股骨颈骨折修复后股骨头坏死7个相关因素：199例回顾分析

BACKGROUND: The incidence of femoral head necrosis after internal fixation in femoral neck fracture is at high level, but the risk factors are still under discussion. OBJECTIVE:To retrospectively propose and analyze the relative risk factors of femoral head necrosis after internal fixation with femoral neck fracture in patients younger than 60 years old. METHODS:Data from 199 patients with femoral neck fractures, younger than 60 years, undergoing closed reduction and internal fixation were analyzed retrospectively. Seven factors including age, sex, body mass index, Garden classification, fracture seasons, reduction quality and weight-bearing time after internal fixation were statistically analyzed to evaluate their correlation with femoral head necrosis. RESULTS AND CONCLUSION: The incidence of femoral head necrosis was 13.1% among the 199 cases. Body mass index, Garden classification, fracture seasons, reduction quality were significantly associated with femoral head necrosis. The age, sex and weight-bearing time were in significantly associated with femoral head necrosis. In multivariate logistic regression analysis, Garden classification, reduction quality and fracture seasons (winter versus summer) had overt effects on development of femoral head necrosis. These results suggest that Garden classification and reduction quality make an important effect on the healing of femoral neck fracture. In addition, fracture in winter may be the risk factor of the femoral head necrosis after internal fixation in femoral neck fracture.| 中国组织工程研究杂志出版内容重点：组织构建;骨细胞;软骨细胞;细胞培养;成纤维细胞;血管内皮细胞;骨质疏松;组织工程     

股骨头坏死动物模型评价方法的优缺点及展望

背景:股骨头坏死发病机制仍需要进一步研究,因此需要建立一个能够高度模拟人类股骨头坏死的动物模型,而如何正确评价股骨头坏死动物模型,是建立股骨头坏死动物模型的前提条件。目的:归纳总结近几年国内外对股骨头坏死动物模型的评价方法,综述各评价方法的优缺点,并探索新的评价方法,为动物模型的建立提供参考。方法:以“股骨头坏死,动物模型,评价方法”为检索词检索CNKI中国知网、万方、维普数据库,以“osteonecrosis of femoral head,femoral head necrosis,animal model,evaluation methods”为检索词检索PubMed、Web of Science及Medline数据库,检索2010年1月至2020年9月发表关于股骨头坏死动物模型评价方法的文献。结果与结论:①根据纳入标准通过阅读文献进行初步筛选,共获得51篇文章进行综述,其中中文文献33篇,英文文献18篇;②近年来,随着影像技术的发展和新技术的引入,股骨头坏死动物模型评估方法的选择增多,而选择合理的评价方式能减少建立动物模型过程中的工作量,并为后续研究提供参考,因此需要继续完善和改进。     

股骨头坏死“三部失效”塌陷机制假说与保存自身髋关节的新理念

BACKGROUND: Unsatisfactory clinical efficacy of hip-preserving treatment after osteonecrosis of the femoral head is unavoidable. OBJECTIVE: To reveal the collapse mechanism of osteonecrosis of the femoral head, and then point out the direction for improvement. METHODS: We put up with three-part failure collapse mechanism hypothesis of osteonecrosis of the femoral head for the first time according to a series of studies by our research team in recent 5 years, paralleling with preliminary verification from three aspects of biomechanics, pathology and clinical application. RESULTS AND CONCLUSION:New concept of maintaining stability and promoting repair for hip preservation and new surgical procedures aiming at the reconstruction of femoral head anterior lateral columns are well presented, and good short-term effects have been achieved. These results show that the mid-long-term clinical curative effect and mechanism of action are worthy of further study. 中国组织工程研究杂志出版内容重点：组织构建;骨细胞;软骨细胞;细胞培养;成纤维细胞;血管内皮细胞;骨质疏松;组织工程     

成骨细胞、破骨细胞与酒精性股骨头坏死的关联性： 预防与靶向治疗的新思路

BACKGROUND: Alcohol-induced femoral head necrosis is a bone metabolism disease that involves a series of alcoholism-induced pathological changes, including degeneration, necrosis and deposition of adipocytes and osteoporosis, and trabecular collapse in the subchondral bone trabeculae of the femoral head. OBJECTIVE: To introduce the correlation of osteoblasts and osteoclasts with alcohol-induced femoral head necrosis. METHODS: The first author searched relative articles in PubMed and CNKI databases published before May 2016 using the keywords of “osteoblast, osteoclast, alcohol-induced ONFH, bone metabolism” in English and Chinese, respectively. 133 literatures were retrieved and 38 literatures were in accordance with the inclusion criteria. RESULTS AND CONCLUSION: During the process of bone metabolism, osteoblasts and osteoclasts exhibit interaction in term of cell number and viability. In-depth study on osteoblasts, osteoclasts and their interaction cannot only give insight into the pathogenesis and repair of alcohol-induced femoral head necrosis, but also provide new ideas and strategies for prevention and target treatment of bone metabolic diseases. 中国组织工程研究杂志出版内容重点：组织构建;骨细胞;软骨细胞;细胞培养;成纤维细胞;血管内皮细胞;骨质疏松;组织工程     

早期激素性股骨头坏死过程中细胞色素c的作用

BACKGROUND: Studies have shown that apoptosis is closely related to the pathogenesis of steroid-induced femoral head necrosis. The release of cytochrome c plays a very important role in the process of apoptosis. OBJECTIVE: To observe the effects of cytochrome c on early steroid-induced femoral head necrosis. METHODS: Twenty-four healthy adult male New Zealand rabbits at 5 months old were randomly divided into model group and control group (n=12 per group). Models of early steroid-induced femoral head necrosis were established by intragluteal injection of hormone combined with ear vein injection of horse serum. In the control group, rabbits were given ear vein injection of the same amount of physiological saline. At 2, 4 and 6 weeks after model establishment, histopathological changes of bilateral femoral head were observed by optical microscope, and the ratio of empty lacuna was calculated. Apoptosis of osteocytes was determined by TUNEL assay, and apoptotic index was calculated. Immunohistochemical method was used to determine cytochrome c and to calculate cytochrome c-positive expression rate. RESULTS AND CONCLUSION: (1) The ratio of empty lacuna and apoptotic index: The model of early steroid-induced femoral head necrosis was successfully established in the experiment. Compared with the control group, ratio of empty lacuna, apoptotic index and expression rate of cytochrome c in osteocytes were significantly higher in the model group (P < 0.05 or P < 0.01). (2) Correlation analysis: Ratio of empty lacuna was significantly positively associated with apoptotic index at various time points in the model group (r=0.856, P < 0.01). Expression rate of cytochrome c was significantly positively associated with apoptotic index at various time points in the model group (r=0.824, P < 0.01). (3) These findings confirm that cytochrome c-involved apoptosis of osteocytes may play an important role in steroid-induced femoral head necrosis. Expression rate of cytochrome c in osteocytes is remarkably positively associated with the occurrence of steroid-induced femoral head necrosis in rabbits. 中国组织工程研究杂志出版内容重点：组织构建;骨细胞;软骨细胞;细胞培养;成纤维细胞;血管内皮细胞;骨质疏松;组织工程     

早期股骨头缺血性坏死的影像学诊断方法选择

股骨头缺血性坏死（avascular necrosis of the femoral head,ANFH）又称无菌性坏死,是骨科常见病。对于该病的诊断目前主要依靠影像学诊断,常用的方法有X线平片、CT扫描及MRI等检查。为了探讨如何选择合适的检查方法才能既节约费用又提高检出率，本文作者收集了我院近3年检查诊断为ANFH的32例患者资料，分析总结如下。     

Therapeutic mechanism of traditional Chinese medicine in the treatment of hormone-induced necrosis of the femoral head北大核心

BACKGROUND: In recent years, there have been many studies on the prevention and treatment of femoral head necrosis with traditional Chinese medicine. A variety of single Chinese medicines, Chinese medicine monomers and Chinese medicine compounds can regulate bone metabolism, lipid metabolism, and oxidative stress by targeting signaling molecules. The prevention and treatment of femoral head necrosis by translation-related signaling pathways has become a research hotspot. OBJECTIVE: To expound the global research progress in hormone-induced femoral head necrosis treated with Chinese medicine, in order to provide some ideas for the treatment of hormone-induced femoral head necrosis. METHODS: CNKI, WanFang, VIP, SinoMed, PubMed, Embase, and Web of Science databases were searched with the search terms “glucocorticoids, avascular necrosis of the femoral head, ANFH, pathogenesis, signal path, Chinese medicine compound, oxidative stress” in Chinese and English. Literature was retrieved on Chinese medicine compounds and active ingredients for intervention of the signaling pathway related to hormone-induced femoral head necrosis. A total of 71 documents were included according to the inclusion and exclusion criteria. RESULTS AND CONCLUSION: Chinese medicine may treat hormone-induced femoral head necrosis through multiple signaling pathways. Total saponins of Panax notoginseng, total flavonoids of Rhizoma Drynariae, and resveratrol glucoside promote osteoblast proliferation and differentiation and inhibit osteoclast formation by regulating the level of β-catenin protein and the formation of β-catenin-TCF/LEF complex via the Wnt/β-catenin signaling pathway. Recipes for invigorating blood and reinforcing marrow, warming yang and tonifying kidney, and relieving bone bi-syndrome maintain osteoblast-osteoclast dynamic balance and bone homeostasis by regulating the OPG/RANK/RANKL pathway. Puerarin, salidroside, allicin, and icariin influence the proliferation and apoptosis of osseous cells and angiogenesis of microvascular endothelial cells in the femoral head via the PI3K/Akt signaling pathway. Ginsenosides can down-regulate the expressions of superoxide dismutase and catalase by interfering with the Keapl-Nrf2-ARE signaling pathway, thereby attenuating oxidative stress damage. Gastrodin, lutein, and astragaloside IV can promote the proliferation and differentiation of osteoblasts by intervening Nrf2/HO-1 signaling, thereby improving the level of oxidative substances. Naringin and polygonin balance the osteogenic/adipogenic differentiation of bone marrow mesenchymal stem cells via the Nrf2/ARE signaling pathway. Traditional Chinese medicine can regulate oxidative stress response of osteocytes, which is another important way to treat hormone-induced necrosis of the femoral head. © 2023, Publishing House of Chinese Journal of Tissue Engineering Research. All rights reserved.     

组织工程治疗股骨头坏死软骨下分离的适用技术

背景：股骨头坏死出现新月征是病情进程的“分水岭”，修复和稳定骨-软骨界面对阻止病情继续进展和预防股骨头塌陷尤为重要。利用组织工程学同步修复、整合骨-软骨界面具有潜在优势。目的：综述探讨解决股骨头坏死软骨下分离的潜在适宜技术。方法：检索1970年1月至2023年4月PubMed、Web of Science及中国知网、万方数据库中发表的相关文献，英文检索词：“Femoral head necrosis,Avascular necrosis of femoral head,Osteonecrosis of femoral head”等，中文检索词：“股骨头坏死，软骨下骨，软骨，软骨与软骨下骨整合”等，最终纳入114篇文献进行综述分析。结果与结论：(1)结构缺陷、缺血缺氧环境、炎症因素和应力集中可能造成股骨头坏死软骨下分离现象，软骨下骨分离会造成塌陷进展，并且可能与保髋手术失败相关，利用组织工程支架实现支架与骨-软骨界面的整合是治疗股骨头坏死软骨下分离的潜在方法之一。(2)目前的文献研究表明，多相、梯度支架和复合材料在促进骨、软骨细胞黏附与增殖，骨软骨基质的沉积方面均有提升，有助于支架与骨-...     

活血祛瘀法干预激素性股骨头坏死骨组织的修复

BACKGROUND: The pathogenesis of steroid-induced osteonecrosis of the femoral head remains unclear. Femoral head reconstruction after collapse is related to the bone remodeling due to disorder of the bone formation-absorption coupling. “Removing Blood Stasis” Method has been shown to have a positive effect on the disease in clinics. However, the mechanisms by which the “Removing Blood Stasis” Method confers bone repair after osteonecrosis remain poorly understood. OBJECTIVE: To explore the effect of “Removing Blood Stasis” Method on bone repair in rabbits with steroid-induced femoral head osteonecrosis. METHODS: Fifty New Zealand rabbits were randomly assigned into three groups: normal control (n=10), model (n=20) and Taohong Siwu Decoction (n=20) groups, respectively. The steroid-induced osteonecrosis of the femoral head animal models were established by intramuscular injection of endotoxin combined with methylprednisolone (MPS). Rabbits in Taohong Siwu Decoction group were intragastrically administered with 0.3 g/kg of Taohong Siwu Decoction suspension after the last injection of methylprednisolone. The control and model groups were administrated by equal volume of ultrapure water for 8 consecutive weeks. High-resolution MRI and pathological determinations were used to assess the successful models. Protein expression levels of ABCB1, RUNX2, OPN, RANK, RANKL, PPAR, osteoprotegerin (OPG), vascular endothelial growth factor (VEGF) in rabbit femoral heads were detected by western blot assay. RESULTS AND CONCLUSION: (1) Hematoxylin-eosin staining showed that trabecular bone fracture, karyopyknosis, empty lacunae, necrotic bone marrow cells were seen in the model group. Empty lacunae rate in the model group was significantly different from that in the normal control group (P < 0.05). Bone formation was active and kept better trabecular morphology in the Taohong Siwu Decoction group. It suggested that “Removing Blood Stasis” Method can improve repair of necrotic area. (2) In the model group, femoral head with a wide range of low-density areas in high-resolution MRI; Taohong Siwu Decoction group showed the relatively normal shape of the femoral head with small areas of low density. It suggested that “Removing Blood Stasis” Method can improve image changes in the necrotic area. (3) Protein expression levels of RUNX2, RANK, RANKL were significantly up-regulated but protein expression levels of ABCB1, OPG, VEGF were significantly down-regulated in the model group compared with the normal control group; whereas, they were all significantly up-regulated in the Taohong Siwu Decoction group compared with the model group, except for RANK and RANKL (P < 0.05). These results suggest that the “Removing Blood Stasis” Method can promote bone repair in steroid-induced femoral head osteonecrosis rabbits by regulating protein expressions of ABCB1, RUNX2, RANK, RANKL, OPG, and VEGF. 中国组织工程研究杂志出版内容重点：组织构建;骨细胞;软骨细胞;细胞培养;成纤维细胞;血管内皮细胞;骨质疏松;组织工程     

幼犬髋外周动脉对股骨头前外侧部血供影响的实验研究

目的：动态观察幼犬髋外周动脉对股骨头前外侧部血流量的影响。方法：应用Ｈ２清除法测量２２只杂种幼犬结扎髋外周动脉前后股骨头前外侧部血流量。结果：①股骨头前外侧部血流量平均为０．１３９７±０．０５１５ｍｌ·ｍｉｎ－１·ｇ－１;②５条主要动脉中,结扎１条或２条动脉后血流量变化不大,结扎３条、４条或５条后血流量显著降低。结论：定点、定量动态观察股骨头前外侧部血流量变化,可为临床治疗髋关节疾病提供理论参考     

腓骨头血供的应用解剖学

在30例成人、10例儿童、2例胎儿尸体下肢上,对腓骨头血供进行应用解剖学研究。胫前返动脉,旋腓骨支和膝下外侧动脉在腓骨头外形成动脉吻合网。腓骨滋养动脉上升支供养腓骨头内松质骨。研究结果认为:在成人作腓骨头移植时可以腓动脉为蒂:若在儿童作腓骨头移植时,除了吻合腓血管外,最好同时吻合膝下外侧动脉,以充分保证骨骺的血供。     

股骨头缺血性坏死介入治疗的应用解剖

目的：为股骨头缺血性坏死介入治疗提供解剖学基础。方法：在５０侧成人尸体上观察了股深动脉的类型，测量了各分支的长度和外径。结果：股深动脉主要从股动脉后方（６０％）和后外侧（２６％）发出，分为深全干型（６０％）、深外干型（２０％）、深内干型（１４％）和深孤独干型（６％）。各主要血管外径为：股深动脉５．７±１．６ｍｍ；旋股内侧动脉３．６±１．０ｍｍ，其升支２．０±０．９ｍｍ；旋股外侧动脉３．７±１．１ｍｍ，其升支２．５±０．８ｍｍ。结论：该项研究为提高股骨头缺血性坏死介入治疗的成功率提供了详尽的解剖学依据。     

基于动脉铸型标本的猪股骨头内滋养动脉分布规律的解剖学研究

目的 探讨猪股骨头内滋养动脉的分布规律及其意义。方法 选择20例带髋周血管的新鲜猪股骨头标本,制备成股骨头内滋养动脉铸型标本。肉眼及显微镜下观察股骨头骨内动脉的来源、数量、走行特点及分布情况,显微镜下测量股骨头内滋养动脉中最粗骺动脉主干起始点的外径。结果 在猪股骨头内,动脉依其分支走行分布可分为骺动脉区、骺动脉网区和骺上动脉区共3个区。骺动脉起源于支持带动脉,其总数量为5~13（8.7±2.2）支;骺动脉区分为上骺动脉、下骺动脉、前骺动脉3组,分别为（3.2±1.4）、（3.2±1.3）、（2.3±0.8）支,各组中最粗支起始点外径分别为（0.43±0.16）、（0.50±0.08）、（0.34±0.12）mm。3组骺动脉沿皮质下走行,跨越骺板后直接吻合交通形成骺动脉网区。3组骺动脉及骺动脉网向上发出的呈辐射状分支组成骺上动脉区,分布于股骨头软骨下,近中央致密,近周边稀疏。结论 在猪股骨头内,动脉根据其分支、走行及分布分为3个区,其中骺动脉区动脉的走行特点和口径大小为显微吻合提供了解剖学基础,骺动脉网的存在可能为股骨头整体供血理论提供了解剖学依据。     

Superselective embolisation for control of intractable epistaxis from maxillary artery injury

Traumatic intractable epistaxis following fractures of the facial and base of skull rarely may be life-threatening. Common sites of injury are the internal carotid and maxillary artery. When conventional methods of arresting haemorrhage fail, the choices are then an open arterial ligation or superselective embolisation. This paper presents a patient with life-threatening epistaxis from a Le Fort type II fracture. Angiography revealed a maxillary artery injury in which superselective embolisation was performed and the haemorrhage was successfully arrested. A literature review of this technique is discussed, including its advantages and the relationship of the internal maxillary artery to facial fractures.     

胰头的动脉分布及其临床意义

目的：为胰头和十二指肠的分部切除提供应用解剖学依据.方法：选取9例动脉灌注乳胶的胰头标本和3例胰头铸型标本对胰头的动脉分布进行解剖学观测.结果：胰头的动脉主要来源于前后动脉弓;其内部动脉可分为浅深两层和钩突部动脉.浅层动脉4条,以第1支最粗大;深层动脉主要由后动脉弓最上的3条分支营养,其中第3分支是最主要营养支;乳头动脉为后上动脉第3分支上发出的二级分支;钩突部的内部血供主要来自胰下动脉的下降支;在胰头内部浅深层及钩突部营养动脉间有着丰富的交通支,形成广泛的吻合.结论：胰十二指肠后上动脉在胰头与十二指肠血供中占据十分重要的位置,在术中保护好该动脉是手术成功与否的重要一环.     

猪股骨头支持带动脉入头分支的解剖学研究

目的　探索猪股骨头支持带动脉入头分支的数量、分布规律及外径大小并阐述其意义。 方法　解剖39例带有髋周血管的猪股骨头离体标本,分离支持带动脉,采用30%硫酸钡悬浮液显微灌注,观察支持带动脉入头分支的走形、数量、分布及外径。以时钟点位记录支持带动脉入头的分布规律,显微标尺测量支持带动脉入头分支的外径,并对各组支持带动脉入头最粗支的位置进行测量统计。 结果　猪股骨头共有（6.10±1.32）支动脉入头,主要分为后上、后下及前方3组,每组支持带动脉最粗支入头的时钟点位分别为（11：22~01：29）、（06：36~08：15）、（02：01~03：59）;直径分别为（0.37±0.11）、（0.52±0.11）、（0.35±0.09）mm。 结论　猪股骨头入头动脉的数量及位置相对恒定,入头动脉最粗支平均直径为（0.52±0.11）mm,来自后下组支持带动脉,为猪股骨头重要的血供来源。     

膝下外侧动脉远端蒂腓骨头瓣的应用解剖

目的为膝下外侧动脉远端蒂腓骨头瓣移植提供解剖学基础。方法在30侧经动脉内灌注红色乳胶成人下肢标本上重点观测膝下外侧动脉发出腓骨头支近端及远端的长度及外径,另在1侧新鲜标本上进行摹拟手术设计。结果膝下外侧动脉始于腘动脉,近端长(4.1±0.5)cm,外径(1.8±0.2)mm,远端长为(5.3±0.4)cm,外径为(1.0±0.1)mm。结论以膝下外侧动脉远端为蒂的腓骨头瓣,较近端为蒂损伤小、操作简便等优点。     

以胫前返血管为蒂腓骨上段移植的应用解剖

目的:为胫前返血管蒂腓骨瓣的设计提供解剖学基础。方法:30侧经动脉红色乳胶灌注的成人下肢标本,解剖观测胫前返动脉的起始、走行、分支及分布。结果:胫前返动脉始于胫前动脉,起始点距腓骨头尖下(4.5±0.7)cm(3.0～6.0cm),动脉主干长(0.5±0.2)cm(0.2～1.2cm),外径(2.0±0.4)mm(1.3～3.0mm),伴行静脉2条,外径为(2.1±0.5)mm(1.5～3.0mm)和(2.6±0.4)mm(1.7～3.2mm)。胫前返动脉腓骨头支1～2支,外径(1.7±1.3)mm(0.6～2.1mm),分布于腓骨头的前内侧面骨膜,并与其它来源的腓骨上段骨膜支构成动脉网。腓骨头支起始点至胫前返动脉起始点长度为(1.0±0.4)cm(0.3～1.8cm),其中长度≥1.0cm者占46.7%。腓骨头支起始点以远1.5cm处的胫前返动脉外径为(1.4±0.5)mm(0.8～2.1mm)。结论:胫前返血管蒂腓骨瓣的的设计具有可行性,为临床带血管腓骨上段移植提供一种新的可供选择的血管蒂。     

介入治疗股骨头缺血性坏死的应用解剖

目的 介入治疗股骨头缺血性坏死提供解剖学基础.方法 选用经乳胶灌注防腐成人下肢标本20侧及新鲜成人下肢标本2侧,观察股深动脉的起点方位及分支类型,测量股深动脉及各分支长度和外径以及各分支起始部的角度.结果 股深动脉主要从股动脉后方(36.4％)和后外侧方(36.4％)发出,旋股内侧动脉从股深动脉发出(72.7％),从股动脉发出(27.3％).各主要血管的长度为:股深动脉(19.22±10.19) mm,其根部距腹股沟韧带的距离为(38±11.78)mm;旋股内侧动脉(12.56±6.17) mm;旋股外侧动脉(13.93±11.04) mm.各主要血管的外径为:股深动脉(5.20±1.57)mm,旋股内侧动脉(3.64±0.99) mm,其升支(2.66±0.99)mm;旋股外侧动脉(4.48±1.19) mm,其升支(2.12±0.59) mm.旋股内侧动脉升支以与主干成接近90°的夹角;旋股外侧动脉与其升支间约呈115.82°夹角.结论 熟悉股动脉应用解剖,有利于完善这种治疗方法.