RESUMEN
BACKGROUND:Glucocorticoids can inhibit the expression of hub genes in the parathyroid hormone type Ⅰ receptor(PTH1R)/protein kinase A(PKA)signaling axis and interfere with the osteogenic and angiogenic differentiation of bone marrow mesenchymal stem cells,leading to the disruption of blood supply in bone and bone tissue structures.Previous studies of the research team showed that Gubitongxiao granules can induce blood vessel formation and inhibit osteoblast apoptosis,which has a certain effect on the prevention and treatment of steroid-induced femoral head necrosis. OBJECTIVE:To observe the therapeutic effect of Gubitongxiao granules in a mouse model of steroid-induced femoral head necrosis,and to explore its mechanism from the PTH1R/PKA signaling axis. METHODS:An animal model of steroid-induced necrosis of the femoral head was established by intraperitoneal injection of lipopolysaccharide and gluteal muscle injection of prednisolone acetate.After identification by nuclear magnetic resonance method,60 mice that were successfully modeled were divided into model group,Gubitongxiao granule group and Tongluo Shenggu capsule group,with 20 mice in each group.Another 12 normal mice were used as control group.The corresponding groups were intragastrically given the corresponding drugs for 12 weeks,and then the samples were taken under anesthesia.Histomorphology of femoral head samples was observed by hematoxylin-eosin staining.Enzyme-linked immunosorbent assay was used to detect the serum levels of bone alkaline phosphatase,type Ⅰ amino-terminal extension peptide,parathyroid hormone,osteocalcin and alkaline phosphatase.Western blot and RT-qPCR were used to detect PTH1R,PKA,myocyte enhancer factor 2,sclerostin and guanylate-binding protein activity-stimulating peptide at protein and gene expression levels,respectively. RESULTS AND CONCLUSION:Gubitongxiao granules may reduce the serum PTH level in mice,inhibit the activation of the PTH1R/PKA signal axis,further up-regulate the protein expressions of sclerostin and myocyte enhancer factor 2,and increase the levels of bone alkaline phosphatase,type Ⅰ amino-terminal extension peptide,osteocalcin and alkaline phosphatase in mice,thus improving femoral head necrosis,which is comparable to the intervention effect of Tongluo Shenggu capsules.It is speculated that Gubitongxiao granules may prevent and treating hormonal femoral head necrosis by regulating the PTH1R/PKA signaling axis.
RESUMEN
BACKGROUND:Chinese herbal medicine for treatment of steroid-induced necrosis of the femoral head has been shown to be effective, but its mechanism remains controversial. OBJECTIVE:To retrieve and summarize the mechanism of Chinese herbal medicine for steroid-induced necrosis of the femoral head in recent 10 years. METHODS:We retrieved articles addressing the mechanism of Chinese herbal medicine for intervention of steroid-induced necrosis of the femoral head in China National Knowledge Infrastructure published from January 2005 to December 2014. The key words were femur head necrosis, hormones, drugs, and Chinese herbal. According to inclusion and exclusion criteria, 23 articles were selected for discussion. RESULTS AND CONCLUSION:Studies concerning the mechanism of Chinese medicine for steroid-induced necrosis of the femoral head mainly focus on lowering blood lipid and anticoagulation, improving blood rheology, reducing intraosseous pressure, promoting angiogenesis and inhibiting apoptosis, as wel as cytokines and related factors. This study mainly concerns classical formulae, empirical prescription and various Chinese patent medicines, but does not address differentiation of symptoms and signs for classification of syndrome, diagnosis and treatment based on an overal analysis of the ilness and the patient’s condition, targeted rule of treatment, and prescription drugs.
RESUMEN
BACKGROUND:Pereutaneous vertebroplasty and percutaneous kyphoplasty as the minimal y invasive treatment techniques have been widely used in the treatment of vertebral osteoporotic compression fracture, but there are controversies, and each method has its advantages and disadvantages. OBJECTIVE:To compare the clinical efficacy between percutaneous vertebroplasty and percutaneous kyphoplasty in the treatment of vertebral osteoporotic compression fracture. METHODS:100 patients with vertebral osteoporotic compression fracture were col ected, among them, 40 patients received percutaneous vertebroplasty, and 60 patients received percutaneous kyphoplasty. The visual analog scale score was used to assess the pain degree of the patients before treatment;the visual analog scale score was also used at 1 week after treatment. The X-ray film was taken to measure the ratio between anterior and rear edges of vertebrae. RESULTS AND CONCLUSION:The visual analog scale scores in the two groups were significantly decreased after treatment, and there was significant difference when compared with that before treatment (P<0.05);there was significant difference in the restore of vertebral height in two groups when compared with that before treatment, but there was no significant difference in the orthopedic effect between two groups (P<0.05). The incidence of complications of bone cement leakage after treatment was 35%in the pereutaneous vertebroplasty group and 12.5%in the percutaneous kyphoplasty group, and there was significant difference in the incidence of complications between two groups (P<0.05). Pereutaneous vertebroplasty and percutaneous kyphoplasty can significantly relieve the pain of the patients with vertebral osteoporotic compression fracture, but there is no significant difference in the orthopedic effect between pereutaneous vertebroplasty and percutaneous kyphoplasty.
