复阳活骨丸配合髓芯减压术对激素性股骨头坏死模型股骨头骨内压及生物力学的影响

Effect of FUYANG HUOGU(复阳活骨)pill combined with core decompression on the intraosseous pressure within the femoral head and biomechanical parameter for the model with steroid induced avascular necrosis of femoral head

目的:观察复阳活骨丸配合髓芯减压术对激素性股骨头缺血坏死家兔模型股骨头骨内压和生物力学性能的影响,探讨其防治股骨头缺血性坏死的可能机制,为该方法的临床应用提供依据。方法:将45只健康家兔随机分为正常对照组(A组)、模型对照组(B组)、复阳活骨丸组(C组)、髓芯减压组(D组)、复阳活骨丸+髓芯减压组(E组)。除A组外,其余各组家兔建立激素性股骨头坏死模型。造模成功后,A、B两组不作治疗,C组采用复阳活骨丸灌胃治疗,D组行髓芯减压术治疗,E组采用复阳活骨丸灌胃加髓芯减压术治疗。治疗6周后测定各组家兔股骨头骨内压,并检测股骨头生物力学参数。结果:各组股骨头骨内压比较,差异有统计学意义(F=7.894,P=0.000);组间两两比较,B、C组均高于A组(LSD-t=10.284,P=0.000;LSD-t=8.356,P=0.000),D、E组与A组比较差异无统计学意义(LSD-t=0.574,P=0.683;LSD-t=0.654,P=0.725);C、D、E组均低于B组(LSD-t=-4.232,P=0.015;LSD-t=-5.241,P=0.000;LSD-t=-6.766,P=0.000);C组高于D、E组(LSD-t=3.876,P=0.027;LSD-t=4.031,P=0.013);D组与E组比较差异无统计学意义(LSD-t=0.562,P=0.939)。生物力学指标测定,B组骨强度、骨刚度、弹性模量、破裂强度等均呈现骨质疏松表现,C、D、E组上述指标均有所改善,且E组改善优于C、D两组。结论:复阳活骨丸配合髓芯减压术可有效治疗激素性股骨头缺血坏死。其可能机制为改善股骨头内微循环,扭转股骨头缺血状态,促进骨小梁修复,降低骨内压,提高骨强度,阻止股骨头变形,从而达到治疗股骨头缺血性坏死的目的。

Objective：To observe the effect of FUYANG HUOGU（复阳活骨）pill combined with core decompression on the intraosseous pressure within the femoral head and biomechanical parameters for the rabbit model with steroid induced avascular necrosis of femoral head（SANFH）.Methods：45 healthy rabbits were randomly divided into normal control group（group A）,model control group（group B）,FUYANG HUOGU（复阳活骨）pill group（group C）,core decompression group（group D）and FUYANG HUOGU（复阳活骨）pill combined with core decompression group（group E）.SANFH rabbits models were built for all the groups except for group A.After successful modeling,rabbits in group A and group B were administrated with no treatment,rabbits in group C were intragastric administrated with FUYANG HUOGU（复阳活骨）pills,rabbits in group D were administrated with core decompression,and rabbits in group E were administrated with FUYANG HUOGU（复阳活骨）pill combined with core decompression.6 weeks after treatment,intraosseous pressure within the femoral head and the biomechanical parameters of the femoral head of rabbits in the 5 groups were evaluated.Results：On the aspect of intraosseous pressure within the femoral head of the rabbits,there was statistical difference among the 5 groups（F=7.894,P=0.000）;intraosseous pressure within the femoral head of group B and group C was higher than that of group A respectively（LSD-t=10.284,P=0.000;LSD-t=8.356,P=0.000）;there was no statistical difference between group D and group A,between group E and group A（LSD-t=0.574,P=0.683;LSD-t=0.654,P=0.725）;intraosseous pressure within the femoral head of group C,group D and group E was lower than that of group B respectively（LSD-t=-4.232,P=0.015;LSD-t=-5.241,P=0.000;LSD-t=-6.766,P=0.000）;ntraosseous pressure within the femoral head of group C was higher than that of group D and group E respectively（LSD-t=3.876,P=0.027;LSD-t=4.031,P=0.013）;there was no statistical difference between group D and group E（LSD-t=0.562,P=0.939）.Bone strength,bone rigidity,elastic modulus and rupture strength of group B were all reflected as osteoporosis,while these biomechanical parameters were all improved in group C,group D and group E,and these biomechanical parameters of group E were improved more obviously than those of group C and group D.Conclusion：The method of FUYANG HUOGU（复阳活骨）pill combined with core decompression performs well on the treatment of SANFH through improving the microcirculation within the femoral head,reversing the state of avascular necrosis of the femoral head,promoting the repair of trabecular bone,reducing intraosseous pressure,improving bone strength and preventing from the femoral head deformation.