Pathogenesis of hormonal osteonecrosis of the femoral head and the target effect of related signaling pathways / 中国组织工程研究

ABSTRACT

BACKGROUND: The early stage of avascular necrosis of the femoral head is difficult to find, easy to be ignored and misdiagnosed. Due to the relatively poor medical conditions in some areas, the treatment is often delayed, resulting in a high rate of late disability. OBJECTIVE: To summarize the related literature in and outside China, and the research on the pathogenesis of hormonal osteonecrosis of the femoral head and related signal pathway so as to understand the pathogenesis. METHODS: The databases of CNKI, Wanfang and VIP were retrieved in Chinese with the key words of “necrosis of femoral head, glucocorticoid, pathogenesis, apoptosis, signal pathway, lipid metabolism disorder, BMSCs, Wnt/β-catenin”. PubMed and MEDLINE databases were retrieved in English with the key words of “ANFH, glucocortioids, pathogenesis, cell apoptosis, signal path, lipid metabolism disorder, BMSCs, Wnt/β-catenin”. The articles regarding the pathogenesis of hormonal osteonecrosis of the femoral head were collected. Finally, 57 articles were included according to the inclusion and exclusion criteria. RESULTS AND CONCLUSION: (1) The pathogenesis of steroid-induced femoral head necrosis is the result of a combination of multiple mechanisms and factors. Currently, the accepted theories mainly include intravascular coagulation, lipid metabolism disorder, osteoporosis and cell apoptosis. However, the pathological process has not yet been fully elucidated and further in-depth research is needed. (2) At present steroid-induced femoral head necrosis has not been completely cured because its pathogenesis has not been clearly identified. The reason for this difficulty may be that animal models in a large number of experiments at present cannot satisfactorily simulate the complex pathological changes and mechanisms of human femoral head necrosis. It is hoped that animal models of femoral head necrosis can be further improved in future experiments on steroid-induced femoral head necrosis. (3) On the basis of fully understanding the pathogenesis of steroid-induced femoral head necrosis, rational clinical use of glucocorticoids and preventive and intervention measures may be the key to prevent femoral head necrosis. In addition, speeding up the research on relevant signal pathways will help investigators find targets for the prevention and treatment of steroid-induced femoral head necrosis, and hopefully find more effective therapeutic schemes.