埋线针刀结合骨蚀胶囊对早期激素性股骨头坏死患者血清OPG/RANKL表达的影响
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摘要
目的:观察埋线针刀结合骨蚀胶囊对激素性股骨头坏死(SANFH)的临床疗效及对病人OPG/RANKL表达的影响。方法:选择SANFH患者50例(56髋),随机分为埋线针刀结合骨蚀胶囊组(25例,27髋)和仙灵骨葆胶囊组(25例,29髋)。比较两组施行试验方案之前与足疗程治疗后Harris评分中疼痛评分、功能积分、骨节活动度积分、总评分以及患者血清中的外周血骨保护素(OPG)、NF-κB受体活化因子配体(RANKL)含量水平的变化。结果:两组患者治疗后Harris评分中骨节活动度、疼痛、骨节功能部分的评分及总分均明显高于治疗前(P<0.01),且埋线针刀结合骨蚀胶囊组Harris评分明显高于仙灵骨葆胶囊组(P<0.01);干预后两组患者血清OPG明显上升、RANKL水平均下降,具有显著差异(P<0.01),且埋线针刀结合骨蚀胶囊组血清OPG水平明显高于仙灵骨葆胶囊组,差异具有统计学意义(P<0.01);埋线针刀结合骨蚀胶囊组血清RANKL水平明显低于仙灵骨葆胶囊组(P<0.01)。结论:埋线针刀结合骨蚀胶囊治疗SANFH具有一定的临床疗效,发挥作用可能与其调节血清中OPG、RANKL的含量、防止股骨头骨质疏松的发生有关。
Objective: To observe the clinical effect of Gushi Capsule combined with needle knife-catgut embedding on steroid induced avascular necrosis of femoral head( SANFH) and its effect on the expression of OPG/RANKL in serum. Methods: 50 SANFH patients( 56 hips) were randomly divided into the observation group( 25 cases,27 hips) and the control group( 25 cases,29 hips). The observation group was treated with Gushi Capsule combined with needle knife-catgut embedding; whereas the control group was treated with Xianling Gubao Capsule. Scores of hip joint activity and hip joint function,as well as pain score were evaluated by the Harris scoring method before and after treatment; serum levels of osteoprotective hormone( OPG) and receptor activator of NF-k B ligand( RANKL) were detected and compared at the same time in the two groups.Results: After treatment,the Harris scores were significantly higher than those before treatment in the two groups( P < 0. 01); they were more higher in the observation group than those in the control group( P < 0. 01).OPG level was obviously increased and RANKL level was greatly decreased after intervention in the two groups( P < 0. 01); the changes in the observation group was more significant than those in the control group( P < 0. 01). Conclusion: The therapy of Gushi Capsule combined with needle knife-catgut embedding has good effect on SANFH,and its mechanism may be related to regulating the contents of OPGN and RANKL in serum,thus to prevent the osteoporosis of the femoral head.
Objective: To observe the clinical effect of Gushi Capsule combined with needle knife-catgut embedding on steroid induced avascular necrosis of femoral head( SANFH) and its effect on the expression of OPG/RANKL in serum. Methods: 50 SANFH patients( 56 hips) were randomly divided into the observation group( 25 cases,27 hips) and the control group( 25 cases,29 hips). The observation group was treated with Gushi Capsule combined with needle knife-catgut embedding; whereas the control group was treated with Xianling Gubao Capsule. Scores of hip joint activity and hip joint function,as well as pain score were evaluated by the Harris scoring method before and after treatment; serum levels of osteoprotective hormone( OPG) and receptor activator of NF-k B ligand( RANKL) were detected and compared at the same time in the two groups.Results: After treatment,the Harris scores were significantly higher than those before treatment in the two groups( P < 0. 01); they were more higher in the observation group than those in the control group( P < 0. 01).OPG level was obviously increased and RANKL level was greatly decreased after intervention in the two groups( P < 0. 01); the changes in the observation group was more significant than those in the control group( P < 0. 01). Conclusion: The therapy of Gushi Capsule combined with needle knife-catgut embedding has good effect on SANFH,and its mechanism may be related to regulating the contents of OPGN and RANKL in serum,thus to prevent the osteoporosis of the femoral head.
引文
[1]中华医学会骨科分会显微修复学组及中国修复重建外科专业委员会骨缺损及骨坏死学组.成人股骨头坏死诊疗标准专家共识(2012年版)[J].中国骨与关节外科,2012,5(2):185.
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[3]Harris WH.Traumatic arthritis of the hip after dislocation and acetabular fractures:treatment by mold arthroplasty.An end-result study using a new method of result evaluation[J].J Bone Joint Surg Am,1969,51(4):737-755.
[4]Ganzer D,Forke L,Irlenbusch U.Two-year follow-up of revision total hip arthroplasty using a ceramic revision head with a retained wellfixed femoral component:a case series[J].J Med Case Rep,2014,8(1):434.
[5]王傲.激素性股骨头坏死发病机制的研究进展[J].中国骨与关节损伤杂志,2016,31(4):445.
[6]马勇,马喜洪.股骨头坏死病因、发病机制及治疗研究进展[J].医学综述,2015,21(9):1575.
[7]邵阳,赵晓艳,马勇.激素性股骨头坏死发病机制的研究进展[J].中国中医骨伤科杂志,2012,20(8):89.
[8]Jones DH,Kong YY,Penninger JM.Role of RANKL and RANK in bone loss and arthritis[J].Ann Rheum Dis,2007,61(2):32-39.
[9]Kong YY,Yoshida H,Sarosi I,et al.OPGL is a key regulator of osteoclastogenesis,lymphocyte development and lymph-node organogenesis[J].Nature,2008,397:315-323.
[10]Bucay N,Sarosi I,Dunstan CR,et al.Osteoprotegerin-deficient mice develop early onset osteoporosis and arterial calcification[J].Genes Dev,2002(12):1260-1268.
[11]Song HM,Wei YC,Li N,et al.Effects of Wenyangbushen formula on the expression of VEGF,OPG,RANK and RANKL in rabbits with steroid-induced femoral head avascular necrosis[J].Molecular Medicine Reports,2015,12(6):8155.
[12]黎彦龙,何明,陈秉雄,等.OPG-RANKL-RANK信号系统是调节破骨骼细胞及股骨头的骨质疏松症的重要途径[J].中国组织工程研究,2015,19(24):3897.
[13]Peng WX,Ye C,Dong WT,et al.MicroRNA-34a alleviates steroidinduced avascular necrosis of femoral head by targeting Tgif2 through OPG/RANK/RANKL signaling pathway[J].Experimental Biology Medicine,2017,242(12):1535370217703975.
[14]周燕琳,杜晓刚.GC相关性股骨头坏死早期防治的研究进展[J].医学综述,2018,24(4):672-676.
[15]刘新宇,曹林忠,宋敏,等.中医药对激素性股骨头坏死防治的研究概况[J].中国中医急症,2016,25(8):1561-1563.
[2]杨才德,高敬辉,刘文韬.埋线针刀治疗学[M].北京:中国中医药出版社,2018:396-397.
[3]Harris WH.Traumatic arthritis of the hip after dislocation and acetabular fractures:treatment by mold arthroplasty.An end-result study using a new method of result evaluation[J].J Bone Joint Surg Am,1969,51(4):737-755.
[4]Ganzer D,Forke L,Irlenbusch U.Two-year follow-up of revision total hip arthroplasty using a ceramic revision head with a retained wellfixed femoral component:a case series[J].J Med Case Rep,2014,8(1):434.
[5]王傲.激素性股骨头坏死发病机制的研究进展[J].中国骨与关节损伤杂志,2016,31(4):445.
[6]马勇,马喜洪.股骨头坏死病因、发病机制及治疗研究进展[J].医学综述,2015,21(9):1575.
[7]邵阳,赵晓艳,马勇.激素性股骨头坏死发病机制的研究进展[J].中国中医骨伤科杂志,2012,20(8):89.
[8]Jones DH,Kong YY,Penninger JM.Role of RANKL and RANK in bone loss and arthritis[J].Ann Rheum Dis,2007,61(2):32-39.
[9]Kong YY,Yoshida H,Sarosi I,et al.OPGL is a key regulator of osteoclastogenesis,lymphocyte development and lymph-node organogenesis[J].Nature,2008,397:315-323.
[10]Bucay N,Sarosi I,Dunstan CR,et al.Osteoprotegerin-deficient mice develop early onset osteoporosis and arterial calcification[J].Genes Dev,2002(12):1260-1268.
[11]Song HM,Wei YC,Li N,et al.Effects of Wenyangbushen formula on the expression of VEGF,OPG,RANK and RANKL in rabbits with steroid-induced femoral head avascular necrosis[J].Molecular Medicine Reports,2015,12(6):8155.
[12]黎彦龙,何明,陈秉雄,等.OPG-RANKL-RANK信号系统是调节破骨骼细胞及股骨头的骨质疏松症的重要途径[J].中国组织工程研究,2015,19(24):3897.
[13]Peng WX,Ye C,Dong WT,et al.MicroRNA-34a alleviates steroidinduced avascular necrosis of femoral head by targeting Tgif2 through OPG/RANK/RANKL signaling pathway[J].Experimental Biology Medicine,2017,242(12):1535370217703975.
[14]周燕琳,杜晓刚.GC相关性股骨头坏死早期防治的研究进展[J].医学综述,2018,24(4):672-676.
[15]刘新宇,曹林忠,宋敏,等.中医药对激素性股骨头坏死防治的研究概况[J].中国中医急症,2016,25(8):1561-1563.