OBJECTIVE: To study the relationship between osteonecrosis of femoral head after internal fixation of femoral neck fracture and serum bone metabolism, vascular active factors, and analyze the risk factors. METHODS: Total 150 patients with femoral neck fracture who underwent reduction and internal fixation from April 2016 to April 2019 were selected, including 83 males and 67 females. According to whether there was necrosis of femoral head after operation, they were divided into necrosis group(32 cases) and non necrosis group (118 cases). Before operation and 1, 3, 5 days after operation, the serum levels of beta-C terminal cross-linked telopeptides of typeⅠ collagen(β-CTX), N-telopeptide of typeⅠ procollagen(PINP), nitric oxide (NO), Endothelin-1 (ET-1) were measured. The clinical characteristics of the two groups were compared. The risk factors of postoperative femoral head necrosis were analyzed by logistic regression model. The value of serum indexes in predicting postoperative femoral head necrosis was analyzed by ROC curve. RESULTS: There was no significant difference in the levels of serum PINP and β-CTX between necrotic group and non necrotic group before operation and 1, 3 and 5 days after operation( CONCLUSION The content of serum NO and ET-1 on the first day after operation can predict the necrosis of femoral head.
Female ; Femoral Neck Fractures/surgery* ; Femur Head ; Femur Head Necrosis/etiology* ; Fracture Fixation, Internal/adverse effects* ; Humans ; Male ; Osteonecrosis ; Retrospective Studies ; Risk Factors

BACKGROUNDMany potential causative factors are related to the initiation and progression of osteonecrosis of the femoral head. The aim of this research was to investigate the etiology and clinical features of osteonecrosis of the femoral head in Chinese patients.

METHODSFrom January 1990 to July 2011, 643 cases of osteonecrosis of the femoral head were investigated retrospectively to analyze the potential causative factors, age, gender, latency period, time from the onset of pain to diagnosis, and Association Research Circulation Osseous stage.

RESULTSOf 643 cases, 315 cases were bilateral and 328 cases were unilateral, with an average age of (47.55 ± 15.27) years. In the steroid-induced group, the average age at symptom onset was (41.80 ± 15.47) years, and the median duration from taking steroid to the onset of pain was 36 months. The underlying diseases in the steroid-induced osteonecrosis of the femoral head group consisted of autoimmune and other diseases, of which systemic lupus erythematosus was the most common. In the alcohol-induced group, the average age at onset of symptoms was (48.06 ± 11.90) years and the median time of habitual alcohol use was 240 months. In the traumatic group, the average age was (51.43 ± 14.23) years and the median time from trauma to the onset of pain was 20 months. In the idiopathic group, the average age was (50.33 ± 15.88) years. Of the total of 958 hips, 647 were at stage III or IV. The stage at diagnosis was earlier in the steroid-induced group than in the alcohol-induced, traumatic, or idiopathic groups.

CONCLUSIONSSteroid use is the most common cause for osteonecrosis of the femoral head in this study. The age at diagnosis, time from the onset of pain to diagnosis, and stage were significantly earlier in the steroid-induced group.

Adolescent ; Adult ; Aged ; Aged, 80 and over ; Female ; Femur Head Necrosis ; etiology ; Humans ; Male ; Middle Aged ; Risk Factors

OBJECTIVETo observe the efficacy and features of treating early-to-middle stage nontraumatic osteonecrosis of femoral head (NONFH) patients by Jianpi Huogu Recipe (JHR).

METHODSUsing retrospective paired control method, early-to-middle stage NONFH patients treated by JHR and followed-up for 2 years were recruited as the test group (47 cases). Those accepted surgery of core decompression, focus debridement and bone graft were recruited as the control group (48 cases). Radiographic images and clinical data of patients were collected before and after treatment. The stable rate and excellent rate of Harris score were taken as efficacy evaluation indicators.

RESULTS(1) There was no statistical difference in excellent rate of Harris score between the two groups (95.74% vs. 79.17%, P > 0.05). But better effects were obtained in the test group in relieving pain, improving joint deformation, joint mobility, and total Harris score (P < 0. 05, P < 0. 01). There was no statistical difference in the stable rate of radiography between the two groups (74.47% vs. 75.00%, P > 0.05). (2) There was no statistical difference in the stable rate of radiography at phase II and Ill [staging by Association Research Circulation Osseous (ARCO)] between the two groups (82.05% vs. 80.00%, 37.50% vs. 50.00%, P > 0.05). (3) The stable rate of radiography and excellent rate of Harris score were obviously higher in ARCO phase II patients than in ARCO phase Il patients (82.05% vs. 37.50%,97.44% vs. 87.50%, P < 0.01).

CONCLUSIONSEquivalent stable rate of radiography to that of surgery could be obtained in treating early-to-middle stage NONFH patients by JHR. But it was better than surgery in relieving pain, improving joint deformation and joint mobility.

Adult ; Case-Control Studies ; Drugs, Chinese Herbal ; therapeutic use ; Female ; Femur Head Necrosis ; drug therapy ; etiology ; Humans ; Male ; Middle Aged ; Phytotherapy ; Retrospective Studies ; Treatment Outcome ; Young Adult

BACKGROUND: We evaluated the clinical and radiologic results of impacted femoral neck fractures treated with multiple pinning and determined the influence of the progression of impaction at the fracture site on clinical outcome. METHODS: There were 34 patients with a mean age of 65.5 years. The mean follow-up period was 3.4 years. Progression of fracture site impaction was measured using an articulo-trochanteric distance index and the percentage decrease in the articulo-trochanteric distance index between follow-up intervals. The failure of treatment was clarified as non-union and avascular necrosis. Other characteristics of the patients, including mean waiting time for surgery, preoperative Singh index score, and body mass index, were also measured to evaluate the influence on the clinical outcome of surgery. RESULTS: There were 6 fractures which were not treated successfully (3 non-union, 8.8% and 3 avascular necrosis, 8.8%). The mean percentage decrease of the articulo-trochanteric distance index within the first 6 weeks after surgery was 4.5% in the successful group and 25.1% in the failure group (p < 0.001). There was also a significant mean percentage decrease in the articulo-trochanteric distance index between 6 weeks and 3 months (p < 0.001). CONCLUSIONS: Primary stabilization with Knowles pins for impacted femoral neck fractures had a reasonable clinical outcome with low morbidity. Despite a significant difference of a mean percentage decrease in the articulo-trochanteric distance index between the successful group and the failure group, we could not verify it as a risk factor for failure of treatment because the odds ratio was not statistically significant.
Adult ; Aged ; Aged, 80 and over ; Bone Nails ; Female ; Femoral Neck Fractures/complications/radiography/*surgery ; Femur Head Necrosis/etiology/radiography ; Follow-Up Studies ; *Fracture Fixation, Internal ; Fractures, Ununited/radiography ; Hip Joint/*pathology/radiography ; Humans ; Male ; Middle Aged ; Odds Ratio ; Treatment Outcome

BACKGROUND: We evaluated the clinical and radiologic results of impacted femoral neck fractures treated with multiple pinning and determined the influence of the progression of impaction at the fracture site on clinical outcome. METHODS: There were 34 patients with a mean age of 65.5 years. The mean follow-up period was 3.4 years. Progression of fracture site impaction was measured using an articulo-trochanteric distance index and the percentage decrease in the articulo-trochanteric distance index between follow-up intervals. The failure of treatment was clarified as non-union and avascular necrosis. Other characteristics of the patients, including mean waiting time for surgery, preoperative Singh index score, and body mass index, were also measured to evaluate the influence on the clinical outcome of surgery. RESULTS: There were 6 fractures which were not treated successfully (3 non-union, 8.8% and 3 avascular necrosis, 8.8%). The mean percentage decrease of the articulo-trochanteric distance index within the first 6 weeks after surgery was 4.5% in the successful group and 25.1% in the failure group (p < 0.001). There was also a significant mean percentage decrease in the articulo-trochanteric distance index between 6 weeks and 3 months (p < 0.001). CONCLUSIONS: Primary stabilization with Knowles pins for impacted femoral neck fractures had a reasonable clinical outcome with low morbidity. Despite a significant difference of a mean percentage decrease in the articulo-trochanteric distance index between the successful group and the failure group, we could not verify it as a risk factor for failure of treatment because the odds ratio was not statistically significant.
Adult ; Aged ; Aged, 80 and over ; Bone Nails ; Female ; Femoral Neck Fractures/complications/radiography/*surgery ; Femur Head Necrosis/etiology/radiography ; Follow-Up Studies ; *Fracture Fixation, Internal ; Fractures, Ununited/radiography ; Hip Joint/*pathology/radiography ; Humans ; Male ; Middle Aged ; Odds Ratio ; Treatment Outcome

BACKGROUNDWith the increase of survival in liver transplantation recipients, more patients are at a high risk of developing osteonecrosis, especially in the femoral head, due to immunosuppressive treatment. The purpose of this study was to report the incidence, possible risk factors, and outcome of symptomatic osteonecrosis of the femoral head (ONFH) in adult patients with current immunosuppressive agents and individual protocol after liver transplantation in China.

METHODSA retrospective analysis was performed on 226 adult patients who underwent orthotopic liver transplantation (OLT) at a single liver transplantation institution between January 2004 and December 2008. The posttransplant survival time (or pre-retransplantation survival time) of all the patients were more than 24 months. The possible pre- and post-transplantation risk factors of symptomatic ONFH were investigated and the curative effects of the treatment were also reported.

RESULTSThe incidence of ONFH was 1.33% in patients after OLT. ONFH occurred at a mean of (14 ± 6) months (range, 10 - 21 months) after transplantation. Male patients more often presented with osteonecrosis as a complication than female patients. The patients with lower pre-transplantation total bilirubin and direct bilirubin levels (P < 0.05). There was no difference in the cumulative dose of corticosteroids or tacrolimus between the patients with or without symptomatic ONFH. Patients were treated either pharmacologically or surgically. All patients showed a nice curative effect without major complications during the 18 - 63 months post-treatment follow up.

CONCLUSIONSThe symptomatic ONFH does not occur commonly after adult OLT in the current individual immunosuppressive protocol in China.

Adult ; Aged ; Cyclosporine ; adverse effects ; therapeutic use ; Female ; Femur Head Necrosis ; epidemiology ; etiology ; Humans ; Immunosuppressive Agents ; adverse effects ; therapeutic use ; Liver Transplantation ; adverse effects ; Male ; Methylprednisolone ; adverse effects ; therapeutic use ; Middle Aged ; Osteonecrosis ; epidemiology ; etiology ; Retrospective Studies ; Risk Factors ; Sirolimus ; adverse effects ; therapeutic use ; Tacrolimus ; adverse effects ; therapeutic use ; Young Adult

OBJECTIVETo establish a new animal model of osteonecrosis of the femoral head(ONFH) with improved consistency and incidence of femoral head collapse for studies on the mechanism of osteonecrosis. and on the assessment of treatment effectiveness.

METHODSTwenty adult male emus were used. Guide instrumentation was constructed to position the customized probe just articularly and at the proximal part of the femoral head. An alternating focal liquid nitrogen freezing and radiofrequency heating was applied. At 2, 4, 8, 12 and 16 weeks after surgery, hip magnetic resonance imaging (MRI) was performed. Before the emus were sacrificed, barium sulfate was infused to lower extremities for microangiography. The femoral samples were scanned by micro-computed tomography (Micro-CT) and evaluated histologically.

RESULTSNo bird demonstrated signs of infection or died unexpectedly. Hip MRI showed changes massive edema at the 4th week, increasingly localized abnormal signals at the 8th'" week, and femoral head collapse at the 12'h week. Micro-CT scans and histological images at the 16th week showed human-like osteonecrotic changes with impaired local blood supply. Bone mineral density of the collapsed head was (380. 31 + 28. 12) mg/cm3 and trabecular spaces were (0. 86 ±0.32) mm; both were significantly lower than those in the control side, which were (415.75 41.28) mg/cm3 and (1. 17 ± 0. 17) mm, respectively (P < 0. 05). Bone volume fraction of the collapsed head was(47.28 ± 17. 14)% and trabecular thickness was (506. 17 ± 220. 58) p.m; both were significantly higher than those at control side, which were (30. 92 ± 4. 01)% and (325. 50 ±44. 53) pm, respectively (P <0. 05). The microangiography at the 16th week showed that vessel volume fraction was (0. 315 ± 0. 055)% , which was significantly higher than the collapsed side [ (0. 142 ± 0. 059)% ] (P <0. 05).

CONCLUSIONSThe emu model of fem-oral head osteonecrosis was successfully established using focal alternating cooling and heating insults. The models, with improved consistency and incidence of femoral head collapse, can be used in studies on the mechanism of osteonecrosis and on the assessment of treatment effectiveness.

Animals ; Disease Models, Animal ; Dromaiidae ; Femur Head Necrosis ; etiology ; Freezing ; adverse effects ; Heating ; adverse effects ; Male

Adult ; Decompression, Surgical ; Drugs, Chinese Herbal ; therapeutic use ; Femur Head Necrosis ; etiology ; therapy ; Humans ; Integrative Medicine ; Male ; Phytotherapy ; Young Adult

BACKGROUND: Osteonecrosis of the femoral head is classified into idiopathic and secondary forms. A number of etiological factors in the development of osteonecrosis have been suggested but the biological mechanisms are still unclear. Recently, some reports suggested that the apoptosis is closely related to osteonecrosis of the femoral head. Therefore, this study examined the expression of apoptosis in osteonecrosis of the femoral head. METHODS: Of the patients diagnosed preoperatively with osteonecrosis and underwent total hip replacement arthroplasty between August 2004 and July 2005, 58 patients (58 hips) were available for this study. Their diagnoses were confirmed by the postoperative pathology findings. Tissue samples of the femoral head sections were terminal deoxynucleotydyl transferase mediated dUTP nick-end labeling (TUNEL) stained using an in situ cell death detection POD kit. The number of total and TUNEL-positive osteocytes, and the average ratio of TUNEL-positive cells were calculated and analyzed according to the cause. RESULTS: Osteonecrosis was steroid-induced in 8 cases (13.8%), alcohol-induced in 29 cases (50%), post-traumatic in 6 cases (10.3%) and idiopathic in 15 cases (25.9%). The percentage of TUNEL-positive osteocytes was high in patients with steroid- and alcohol-induced osteonecrosis of the femoral head but low in patients with post-traumatic and idiopathic osteonecrosis. The difference in the percentage of TUNEL-positive osteocytes between these groups was significant (p < 0.05). CONCLUSIONS: Apoptosis might play an important role in the pathogenesis of osteonecrosis of the femoral head induced by steroid and alcohol. These findings highlight a need for further research into the role of apoptosis in the development of osteonecrosis of the femoral head.
Adult ; Aged ; Aged, 80 and over ; *Apoptosis ; Female ; Femur Head/*pathology ; Femur Head Necrosis/etiology/*pathology/surgery ; Humans ; In Situ Nick-End Labeling ; Male ; Middle Aged

Adolescent ; Adult ; Cyclophosphamide ; adverse effects ; Female ; Femur Head Necrosis ; etiology ; Humans ; Immunosuppressive Agents ; adverse effects ; Male ; Middle Aged ; Paraquat ; poisoning ; Young Adult