第3代,RT-qPCR檢測各組骨髓間充質(zhì)干細胞中Runx2、OSX、LRP5、catenin、PPARγ、OCN、 TAZ、LEF-1的mRNA表達差異。2.從2015年3月至2016年2月,收集我院非創(chuàng)傷性股骨頭壞死及新鮮股骨頸骨折患者行髖關(guān)節(jié)置換術(shù)的影像學(xué)檢查資料及病歷資料,收集剛手術(shù)截取的新鮮股骨頭標(biāo)本,對標(biāo)本外觀分別從前、后、內(nèi)、外方向拍照,記錄患者患髖發(fā)病以來疼痛時間、程度,觀察股骨頭標(biāo)本的外形、軟骨色澤、表面形態(tài)、彈性及厚度等。取6例X線、CT\MRI資料齊全的新鮮的激素性股骨頭壞死股骨頭標(biāo)本用硬組織切片機沿股骨頭冠狀面負重區(qū)為中心以5-8mm的間距切開,觀察剖面內(nèi)各病理區(qū)形態(tài),選接近正中冠狀位層面行Micro-CT掃描檢測,并選取壞死區(qū)、硬化帶、正常區(qū)進行三維重建后行骨礦密度(BMD)、骨礦容量(BMC)、組織體積(TV)、骨體積(BV)、骨體積分數(shù)(BVF, BV/TV)、骨表面積與骨體積比(BS/BV)、骨表面密度(BS/TV)、骨小梁厚度(Tb.Th)、骨小梁數(shù)目(Tb.N)、骨小梁分離度(Tb.Sp)等相關(guān)參數(shù)分析,其余層面按照負重區(qū)軟骨、壞死區(qū)、硬化區(qū)及正常區(qū)分別取材行HE染色、masson染色及其它相關(guān)檢測分析,與股骨頸骨折組相對照,比較空骨陷窩率、軟骨細胞數(shù)、最大脂肪細胞直徑等。3.回顧性分析2009年1月至2015年3月期間于我院骨科住院治療的87位(102髖)影像資料完整的經(jīng)MRI診斷為ARCO Ⅱ期的非創(chuàng)傷性股骨頭壞死患者的影像學(xué)自然進展。記錄雙髖關(guān)節(jié)正位和蛙式側(cè)位X片上發(fā)生塌陷的髖數(shù)及發(fā)展至塌陷的時間。按照壞死區(qū)所在股骨頭前外側(cè)部位提出蛙式側(cè)位(FLL)分型。將蛙式側(cè)位股骨頭內(nèi)的壞死區(qū)描述為后中和中心部位(I型),部分前外側(cè)(Ⅱ型)和整個前外側(cè)部(Ⅲ型),分別占股骨頭直徑的25%、50%和25%。觀察壞死塌陷與股骨頭前外側(cè)部負重區(qū)骨量保留情況關(guān)系,并通過對術(shù)后切下的股骨頭的形態(tài)分析進行證實。對股骨頭蛙式側(cè)位不同分型的股骨頭塌陷率和塌陷時間進行總結(jié)分析并與傳統(tǒng)的正位分型相比較。結(jié)果：1.提取骨髓間充質(zhì)干細胞的實驗組與對照組相比較,術(shù)前實驗組血液分析中平均紅細胞體積(MCV)、平均血小板體積(MPV)、血小板分布寬度(PDW)、紅細胞分布寬度(RDW-CV)均高于對照組,但差異無統(tǒng)計學(xué)意義(P0.05)；實驗組血液生化分析中總膽固醇(CHOL)、甘油三酯(TG)、載脂蛋白Al (apoAl)、載脂蛋白B(apoB)、高密度脂蛋白膽固醇(HDL-C)、低密度脂蛋白膽固醇(LDL-C)均低于對照組,但差異無統(tǒng)計學(xué)意義(P0.05)。按照患者臨床癥狀和體征所見,結(jié)合股骨頭壞死中醫(yī)臨床路徑診療規(guī)范,可將激素性股骨頭壞死按腎虛血瘀型辯證論治。2.成功分離培養(yǎng)了骨髓間充質(zhì)干細胞,并經(jīng)過細胞表型鑒定CD29、CD44、CD73、 CD 105陽性,CD34、CD45陰性,符合骨髓間充質(zhì)干細胞表型。油紅O染色、茜素紅染色鑒定了其潛在的成脂、成骨分化能力。3. RT-qPCR結(jié)果表明,實驗組(ONFH組)骨髓間充質(zhì)干細胞的Runx2、OSX、 LRP5、catenin的mRNA表達量明顯低于對照組,差異有統(tǒng)計學(xué)意義(P0.05)；實驗組PPARy、OCN、TAZ、LEF-1于對照組,但差異無統(tǒng)計學(xué)意義(P0.05)。4. Micro-CT掃描影像可見壞死區(qū)骨小梁明顯較稀疏,部分可見斷裂,壞死區(qū)與硬化區(qū)之間存在明顯的空隙(大體標(biāo)本上對應(yīng)為肉芽帶),部分有囊變。對壞死區(qū)、硬化區(qū)與正常區(qū)進行三維重建后相關(guān)數(shù)據(jù)分析表明,與正常區(qū)相比較,壞死區(qū)的BMD、 BMC、BVF、Tb.N明顯降低,差異有統(tǒng)計學(xué)意義(P0.05)；Tb.Sp明顯升高,差異有統(tǒng)計學(xué)意義(K0.05)。硬化區(qū)的BMD、BMC、BVF、Tb.Th明顯升高,差異有統(tǒng)計學(xué)意義(P0.05)；BS/BV明顯降低,差異有統(tǒng)計學(xué)意義(P0.05)。與正常區(qū)相比較,壞死區(qū)BS/BV、BS/TV較正常區(qū)高,但差異無統(tǒng)計學(xué)意義(P0.05)；Tb.Th較正常區(qū)低,但差異無統(tǒng)計學(xué)意義(P0.05)。與正常區(qū)相比較,硬化區(qū)BS/TV較高,但差異無統(tǒng)計學(xué)意義(P0.05),Tb.Sp較低,但差異無統(tǒng)計學(xué)意義(P0.05)。統(tǒng)計結(jié)果表明患者患髖疼痛時間越長,一般股骨頭軟骨損傷程度越重。一般疼痛時間不超過6月者,股骨頭軟骨多較完好,建議保髖手術(shù)在患髖疼痛不超過6個月進行為宜。HE染色及masson染色觀察結(jié)果顯示,實驗組負重區(qū)軟骨細胞數(shù)明顯低于對照組,差異有統(tǒng)計學(xué)意義(P0.05)；壞死區(qū)空骨陷窩率明顯高于對照組,差異有統(tǒng)計學(xué)意義(P0.05)；實驗組最大脂肪直徑明顯高于對照組,差異有統(tǒng)計學(xué)意義(P0.05)。實驗組膠原纖維、類骨質(zhì)定性分析均低于對照組。5.回顧性分析研究ARCOⅡ期非創(chuàng)傷性股骨頭壞死的X片影像學(xué)自然進展結(jié)果表明,與正位X片相比較,蛙式側(cè)位X片股骨頭塌陷的數(shù)量明顯高于正位X片的塌陷數(shù),差異有統(tǒng)計學(xué)意義(P0.01)。蛙式側(cè)位X片塌陷時間小于正位X片塌陷時間,但差異無統(tǒng)計學(xué)意義(P0.05)。按照股骨頭壞死區(qū)蛙式側(cè)位分型,Ⅲ型股骨頭壞死的塌陷率明顯高于Ⅱ型股骨頭壞死,差異有統(tǒng)計學(xué)意義(P0.001)。Ⅲ型股骨頭壞死發(fā)展至塌陷時間比Ⅱ型較短,但差異無統(tǒng)計學(xué)意義(P0.05)。對手術(shù)切除的壞死股骨頭標(biāo)本進行組織病理學(xué)分析證實塌陷區(qū)位于股骨頭前外側(cè)部。結(jié)論：1.塌陷期激素性股骨頭壞死患者股骨近端骨髓內(nèi)Wnt/β-catenin信號傳導(dǎo)通路可能受到抑制,導(dǎo)致股骨頭內(nèi)成骨能力下降,破骨細胞對骨細胞再吸收的速度高于成骨細胞生成新骨的速度,修復(fù)能力變?nèi)?修復(fù)反應(yīng)引起骨強度降低,負重區(qū)承重能力下降。2.非創(chuàng)傷性股骨頭壞死壞死區(qū)的BMD、BMC、BVF、Tb.N較正常區(qū)明顯減少,Tb.Sp明顯增加。壞死后其內(nèi)部空間排列以及立體結(jié)構(gòu)改變,導(dǎo)致力學(xué)強度減弱,負重區(qū)承重能力下降,應(yīng)力集中的結(jié)果,骨小梁發(fā)生微骨折。股骨頭內(nèi)生物學(xué)、生物力學(xué)的共同改變,最終導(dǎo)致股骨頭部分塌陷。3.股骨頭壞死前外側(cè)部的保留與塌陷進展有關(guān)。壞死區(qū)蛙式側(cè)位分級有助于減少塌陷的漏診率,為預(yù)測股骨頭壞死塌陷的可能性和選擇適當(dāng)?shù)闹委煼桨柑峁﹨⒖�。在蛙位X片上,當(dāng)壞死區(qū)累及前股骨頭前外側(cè)部時,塌陷風(fēng)險較大,建議外科手術(shù)干預(yù)。
[Abstract]:Objective: 1. to investigate the possible pathogenesis of steroid induced osteonecrosis of the femoral head (kidney deficiency and blood stasis type) from the change of bone marrow microenvironment. Detection of the expression difference of Runx2, catenin, LRP5, OSX, PPAR gamma, OCN, TAZ, LEF-1 mRNA relative to healthy persons in the proximal intramedullary mesenchymal stem cells of femoral head necrosis of the femoral head necrosis, and to discuss the Wnt/ beta -catenin. The significance of signaling pathway in steroid necrosis of the femoral head (kidney deficiency and blood stasis), providing reference.2. for clinical treatment scheme, collecting non traumatic femoral head necrosis patients and femoral neck fractures with joint replacement of fresh femoral head specimens, studying the relationship between the time of pain of the hip and the state of cartilage, and carrying out mic for the steroid necrosis of the femoral head specimens. Ro-CT scan test the difference of BMD and BMC in different parts, observe and study the difference of the pathological structure in the different department of pathology in the necrotic femoral head..3. retrospective study data of the intact non traumatic ARCO II necrosis of the femoral head, the relationship between the retention of the necrosis of the femoral head and the progress of the collapse is studied in order to be the femoral head. Methods: 1. from November 2015 to February 2016, 6 patients with corticosteroid necrosis of the femoral head underwent hip surgery or joint replacement (experimental group) and 5 cases of femoral neck fracture, acetabular dysplasia secondary hip osteoarthritis, or hip arthritis, from November 2015 to February 2016. In the control group, the bone marrow was extracted from the proximal femur during the operation. Each patient signed the informed consent before the operation. The records were recorded before the operation of the researchers. The bone marrow mesenchymal stem cells were isolated and cultured. The phenotype was identified by flow identification, the oil red O staining was used to identify the lipid forming ability and the alizarin red staining was used to identify the osteogenesis ability. The cells were cultured to third generations, RT-qPC R detection of Runx2, OSX, LRP5, catenin, PPAR gamma, OCN, TAZ, LEF-1 mRNA expression in the bone marrow mesenchymal stem cells from March 2015 to February 2016, from March 2015 to February 2016, collection of non traumatic femoral head necrosis and fresh femoral neck fracture patients underwent hip replacement surgery imaging examination data and medical records, collection of fresh femoral intercepted fresh femoral surgery Bone specimens were photographed from the former, after, after, inside and outside, to record the time and degree of pain since the onset of hip onset, to observe the shape of the femoral head, the color of the cartilage, the shape of the cartilage, the shape, the elasticity and the thickness of the femoral head. 6 cases of fresh steroid femoral head necrosis of the femoral head specimens were taken with a hard tissue slicer along the femoral head. The coronal weight area of the bone was divided into the center of 5-8mm and observed the morphology of each department of pathology in the section. Micro-CT scan was selected close to the positive middle crown level, and the necrotic area, sclerosing zone and normal area were selected for bone mineral density (BMD), bone mineral volume (BMC), tissue volume (TV), bone volume (BV), bone volume fraction (BVF, BV/T). V), the bone surface area and bone volume ratio (BS/BV), bone surface density (BS/TV), bone small Liang Houdu (Tb.Th), bone small Liang Shumu (Tb.N), bone trabecular separation degree (Tb.Sp) and other related parameters were analyzed, and the other layers were obtained by HE staining, Masson staining and other correlation detection according to the weight region cartilage, necrotic area, sclerosis area and normal area, and the femoral neck bone. .3. retrospective analysis of the ratio of bone lacunae, the number of chondrocytes, and the diameter of the largest adipocyte in the Department of orthopedics from January 2009 to March 2015 in the Department of orthopedics, 87 (102 hip) imaging data of the patients who were diagnosed as non traumatic femoral head necrosis in stage ARCO II of the hospital during the period from January 2009 to March 2015. The number of collapsed hips and the time of development to collapse on the X of the lateral and the breaststroke lateral position. According to the anterolateral part of the femoral head in the necrotic area, the frog lateral position (FLL) is put forward. The necrotic region in the frog side of the femoral head is described as the center of the posterior neutralization (type I), the part of the anterolateral (type II) and the whole anterolateral part (type III), which account for the femoral head, respectively. The relationship between the necrotic collapse and the bone mass retention in the anterior lateral mass of the femoral head was observed by 25%, 50% and 25%. diameter. The morphological analysis of the femoral head cut down after the operation was confirmed. The collapse rate and the collapse time of the femoral head in different types of the femoral head were analyzed and compared with the traditional type of orthotopic classification. 1. compared with the control group, the average red cell volume (MCV), the average platelet volume (MPV), the distribution width of platelets (PDW) and the red blood cell width (RDW-CV) were higher in the experimental group than in the control group, but the difference was not statistically significant (P0.05). The total bile of the experimental group in the blood biochemical analysis of the experimental group was not significant. Sterol (CHOL), triglyceride (TG), apolipoprotein Al (apoAl), apolipoprotein B (apoB), high-density lipoprotein cholesterol (HDL-C), low density lipoprotein cholesterol (LDL-C) were lower than those of the control group, but the difference was not statistically significant (P0.05). According to the clinical symptoms and signs of the patients, the clinical pathway diagnosis and treatment combined with the femoral head necrosis can be stimulated. The osteonecrosis of the femoral head was successfully separated and cultured in.2.. The bone marrow mesenchymal stem cells were successfully isolated and cultured in accordance with the syndrome of kidney deficiency and blood stasis. The phenotype of CD29, CD44, CD73, CD 105, CD34, CD45 negative, was conformed to the phenotype of bone marrow mesenchymal stem cells through the cell phenotype. Alizarin red staining identified the potential lipid and.3. RT-qPCR junction of osteogenesis differentiation. The results showed that the mRNA expression of Runx2, OSX, LRP5 and catenin in the bone marrow mesenchymal stem cells in the experimental group (group ONFH) was significantly lower than that of the control group (P0.05). The experimental group was PPARy, OCN, TAZ, LEF-1 in the control group, but the difference was not statistically significant (P0.05) showed that the small bone Liang Mingxian in the necrotic area was thinner and partially available. There was a clear gap between the necrotic area and the hardened area (the gross specimen was the granulation zone), and some cystic changes were found in the necrotic area. The correlation data after three-dimensional reconstruction of the necrotic area, the hardened area and the normal area showed that the BMD, BMC, BVF, and Tb.N in the necrotic region were significantly lower than those in the normal area, and the difference was statistically significant (P0.05); Tb.Sp was obvious. The difference was statistically significant (K0.05). The BMD, BMC, BVF and Tb.Th in the hardened area were significantly higher, and the difference was statistically significant (P0.05). The difference was statistically significant (P0.05). Compared with the normal area, the necrotic region was higher than the normal region, but the difference was not statistically significant (P0.05); the Tb.Th was lower than the normal region, but the difference was not statistically significant. Learning significance (P0.05). Compared with the normal area, the hardened area BS/TV was higher, but the difference was not statistically significant (P0.05), and the Tb.Sp was lower, but the difference was not statistically significant (P0.05). The statistical results showed that the longer the pain time of the hip, the more severe the cartilage damage in the common femoral head. The pain time did not exceed the June, the cartilage of the femoral head was more perfect. The results showed that the number of chondrocytes in the weight bearing area of the experimental group was significantly lower than that of the control group (P0.05), and the rate of empty lacunae in the necrotic area was significantly higher than that of the control group (P0.05). The maximum fat diameter in the experimental group was significant (P0.05). The maximum fat diameter in the experimental group was significantly higher than that of the control group (P0.05). The maximum fat diameter in the experimental group was significant (.HE). The difference was significantly higher than that of the control group (P0.05). The qualitative analysis of collagen fiber and osteoid in the experimental group was lower than that of the control group.5. retrospective analysis of the ARCO II non traumatic femoral head necrosis of the X slice imaging nature progress results showed that the number of the frog type side X slices of the femoral head was obviously higher than that of the positive X. The collapse number of the slices was statistically significant (P0.01). The collapse time of the frog lateral X tablet was less than the collapse time of the positive X tablet, but the difference was not statistically significant (P0.05). The collapse rate of type III femoral head necrosis was significantly higher than that of type II femoral head necrosis (P0.001). The difference was statistically significant (P0.001). The time of necrotic development to collapse was shorter than that of type II, but the difference was not statistically significant (P0.05). Histopathological analysis of the necrotic femoral head specimens confirmed that the collapse area was located in the anterolateral part of the femoral head. Conclusion: 1. the Wnt/ beta -catenin signal transduction pathway in the proximal femur of the femoral head necrosis of the patients with the collapse stage may be affected by the signal transduction pathway. Inhibition resulted in a decrease in osteogenesis ability in the femoral head, the rate of osteoclast reabsorption to bone cells was higher than that of osteoblasts, the ability to repair the bone was weakened, the repair reaction caused the reduction of bone strength and the weight bearing capacity decreased in the.2. non traumatic necrosis and necrosis area of the femoral head, and the BMD, BMC, BVF, and Tb.N were significantly lower than those of the normal area, Tb.Sp After necrosis, the internal space arrangement and the three-dimensional structure change resulted in the weakening of the mechanical strength, the decline in weight bearing capacity, the result of the stress concentration, the micro fracture of the trabecular bone. The common changes of biology and biomechanics in the femoral head resulted in the retention and collapse of the anterolateral part of the femoral head.3. femoral head necrosis. Progress is related. The frogs lateral classification of the necrotic region helps to reduce the missed diagnosis rate of the collapse, and provides a reference for the possibility of predicting the collapse of the femoral head and the choice of appropriate treatment options. On the frog position X, the risk of collapse is greater when the necrotic area is involved in the anterolateral part of the anterior femoral head, and the surgical intervention is suggested.
【學(xué)位授予單位】：廣州中醫(yī)藥大學(xué)
【學(xué)位級別】：博士
【學(xué)位授予年份】：2016
【分類號】：R274.9
本文編號：2127249
[Abstract]:Objective: 1. to investigate the possible pathogenesis of steroid induced osteonecrosis of the femoral head (kidney deficiency and blood stasis type) from the change of bone marrow microenvironment. Detection of the expression difference of Runx2, catenin, LRP5, OSX, PPAR gamma, OCN, TAZ, LEF-1 mRNA relative to healthy persons in the proximal intramedullary mesenchymal stem cells of femoral head necrosis of the femoral head necrosis, and to discuss the Wnt/ beta -catenin. The significance of signaling pathway in steroid necrosis of the femoral head (kidney deficiency and blood stasis), providing reference.2. for clinical treatment scheme, collecting non traumatic femoral head necrosis patients and femoral neck fractures with joint replacement of fresh femoral head specimens, studying the relationship between the time of pain of the hip and the state of cartilage, and carrying out mic for the steroid necrosis of the femoral head specimens. Ro-CT scan test the difference of BMD and BMC in different parts, observe and study the difference of the pathological structure in the different department of pathology in the necrotic femoral head..3. retrospective study data of the intact non traumatic ARCO II necrosis of the femoral head, the relationship between the retention of the necrosis of the femoral head and the progress of the collapse is studied in order to be the femoral head. Methods: 1. from November 2015 to February 2016, 6 patients with corticosteroid necrosis of the femoral head underwent hip surgery or joint replacement (experimental group) and 5 cases of femoral neck fracture, acetabular dysplasia secondary hip osteoarthritis, or hip arthritis, from November 2015 to February 2016. In the control group, the bone marrow was extracted from the proximal femur during the operation. Each patient signed the informed consent before the operation. The records were recorded before the operation of the researchers. The bone marrow mesenchymal stem cells were isolated and cultured. The phenotype was identified by flow identification, the oil red O staining was used to identify the lipid forming ability and the alizarin red staining was used to identify the osteogenesis ability. The cells were cultured to third generations, RT-qPC R detection of Runx2, OSX, LRP5, catenin, PPAR gamma, OCN, TAZ, LEF-1 mRNA expression in the bone marrow mesenchymal stem cells from March 2015 to February 2016, from March 2015 to February 2016, collection of non traumatic femoral head necrosis and fresh femoral neck fracture patients underwent hip replacement surgery imaging examination data and medical records, collection of fresh femoral intercepted fresh femoral surgery Bone specimens were photographed from the former, after, after, inside and outside, to record the time and degree of pain since the onset of hip onset, to observe the shape of the femoral head, the color of the cartilage, the shape of the cartilage, the shape, the elasticity and the thickness of the femoral head. 6 cases of fresh steroid femoral head necrosis of the femoral head specimens were taken with a hard tissue slicer along the femoral head. The coronal weight area of the bone was divided into the center of 5-8mm and observed the morphology of each department of pathology in the section. Micro-CT scan was selected close to the positive middle crown level, and the necrotic area, sclerosing zone and normal area were selected for bone mineral density (BMD), bone mineral volume (BMC), tissue volume (TV), bone volume (BV), bone volume fraction (BVF, BV/T). V), the bone surface area and bone volume ratio (BS/BV), bone surface density (BS/TV), bone small Liang Houdu (Tb.Th), bone small Liang Shumu (Tb.N), bone trabecular separation degree (Tb.Sp) and other related parameters were analyzed, and the other layers were obtained by HE staining, Masson staining and other correlation detection according to the weight region cartilage, necrotic area, sclerosis area and normal area, and the femoral neck bone. .3. retrospective analysis of the ratio of bone lacunae, the number of chondrocytes, and the diameter of the largest adipocyte in the Department of orthopedics from January 2009 to March 2015 in the Department of orthopedics, 87 (102 hip) imaging data of the patients who were diagnosed as non traumatic femoral head necrosis in stage ARCO II of the hospital during the period from January 2009 to March 2015. The number of collapsed hips and the time of development to collapse on the X of the lateral and the breaststroke lateral position. According to the anterolateral part of the femoral head in the necrotic area, the frog lateral position (FLL) is put forward. The necrotic region in the frog side of the femoral head is described as the center of the posterior neutralization (type I), the part of the anterolateral (type II) and the whole anterolateral part (type III), which account for the femoral head, respectively. The relationship between the necrotic collapse and the bone mass retention in the anterior lateral mass of the femoral head was observed by 25%, 50% and 25%. diameter. The morphological analysis of the femoral head cut down after the operation was confirmed. The collapse rate and the collapse time of the femoral head in different types of the femoral head were analyzed and compared with the traditional type of orthotopic classification. 1. compared with the control group, the average red cell volume (MCV), the average platelet volume (MPV), the distribution width of platelets (PDW) and the red blood cell width (RDW-CV) were higher in the experimental group than in the control group, but the difference was not statistically significant (P0.05). The total bile of the experimental group in the blood biochemical analysis of the experimental group was not significant. Sterol (CHOL), triglyceride (TG), apolipoprotein Al (apoAl), apolipoprotein B (apoB), high-density lipoprotein cholesterol (HDL-C), low density lipoprotein cholesterol (LDL-C) were lower than those of the control group, but the difference was not statistically significant (P0.05). According to the clinical symptoms and signs of the patients, the clinical pathway diagnosis and treatment combined with the femoral head necrosis can be stimulated. The osteonecrosis of the femoral head was successfully separated and cultured in.2.. The bone marrow mesenchymal stem cells were successfully isolated and cultured in accordance with the syndrome of kidney deficiency and blood stasis. The phenotype of CD29, CD44, CD73, CD 105, CD34, CD45 negative, was conformed to the phenotype of bone marrow mesenchymal stem cells through the cell phenotype. Alizarin red staining identified the potential lipid and.3. RT-qPCR junction of osteogenesis differentiation. The results showed that the mRNA expression of Runx2, OSX, LRP5 and catenin in the bone marrow mesenchymal stem cells in the experimental group (group ONFH) was significantly lower than that of the control group (P0.05). The experimental group was PPARy, OCN, TAZ, LEF-1 in the control group, but the difference was not statistically significant (P0.05) showed that the small bone Liang Mingxian in the necrotic area was thinner and partially available. There was a clear gap between the necrotic area and the hardened area (the gross specimen was the granulation zone), and some cystic changes were found in the necrotic area. The correlation data after three-dimensional reconstruction of the necrotic area, the hardened area and the normal area showed that the BMD, BMC, BVF, and Tb.N in the necrotic region were significantly lower than those in the normal area, and the difference was statistically significant (P0.05); Tb.Sp was obvious. The difference was statistically significant (K0.05). The BMD, BMC, BVF and Tb.Th in the hardened area were significantly higher, and the difference was statistically significant (P0.05). The difference was statistically significant (P0.05). Compared with the normal area, the necrotic region was higher than the normal region, but the difference was not statistically significant (P0.05); the Tb.Th was lower than the normal region, but the difference was not statistically significant. Learning significance (P0.05). Compared with the normal area, the hardened area BS/TV was higher, but the difference was not statistically significant (P0.05), and the Tb.Sp was lower, but the difference was not statistically significant (P0.05). The statistical results showed that the longer the pain time of the hip, the more severe the cartilage damage in the common femoral head. The pain time did not exceed the June, the cartilage of the femoral head was more perfect. The results showed that the number of chondrocytes in the weight bearing area of the experimental group was significantly lower than that of the control group (P0.05), and the rate of empty lacunae in the necrotic area was significantly higher than that of the control group (P0.05). The maximum fat diameter in the experimental group was significant (P0.05). The maximum fat diameter in the experimental group was significantly higher than that of the control group (P0.05). The maximum fat diameter in the experimental group was significant (.HE). The difference was significantly higher than that of the control group (P0.05). The qualitative analysis of collagen fiber and osteoid in the experimental group was lower than that of the control group.5. retrospective analysis of the ARCO II non traumatic femoral head necrosis of the X slice imaging nature progress results showed that the number of the frog type side X slices of the femoral head was obviously higher than that of the positive X. The collapse number of the slices was statistically significant (P0.01). The collapse time of the frog lateral X tablet was less than the collapse time of the positive X tablet, but the difference was not statistically significant (P0.05). The collapse rate of type III femoral head necrosis was significantly higher than that of type II femoral head necrosis (P0.001). The difference was statistically significant (P0.001). The time of necrotic development to collapse was shorter than that of type II, but the difference was not statistically significant (P0.05). Histopathological analysis of the necrotic femoral head specimens confirmed that the collapse area was located in the anterolateral part of the femoral head. Conclusion: 1. the Wnt/ beta -catenin signal transduction pathway in the proximal femur of the femoral head necrosis of the patients with the collapse stage may be affected by the signal transduction pathway. Inhibition resulted in a decrease in osteogenesis ability in the femoral head, the rate of osteoclast reabsorption to bone cells was higher than that of osteoblasts, the ability to repair the bone was weakened, the repair reaction caused the reduction of bone strength and the weight bearing capacity decreased in the.2. non traumatic necrosis and necrosis area of the femoral head, and the BMD, BMC, BVF, and Tb.N were significantly lower than those of the normal area, Tb.Sp After necrosis, the internal space arrangement and the three-dimensional structure change resulted in the weakening of the mechanical strength, the decline in weight bearing capacity, the result of the stress concentration, the micro fracture of the trabecular bone. The common changes of biology and biomechanics in the femoral head resulted in the retention and collapse of the anterolateral part of the femoral head.3. femoral head necrosis. Progress is related. The frogs lateral classification of the necrotic region helps to reduce the missed diagnosis rate of the collapse, and provides a reference for the possibility of predicting the collapse of the femoral head and the choice of appropriate treatment options. On the frog position X, the risk of collapse is greater when the necrotic area is involved in the anterolateral part of the anterior femoral head, and the surgical intervention is suggested.
【學(xué)位授予單位】：廣州中醫(yī)藥大學(xué)
【學(xué)位級別】：博士
【學(xué)位授予年份】：2016
【分類號】：R274.9
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