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Osteonecrosis of the femoral head （ONFH） is a painful and debilitating disease caused by impaired blood supply to the femoral head and cellular and tissue degeneration， leading to gradual destruction of the bone structure and progressive collapse of the femoral head. The main pathological mechanism of ONFH is the disruption of the balance between bone absorption and the reconstruction of new bone， resulting from microcirculation damage and decreased cellular tissue ability. This imbalance leads to biomechanical changes and accelerates the pathological progression of ONFH. In the early stages， clinical manifestations may not be obvious， mainly presenting as pain or discomfort in the hip or groin area， which can be relieved after rest. In the later stage of the disease， pain intensifies， and limb shortening， lower limb weakness， difficulty walking， or limping may occur. Currently， western medicine commonly uses osteogenic agents， anticoagulants， and artificial joint replacement for treatment， but there are also many issues such as prosthesis loosening and infection. Research has shown that traditional Chinese medicine （TCM） treatment of ONFH takes a holistic approach and employs multi-functional， multi-target， and multi-system Chinese medicine therapies， ensuring the safety and effectiveness of the treatment. The osteoprotegerin （OPG）/receptor activator of nuclear factor-κB （RANK）/RANK ligand （RANKL） signaling pathway plays a crucial role in maintaining the dynamic balance of bone remodeling. TCM treatments utilize this pathway to promote apoptosis of osteoclasts， reduce bone resorption， and accelerate bone formation， thereby playing an important role in the prevention and treatment of ONFH. This paper reviewed the role of OPG/RANK/RANKL signaling pathway and related cytokine expression in ONFH by reviewing relevant literature in China and abroad and research status of Chinese medicinal monomers， Chinese medicinal formulations， and combinations with physical therapy in increasing osteoblast secretion， promoting OPG expression， enhancing cytokine expression levels， and inhibiting osteoclast activity for the prevention and treatment of ONFH. This paper is expected to provide new ideas and directions for TCM in the prevention and treatment of ONFH.
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Patients with knee osteoarthritis increase gradually.Arthroscopic debridement has achieved good results in clinical treatment at home and abroad in recent years.The technology is not only easy to operate at a low cost, it but also can directly improve the internal environment and function of the knee joints, cut off the vicious circle of joint cavity, which can provide a good environment for the normal production of joint fluid after a large amount of saline lavaging knee joint cavity during operation. This review summarizes the clinical curative effect of knee osteoarthritis with arthroscopic debridement in recent five years and provides the guidance and reference for the researchers.
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BACKGROUND: Compound betamethasone injection has been widely used to treat intervertebral disc herniation, but its precise mechanism remains unclear. OBJECTIVE: To explore effects of local injection of compound betamethasone on substance P and calcitonin gene-related peptide in spinal cord and dorsal root ganglia of rat models undergoing autologous transplantation of nucleus pulposus. METHODS: A total of 36 Sprague-Dawley rats were randomly assigned to four groups: blank group, model group, sham surgery group, and western medicine group, with 9 rats in each group. After 1 week of adaptive feeding, rat models of autologous transplantation of nucleus pulposus were established in the model and western medicine groups. At 3, 7 and 12 days after surgery, the rats were given 128.25 μL saline in the model and sham surgery groups. The rats in the western medicine group were administered Betamethason Compound Injection 13.5 μL + 2% Lidocaine Injection 67.5 μL. At 12 hours after final administration, L4-6 segments of the spinal cord and dorsal root ganglion were obtained, and substance P and calcitonin gene-related peptide contents in L4-6 segments of the spinal cord and dorsal root ganglion were determined using immunofluorescence staining. RESULTS AND CONCLUSION: Significant differences in mean fluorescence intensity of substance P and calcitonin gene-related peptide were detected in rat spinal cord and dorsal root ganglion in each group (P < 0.01). Further paired comparison showed that compared with the blank and sham surgery groups, substance P and calcitonin gene-related peptide contents were significantly higher in the spinal cord and dorsal root ganglion in the model group (P < 0.01), which verified that models could be replicated and were reliable. Compared with the model and sham surgery groups, substance P and calcitonin gene-related peptide contents were significantly lower in the spinal cord and dorsal root ganglion of rats in the western medicine group (P < 0.01). Above results confirmed that Compound Betamethasone Injection for treating lumbar intervertebral disc herniation eliminated substance P and calcitonin gene-related peptide in dorsal root ganglion possibly by inhibiting dorsal root ganglion neuron synthesis and secreting substance P and reduced their transmission to the spinal cord, resulting in inhibiting and lessening pain.
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Objective To observe the clinical effects of Huoxue Dingxuan Capsules on treatment of vertebral artery type of cervical spondylosis, and evaluate its efficacy and safety. Methods Totally 130 cases of vertebral artery type of cervical spondylosis were randomly assigned to treatment group and control group, and treated with Huoxue Dingxuan Capsules and Sibelium capsules respectively. Integration method was used to compare the differences of main symptoms and signs, the overall efficacy and safety were evaluated, and relapse after six months was followed up. Results Both groups had a significant effect on the improvement of signs and symptoms in vertebral artery type of cervical spondylosis, the total efficiency was 94.03%(63/67) in treatment group and 82.54% (52/63) in control group. The treatment group had a better effect on the overall efficacy and relieving symptoms and signs compared with the control group (P<0.01). The mean blood flow velocity had a significant change after treatment (P<0.05), and the treatment group was better than the control group (P<0.01). Within six months, the treatment group had 4 cases (6.34%) with mild recurrence of symptoms and signs, and the control group had 18 cases (34.61%), the difference between the two groups was statistically significant (P<0.05), and no severe recurrence was found. The two groups showed no side effects. Conclusion Huoxue Dingxuan Capsules is safe and effective for treating vertebral artery type of cervical spondylosis, and the long-term efficacy and subjects’ compliance are better than oral Sibelium capsules.