Regulation of Quan Du Zhong capsule on VEGF/bFGF and expression of Bcl‑2/Bax and Caspase‑3 protein in the repairing process of canine femoral head necrosis

Objective:To explore the repair and treatment effect of Quan Du Zhong capsule on necrosis of femoral head in dogs.Methods:Totally 12 beagles were randomly divided into normal group,model group,Quan Du Zhong capsule group and Xianlinggubao capsule group,with three in each group.In addition to the normal group,the other groups established the femoral head necrosis model by liquid nitrogen alternative freezing.The normal group and the model group did not have any intervention during the modeling period,and the Quan Du Zhong group began to receive the Quan Du Zhong by gavage on the day of modeling;Xianlinggubao capsule group was given Xianlinggubao capsule by gavage once a day for 12 consecutive weeks on the day of modeling.The levels of VEGF and bFGF in the blood vessels of each group at the 12th week were compared,and the ratios of BMD,BS/BV,BV/TV,Tb.Th,Tb.N were measured by Micro CT,and the expressions of Bcl-2,Bax,Caspase-3 proteins were detected by immune reaction.Results:1.Compared with the normal group,the level of serum VEGF and bFGF in the model group decreased after 12 weeks of modeling(P<0.05);Compared with the model group,the levels of serum VEGF and bFGF water in the Xianlinggubao capsule group and the Quan Du Zhong capsule group increased on average at the 12th week of modeling,with statistical difference(P<0.05).The level of the Quan Du Zhong capsule group was the highest,followed by the Xianlinggubao capsule group.2.Compared with the normal group,BMD,BS/BV,BV/TV,Tb.Th and Tb.N in the model group were lower,and Tb.SP were higher,the results were statistically significant(P<0.05).Compared with the model group,the BMD,BV/TV,Tb.Th and Tb.N of Xianlinggubao capsule group and the total eucommia capsule group increased,while the BS/BV and Tb.SP decreased(P<0.05).3.The Quan Du Zhong capsule group and Xianlinggubao capsule group could significantly increase the expression of bcl-2 protein in the femoral head of dogs,which was significantly different from the model group(P<0.05).The expression of bax protein in the femoral head of dogs in the Quan Du Zhong capsule group and the Xianlinggubao capsule group was significantly reduced compared with the model group(P<0.05).The expression of caspase-3 protein in the femoral head of dogs was significantly reduced in the Quan Du Zhong capsule group and Xianlinggubao capsule group,which was significantly different from the model group(P<0.05).Conclusion:Quan Du Zhong capsule can increase the expression of VEGF and bFGF in serum,increase the expression of bcl-2,inhibit the expression of bax,and reduce the expression of caspase-3,which plays a synergistic role in the treatment of avascular necrosis of the femoral head,and has potential targets.

Primary repair for concurrent bilateral intertrochanteric fracture and femoral head necrosis with prolonged shank biologic total hip replacement: A case report and surgical techniques

For the treatment of an intertrochanteric fracture combined with femoral head necrosis in middle-age patients,it has been controversial whether to perform fracture reduction and fixation first then total hip replacement,or direct total hip replacement.We present a rare case of 53-year-old male patient suffered from bilateral intertrochanteric fracture caused by a road traffic injury.The patient had a history of femoral head necrosis for eight years,and the Harris score was 30.We performed total hip replacement with prolonged biologic shank prostheses for primary repair.One year after the surgery,nearly full range of motion was achieved without instability(active flexion angle of 110°,extension angle of 20°,adduction angle of 40°,abduction angle of 40°,internal rotation angle of 25°,and external rotation angle of 40°).The Harris score was 85.For the middle-aged patient with unstable intertrochanteric fractures and osteonecrosis of the femoral head,we can choose primary repair for concurrent bilateral intertrochanteric fracture and femoral head necrosis with prolonged shank biologic total hip replacement.

Current Status of Research on Treatment of Osteonecrosis of Femoral Head with Traditional Chinese Medicine from the Perspective of Security-based Chinese Medicine

The publication of"Evidence-based Chinese Medicine"and the establishment of the Chinese Traditional Medicine Evidence-based Medicine Center mark that evidentiary-based Chinese medicine has stood in front of all Chinese medicine practices in the form of new disciplines,greatly promoting the modernization of Chinese medicine.It will always give Chinese medicine a powerful impetus to the world.Femoral head necrosis is the dominant disease in the treatment of TCM.Chinese medicine practices should seize the optionality to active learn the content of evidentiary-based Chinese medicine and apply it to clinical and scientific research practice.This article review the development status of femoral head necrosis treatment by TCM medicine from the perspective of event-based Chinese medicine.It provides a reference for the event-based development of Chinese medicine in the treatment of femoral head necrosis,and continues to develop advantages and make up for the shortcomings.

Efficacy and risk factors for anxiety and depression after miniincision hip arthroplasty for femoral head osteonecrosis

BACKGROUND Osteonecrosis of the femoral head(ONFH)is a prevalent orthopedic issue,leading to the collapse and fragmentation of the femoral head in its advanced stages,which can severely impair patients'quality of life.Total hip arthroplasty(THA)is a clinical intervention frequently used to alleviate ONFH symptoms and reinstate hip functionality.The conventional surgical technique is invasive and comes with an extended recuperation period,posing significant challenges for patients.With the progression of medical technology,the use of the mini-incision technique in minimally invasive THA(MITHA)has become more prevalent.However,comparative studies examining the effectiveness of these two surgical procedures in treating ONFH remain scarce.Furthermore,understanding patients'psychological well-being is crucial given its profound influence on postoperative recuperation.AIM To evaluate the impact of mini-incision MITHA on ONFH treatment and to identify the risk factors associated with postoperative anxiety and depression.METHODS A retrospective study was conducted on 125 patients treated for ONFH at Xi’an Hong Hui Hospital between February 2020 and January 2022,with the term"consecutive"indicating that these patients were treated in an unbroken sequence without any selection.Among these,60 patients(control group)underwent traditional THA,while 65 patients(observation group)were treated with miniincision MITHA.Variations in the visual analog scale(VAS)score and the Harris hip score were monitored.Additionally,shifts in pre-and posttreatment Hamilton anxiety(HAMA)and Hamilton depression(HAMD)scale scores were recorded.Patients with both postoperative HAMA and HAMD scores of≥8 were identified as those experiencing negative emotions.Logistic regression was utilized to analyze the determinants influencing these negative emotional outcomes.Comparative analyses of surgical and postoperative metrics between the two groups were also conducted.RESULTS Posttreatment results indicated a significantly higher VAS score in the control group than in the observation group,while the Harris score was considerably lower(P<0.0001).The observation group benefited from a notably shorter operation duration,reduced blood loss,diminished incision size,and a decreased postoperative drainage time(P<0.0001),accompanied by a reduced hospital stay and lower treatment costs(P<0.0001).The control group had elevated posttreatment HAMA and HAMD scores in comparison to the observation group(P<0.0001).Multivariate logistic regression revealed that being female[odds ratio(OR):4.394,95%CI:1.689-11.433,P=0.002],having a higher postoperative VAS score(OR:5.533,95%CI:2.210-13.848,P<0.0001),and having higher treatment costs(OR:7.306,95%CI:2.801-19.057,P<0.0001)were significant independent determinants influencing postoperative mood disturbances.CONCLUSION Compared to conventional THA,mini-incision MITHA offers advantages such as reduced operation time,minimal bleeding,and a shorter incision in ONFH patients.Moreover,factors such as sex,postoperative pain(reflected in the VAS score),and treatment costs significantly impact postoperative anxiety and depression.

Effect of Yang-Warming and Kidney-Tonifying Prescription on Expression of Osteogenic and Angiogenic Factors and H-Type Vascular Markers in Steroid-Induced Avascular Necrosis of Femoral Head in Rabbits

Objective: To investigate the effect of Yang-warming and Kidney-tonifying Prescription (YKP) on the treatment of steroid-induced avascular necrosis of the femoral head (SANFH) in rabbits. And to further explore whether its therapeutic mechanism is related to the expression of HIF-1α and VEGF (angiogenic factors), BMP2 and Osterix (osteogenic factor), CD31 (type H vascular marker) and MMP13 (bone destruction-related factor). Methods: Twenty-seven healthy male New Zealand white rabbits were divided into a normal group, model group, traditional Chinese medcine (TCM) group (clinical equivalent dose group of YKP), miR-130a inhibitor group and TCM + inhibitor group. The SANFH model was established by combining horse serum with methylprednisolone. After the model is successfully established, TCM group was given 6.44 g/kg·d YKP by gavage, and the miR-130a gene inhibitor group was intraperitoneally injected with 25 mg/kg miR-130a inhibitor, locked nucleic acid (LNA)-anti-miR-130a. TCM + inhibitor group was treated with YKP intragastrically and miR-130a inhibitor intraperitoneally. The rabbits in the normal group and the model group were intragastrically administered with normal saline 10 ml/d. Once a day for 4 weeks. The avascular necrosis was detected by HE staining. The contents of HIF-1α, VEGF, BMP2 and Osterix in rabbit tissues were detected by qRT-PCR kit, and the expression of CD31 and MMP13 was detected by immunofluorescence staining. Results: In the normal group, the surface of the cartilage layer of the femoral head was smooth, the bone trabeculae were intact and densely arranged, the cells of each layer were neatly arranged, the morphology of the bone cells, the chondrocytes and the adipocytes were normal. In the model group, cartilage surfaces of the femoral head showed exfoliative cracks. The bone trabecular structure was loose and incomplete, chondrocytes, osteoblasts and bone marrow cells were significantly reduced, and the number of empty bone traps was significantly increased. In the TCM-treated group, more chondrocytes, thicker cartilage layer, and more regular bone trabeculae were detected as compared to model rabbits. In contrast, the cartilage layer was thinner, the destruction and fracture of bone trabeculae was more serious, chondrocytes and osteocytes were decreased as compared to model group. The expression of HIF-1α, VEGF, BMP2, and Osterix in the model group decreased significantly as compared to the normal group (P Conclusion: YKP can regulate the expression of angiogenic-related factors (VEGF and HIF-α), osteogenic-related factors (BMP2 and Osterix), and H-type vascular marker CD31, resulting in increased expressions of VEGF, HIF-α, BMP2, and Osterix, which promote intra-femoral head revascularization. Meanwhile, YKP decreased the expression of bone-destruction-related factor MMP13, thus enhancing the ability of bone tissue to repair itself. Regulation of these molecules’ expression may be one of the mechanisms of YKP in the treatment of hormonal femoral head necrosis.

Histopathological and imageological studies on clinical outcomes of mineralized collagen reconstruction rod for femoral head necrosis with one case report

In this article,the biodegradation process and bone formation of a mineralized collagen reconstruction rod embedding in necrosis of human femoral head were investigated by imageological and histological methods.Computed radiography(CR)computerized tomography(CT),common pathological section and hard tissue section analysis were used to evaluated the dynamics of imageological and histopathological changes of femoral head,interface between the host bone and implant and the bone reconstruction process.The results showed that the density of rods increased closed to that of host bones after 1 year implanting,and the interface between them turns to blurring.Hard tissue grinding sections analysis showed osteocytes appearing in sparse bone trabecular and bone pit region,as well as a few vessels in the degraded dye powder matrix were noticed,indicating the new bone forming between the implants and host bones.Regular decalcified sections analysis showed scattered osteoclasts,multinucleated giant cells and fibrosis components existing in the degraded rod and the host bone trabecular.Degraded debris was endocytosed by giant cells,and vascular network formed around the boundaries of the implanted rod.The good osteointegration has been expressed by the interface between the implanted rod and the host bone becoming blurred.Histological results indicated that the implanted rod degradation process and new bones regeneration simultaneously occurred around the boundaries of embedding rod.New bone and host bone were hinged and co-existed.

Study on the Effect of Youguiyin(右归饮) on Regulating Gene Expression Profile of the Rats with Femoral Head Necrosis Induced by Steroid

Objective： To observe the regulation of Youguiyin （YGY, 右归钦） on the gene expression profile of the rat with steroid-induced femoral head necrosis （sFHN）, for the sake of investigating its molecular mechanism of sFHN prevention and treatment. Methods： All the 30 rats were randomly divided into three groups, the normal control group （A）, the model control group （B）, and the YGY treated group （C）, 10 in each group. After rats in Groups B and C were being made into FHN models with steroid injection, they received a daily intragastdc administration of saline and YGY respectively in equal volume for a total of 6 weeks, while to the unmodeled normal rats in Group A, saline was administered instead. The rats were sacrificed at the terminal of administration; their mRNA from femoral head tissue was extracted and prepared to cDNA probe through inverse transcription for detecting gene expression profile by microarray, outcomes of which was passing fluorescence quantitative PCR verification, and the differential expressed genes were analyzed adopting gene ontology （GO） method. Results： Compared with Group A, the numbers of differential genes found in Groups B and C were 190 and 92, respectively, but the changing trend in the two groups was opposite, mainly manifested as down-regulating in Group B/Group A （GB/GA） and up-regulating in Group C/Group B （GC/GB）. The analysis showed that these differential genes were mainly assigned to cell apoptosis, signal transduction, metabolism, cell proliferation and differentiation, cell cycle, blood coagulation, antioxidant activity, etc. Conclusions： sFHN was regulated by various genes; the regulation of YGY on expressions of these genes and the intra]extra-cellular signaling processes was possibly the molecular mechanism of YGY for preventing/treating sFHN. This study gave an explanation to the effectiveness of Chinese medicine in preventing/treating FHN from aspects of gene expression and enriched the Chinese medicine theory of ＂Kidney （Shen） governing bones＂.

Multivariate Analysis of Femoral Adductor Muscle Contracture after Total Hip Arthroplasty in Patients with Avascular Necrosis of Femoral Head

Objective:This study is to investigate the nisk factors of femoral head contracture after total hip arthroplasty(THA)in patients with avascular necrosis of femoral head.Methods:Retrospective analysis was perfomed in 361 cases of femoral head necrosis patients taking THA fom September 2016 to December 2017.A total of 179 patents with no significant preoperative adductor muscle contraction were finally enrolled in this study.These 179 patients were further divided into two groups:contracture group(64 cases)and noncompaction group(115 cases).The chi-square test was used to compare the differences between the two groups.Risk factors were identifed by logistic regession analysis.Results:of the patients included,64 patients (35.75%)developed into end adductor muscle contracture.There were signuificant differences in limb shortening.surgical history,whether taction,surgical approach,surgical methods,and fumctional training between the two goups(P<0.05).Logistic regression analysis showed that shortness of extremity,sugical approach,effective taction,surgical history,and etiology were the factors affecting femoral head contracture after THA in patients with avascular necrosis of femoral head.Conclusions:Preoperative traction therapy,surgical methods,and postoperative functional training are the factors that affect the adductor muscle contraction after THA.

Preoperative traction is a risk factor for osteonecrosis of femoral head in patients with stable femoral neck fractures

To explore the relationship between preoperative traction and osteonecrosis of femoral head(ONFH)in patients with stable femoral neck fractures.Data from medical charts for 115 patients admitted to our institution with Garden II femoral neck fracture operated from January 2012 to December 2013 were extracted.Seven-year retrospective comparative study in the first affiliated hospital of Soochow University.Patients were divided into two groups by preoperative treatment:a preoperative traction group(group I)and a T-shaped shoe fixation group(group II).There were 14 patients lost to follow-up.101 patients with Garden II femoral neck fracture followed until July 2016 were available for complete analysis.Intervention:patients received skeletal traction or T-shaped shoe fixation preoperatively.All patients accepted internal fixation with multiple annulated screws.Main outcome measurements:the incidence of osteonecrosis of femoral head was analyzed based on preoperative traction,gender and implant removal.The average follow-up of these patients was 35 months(range,24-48 months).There was no implant failure or nonunion in our study.Nine patients(8.91%)had avascular necrosis.8(15.38%)patients in group I had osteonecrosis of femoral head,whereas only onepatient(2.04%)in group II had osteonecrosis of femoral head.Patients with preoperative traction had significantly higher incidence of osteonecrosis of femoral head compared with T shaped shoe fixation(P=0.032).No significant difference was found between the incidence of osteonecrosis of femoral head based on gender,age,injury-to-surgery interval time,implant removal or weight-bearing time.In patients with femoral neck fracture,preoperative traction may increase the incidence of osteonecrosis.Preoperative traction may not benefit patients with Garden II femoral neck fracture.The weight of traction may be a risk factor to osteonecrosis of femoral head.

A Rabbit Model of Hormone-induced Early Avascular Necrosis of the Femoral Head

Objective To establish an experimental model of early stage avascular necrosis of the femoral head （ANFH） caused by corticosteroid in adult rabbits and to observe the pathological changes with various imaging techniques. Methods ANFH was induced by a combination of hypersensitivity vasculitis caused by injection of horse serum and subsequent administration of a high dose of corticosteroid. The pathological changes were detected with digital radiography （DR）, computed tomography （CT）, magnetic resonance imaging （MRI）, ink artery infusion angiography, hematoxylin-eosin staining, and immunohistochemistry. Results The imageological and pathological changes corresponded to the clinical characteristics of early stage ANFH. DR showed bilaterally increased bone density, an unclear epiphyseal line, and blurred texture of cancellous bone. CT showed spot-like low-density imaging of cancellous bone, thinner cortical bone, osteoporosis, and an unclear epiphyseal line. MR! showed bone marrow edema and spot-like high signals in T2-weighted imaging in cancellous bone. Ink artery infusion angiography showed fewer obstructed blood vessels in the femoral head. HE staining of pathological sections showed fewer trabeculae and thin bone, an increased proportion of empty osteocyte lacunae, decreased hematopoiesis, thrombosis, and fat cell hypertrophy. Immunohistochemistry showed attenuated expression of vascular endothelial growth factor in osteoblasts and chondrocytes, and on the inner membrane of blood vessels. Conclusion Experimental rabbit model of early stage ANFH caused by corticosteroid can be successfully established and provide the foundation for developing effective methods to treat early stage ANFH.

Experimental Study of Vascular Endothelial Growth Factor Gene Therapy for Avascular Necrosis of the Femoral Head

To explore a new method for the therapy of the avascular necrosis of the femoral head, the recombinant plasmid pCD-hVEGF 165 was mixed with collagen and was implanted in the necrotic femoral head The expression of vascular endothelial growth factor (VEGF) was detected by RNA dot hybridization and immunohistochemical method The repair of the femoral head was observed by histological method The results showed that the expression of VEGF was detectable in the femoral head treated with VEGF gene Angiogenesis in these femoral heads was more abundant than the control Bone repairing was augmented in the femoral head treated with VEGF gene The results suggest that angiogenesis in bone tissue could be augmented by gene transfection of VEGF and bone repairing would be accelerated accordingly

Microstructures and properties of cancellous bone of avascular necrosis of femoral heads

The aim of this study is to investigate microscopic structure and characterize cancellous bone of avascular necrosis of the femoral head （ANFH）. The rabbit model of the ANFH is established. The histopathologic features are studied successfully. The differences between the steroidinjection group （S.G.） and the controlled group （C.G.） are examined, including the weight of rabbits, the hematological examination and the three-dimensional stnactures. It is found that the plasma levels of cholesterol （CHO）, high-density lipoprotein （HDL） and low-density lipoprotein （LDL） in S.G. are lower than those in C.G. when the triglyceride （TG） increased in the S.G.; but the bone mineral content （BMC） and the structural model index （SMI） of the organ and tissue decreased significantly in S.G. Three-dimensional structures of the femoral head are obtained using micro-computed tomography （CT） scanning and the mechanical model is established to analyze the influences of these structural changes on the mechanical properties of the cancellous bone.

Effects of sodium ferulate on preventing steroid-induced femoral head osteonecrosis in rabbits

The aim of this study is to investigate the effects and possible mechanisms of sodium ferulate (SF) on anti-apoptosis in steroid-induced femoral head osteonecrosis in rabbits. Japanese white rabbits were randomly divided into three groups (control group, treatment group, and model group), each with 24 rabbits. The model and treatment groups were first injected with an intravenous dose of horse serum, 10 ml/kg, three weeks later with an intravenous dose of 7.5 ml/kg, and two weeks later with an intramuscular dose of methylprednisolone, 45 mg/kg, three times in order to establish rabbit models of osteonecrosis. Concurrently, the treatment group was injected with intravenous doses of SF 20 mg/kg for two weeks, once per day. Three time points, Weeks 2, 4, and 8, were selected after modeling was completed. Osteonecrosis was verified by histopathology with haematoxylin-eosin (HE) staining. The apoptosis rate of osteonecrosis was observed by terminal deoxynucleotidyl transferase dUTP nick end labeling (TUNEL) assay. The apoptosis expressions of caspase-3 and Bcl-2 were analyzed by immunohistochemistry and Western blot. The rabbit models of osteonecrosis were successfully established and observed by HE staining. SF was effective in intervening in apoptosis and decreasing the apoptosis rate in femoral head necrosis by the immunohistochemistry and TUNEL assay (P<0.01). Western blot analysis indicated that there were statistical significances in the protein levels of caspase-3 and Bcl-2 (P<0.01). SF has a protective effect by reducing the incidence of early steroid-induced femoral head necrosis in rabbits, effectively intervening in apoptosis through decreasing caspase-3 expression and up-regulating Bcl-2 expression.

Deproteinized bone with VEGF gene transfer to facilitate the repair of early avascular necrosis of femoral head of rabbit

Objective: To explore a new method for early avascular necrosis of femoral head (AVNFH) therapy.Methods: Sixty-nine AVNFH New Zealand adult rabbits were randomly divided into three groups with equal number. In Group A, deproteinized bone (DPB) that absorbed with recombinant plasmid pcDNA3.1-hVEGF165 was implanted into the drilled tunnel of necrotic femoral head. In Group B, only DPB was implanted. In Group C, only tunnel was drilled without DPB or plasmid implanted. Femoral head specimens were obtained at postoperative 1, 2, 4, 8, 16 weeks. The expression of VEGF165 and collagen I was detected by immunohistochemistry. Bone formation was detected generally by X-ray. Angiogenesis and the repair of the femoral head were observed histologically.Results: The expression of VEGF 165 could be detected 2 weeks after implantation in Group A, but it was not observed in other groups. The result of collagen I expression had a significantly difference 2, 4 and 8 weeks after operation in Group A from those in other groups (P＜0.01).X-ray results indicated that there was more bone formation in Group A than in other groups. The regenerated capillary vessels staining result of necrotic femoral head in Group A was significantly different from those in other groups at postoperative 2 and 4 weeks (P＜0.01).Conclusions: Transfection ofhVEGF165 gene enhances local angiogenesis and DPB-VEGF compound improves the repair of necrotic femoral head. Deproteinized bone grafting with VEGF gene transfer provides a potential method for the treatment of osteonecrosis.

Reconstructing avascular necrotic femoral head through a bioactiveβ-TCP system:From design to application

A variety of techniques have been used for treating avascular necrosis of the femoral head(ANFH),but have frequently failed.In this study,we proposed aβ-TCP system for the treatment of ANFH by boosting revascularization and bone regeneration.The angio-conductive properties and concurrent osteogenesis of the highly interconnected porousβ-TCP scaffold were revealed and quantified through an in vivo model that simulated the ischemic environment of ANFH.Mechanical test and finite element analysis showed that the mechanical loss caused by tissue necrosis and surgery was immediately partially compensated after implantation,and the strength of the operated femoral head was adaptively increased and eventually returned to normal bone,along with continuous material degradation and bone regeneration.For translational application,we further conducted a multi-center open-label clinical trial to assess the efficacy of theβ-TCP system in treating ANFH.Two hundred fourteen patients with 246 hips were enrolled for evaluation,and 82.1%of the operated hips survived at a 42.79-month median follow-up.The imaging results,hip function,and pain scores were dramatically improved compared to preoperative levels.ARCO stage II disease outperformed stage III in terms of clinical effectiveness.Thus,bio-adaptive reconstruction using theβ-TCP system is a promising hip-preserving strategy for the treatment of ANFH.

Long-term Outcome of Multiple Small-diameter Drilling Decompression Combined with Hip Arthroscopy versus Drilling Alone for Early Avascular Necrosis of the Femoral Head

Background： Avascular necrosis of femoral head （AVNFH） typically presents in the young adults and progresses quickly without proper treatments. However, the optimum treatments for early stage of AVNFH are still controversial. This study was conducted to evaluate the therapeutic effects of multiple small-diameter drilling decompression combined with hip arthroscopy for early AVNFH compared to drilling alone. Methods： This is a nonrandomized retrospective case series study. Between April 2006 and November 2010, 60 patients （98 hips） with early stage AVNFH participated in this study. The patients underwent multiple small-diameter drilling decompression combined with hip arthroscopy in 26 cases/43 hips （Group A） or drilling decompression alone in 34 cases/55 hips （Group B）. Patients were followed up at 6, 12, and 24 weeks, and every 6 months thereafter. Radiographs were taken at every follow-up, Harris scores were recorded at the last follow-up, the paired t-test was used to compare the postoperative Harris scores. Surgery effective rate of the two groups was compared using the Chi-square test. Results： All patients were followed up for an average of 57.6 months （range： 17-108 months）. Pain relief and improvement of hip function were assessed in all patients at 6 months after the surgery. At the last follow-up, Group A had better outcome with mean Harris＇ scores improved from 68.23 ± 11.37 to 82.07 ± 2.92 （t = -7.21, P = 0.001） than Group B with mean Harris＇ scores improved from 69.46 ± 9.71 to 75.79± 4.13 （t = -9.47, P = 0.037） （significantly different： t = -2.54, P = 0.017）. The total surgery effective rate was also significantly different between Groups A and B （86.0% vs. 74.5%; Z2 = 3.69, P = 0.02）. Conclusion： For early stage of AVNFH, multiple small-diameter drilling decompression combined with hip arthroscopy is more effective than drilling decompression alone.

Association of sterol regulatory element binding protein 2 and insulin-like growth factor binding protein 3 genetic polymorphisms with avascular necrosis of the femoral head in the Chinese population

Background Sterol regulatory element binding protein （SREBP）-2 plays a key role in lipid homeostasis by stimulating gene expression of cholesterol biosynthetic pathways. The insulin-like growth factor binding protein （IGFBP） family regulates growth and metabolism, especially bone cell metabolism, and correlates with osteonecrosis. However, association of their gene polymorphisms with risk of avascular necrosis of the femoral head （ANFH） has rarely been reported. We determined whether SREBP-2 and IGFBP-3 gene polymorphisms were associated with increased ANFH risk in the Chinese population. Methods Two single nucleotide polymorphisms of SREBP2 gene, rs2267439 and rs2267443, and one of IGFBP-3 gene, rs2453839, were selected and genotyped in 49 ANFH patients and 42 control individuals by direct sequencing assay. Results The frequencies of rs2267439 TT and rs2267443 GA of SREBP2 and rs2453839 TT and CT of IGFBP-3 in the ANFH group showed increased and decreased tendencies （against normal control group）, respectively. Interaction analysis of genes revealed that the frequency of carrying rs2267439 TT and rs2267443 GA genotypes of SREBF-2 in ANFH patients was significantly higher than in the control group （P 〈0.05）. Association analysis between polymorphisms and clinical phenotype demonstrated that the disease course in ANFH patients with the rs2453839 TT genotype of IGFBP-3 was significantly shorter than that of CT＋CC carriers （P 〈0.01）. CT＋CC genotype frequency in patients with stage Ill/IV bilateral hip lesions was significantly higher than in those with stage Ill/IV unilateral lesions and stage II/111 bilateral lesions （P 〈0.05-0.02）. Conclusions Our results suggested that interaction of SREBP-2 gene polymorphisms and the relationship between the polymorphisms and clinical phenotype of IGFBP-3 were closely related to increased ANFH risk in the Chinese population. The most significant finding was that the CT＋CC genotype carriers of IGFBP-3 rs2453839 were highly associated with the development of ANFH.

Systemic Lupus Erythematosus Complicated with Femoral Head Ischemic Necrosis Treated by Chinese Medicine Therapy for Activating Blood and Dredging Collaterals Method

Objective：To observe the effect and mechanism of Chinese medicine therapy for activating blood and dredging collaterals（ABDC） on treating systemic lupus erythematosus complicated with avascular necrosis of the femoral head（SLE-ANFH）.Methods：Thirty-four patients（51 joints） with SLE-ANFH were assigned by a random number table to two groups：22 patients（32 joints） in the treatment group and 12 patients （19 joints） in the control group.All received Western medical conventional treatment for anti-inflammation and immunosuppression,but an additional Chinese medicine decoction prescribed based on ABDC principle was administered to patients in the treatment group.The observation on the patients＇ condition and therapeutic effect lasted for 3 years.Results：The patients＇ conditions in the two groups,as assessed by Association for Research Circulation Osseous（ARCO） staging,were similar before treatment.After treatment,comparison between groups showed significant difference（P0.05）,and the raised Harris functional scores in the treatment group were higher than that in the control group（P0.01）.The post-treatment symptom improving rate in the treated group was 72.73%,which was higher than that in the control group（50.00%,P0.05）.Moreover,the former was superior in improving hematologic and hemorrheologic parameters in terms of prolonging activated partial thromboplastin time,lowering whole blood middle/low shear viscosity,and plasma viscosity（P0.05 or P0.01）. Two patients in the control group but none in the treatment group received hip joint replacement operation during the observation period.Conclusions：Chinese medicine ABDC therapy could effectively alleviate clinical symptoms and improve joint function of patients with SLE-ANFH.The mechanism may be related to its effects on improving high coagulation manner and trend for getting embolism.

Mid-term results of sub-trochanteric valgus osteotomy for symptomatic late stages Legg-Calvé-Perthes disease

BACKGROUND The treatment of late stages of Legg-Calvé-Perthes disease(LCPD)is controversial.Although the concept of femoral head containment is a well-established technique of treatment,its use remains debatable in the late stages of the disease,as it does not improve symptoms in terms of limb length discrepancy and gait.AIM To assess the results of subtrochanteric valgus osteotomy in symptomatic patients with late-stage Perthes disease.METHODS From 2000 to 2007,36 symptomatic patients with late stage of Perthes disease were surgically treated with subtrochanteric valgus osteotomy and followed-up for 8 to 11 years using the IOWA score and range of motion(ROM)variables.The Mose classification was also assessed at the last follow-up to reflect possible remodeling.The patients were 8 years old or older at the time of surgery,in the post-fragmentation stage,and complaining of pain,limited ROM,Trendelenburg gait,and/or abductor weakness.RESULTS The preoperative IOWA score(average:53.3)markedly improved at the 1-year post follow-up period(average:85.41)and then slightly improved at the last follow-up(average:89.4)(P value<0.05).ROM improved,with internal rotation increased on average by 22°(from 10°preoperatively to 32°postoperatively)and abduction increased on average by 15.9°(from 25°preoperatively to 41°postoperatively).The mean Mose deviation of femoral heads was 4.1 mm at the end of the follow-up period.The tests used were the paired t-test and Pearson correlation test,where the level of significance was a P value less than 0.05.CONCLUSION Subtrochanteric valgus osteotomy can be a good option for symptomatic relief in patients with late-stage of LCPD.

Biomechanical supporting effect of tantalum rods for the femoral head with various sized lesions： a finite-element analysis

Background Features of necrotic lesions and various interventions could affect the biomechanics of the femoral head. A three-dimensional finite-element analysis was designed to demonstrate necrotic femoral head stress changes with various sizes of necrotic lesions, and evaluate the effect of tantalum rods on preventing femoral head cracking. Methods Femoral computed tomography scans were used to build a normal three-dimensional finite-element femoral head model in a computer. Based on the normal model, necrotic models of different lesion diameters （15 mm, 20 mm and 30 mm） were created, as were the repaired models with tantalum rods for each diameter. After a series of meshing and force loading, the von Mises stress distributions, simulating single-legged stance, and stresses on specific points under loaded conditions were determined for each model. Results Deep exploration into the burdened area of the femoral head indicated that higher stresses to the femoral head were observed with a larger necrotic lesion; the largest stress concentration, 91.3 MPa, was found on the femoral head with a lesion diameter of 30 mm. By contrast, topical stress on the surface of the necrotic regions was lowered following implantation of a tantalum rod, and the changes in stress were significant in models with lesions of 15 mm and 30 mm in diameter, with the best biomechanical benefit from the tantalum rod found with a lesion diameter of 15 mm. Conclusions Femoral heads with larger necrotic lesions usually have a higher stress concentration and a higher risk of collapse. Various sized lesions on the femoral head can benefit from the mechanical support offered by the implantation of a tantalum rod; however, femoral heads with smaller sized lesions may benefit more. A thorough evaluation of the lesion size should be conducted prior to the use of tantalum rod implants in the treatment of femoral head necrosis.