【作者】 李勃；

【导师】 袁浩；

【作者基本信息】 广州中医药大学 ， 中医骨伤科学， 2006， 博士

【摘要】 股骨颈骨折(femoral neck fracture)是引起创伤性股骨头坏死最常见的原因。创伤性股骨头坏死(trauma-induced osteonecrosis of femoral head,TONFH)还可继发于股骨头骨折和一部分髋关节脱位(dislocation of the hip joint)的患者,一部分股骨转子间骨折(femoral intertrochanteric fracture)也可以引起股骨头坏死,还有少数轻微髋关节外伤后引发的股骨头坏死患者,其发病机制还不十分清楚。 近几年,股骨颈骨折后引发的股骨头坏死又呈现出一些新特点。①随着社会人口的老龄化以及各类交通事故和暴力性外伤事件的增多,股骨颈骨折的发病率呈上升态势,相应引起股骨头坏死的患者数量不断增多。②有资料表明,随内固定技术和内固定材料的更新,近十年中股骨颈骨折的愈合率明显提高,但伴随骨折愈合率的提高,股骨头坏死率并没有相应降低,仍然保持在10%～30%之间。如何最大限度的减少骨坏死率,成为骨科领域的一个重要课题。③近年对髋关节的局部解剖、血循环状态和再血管化问题有了更深入的认识,研究手段的进步也增进了人们对股骨头坏死病理进程的了解,有必要做进一步的分析和总结。④以往对于创伤性股骨头坏死主要延用非创伤性股骨头坏死的分期分型系统来指导治疗,但创伤性股骨头坏死有较为明确的病因和临床表现,对于其治疗方法、治疗时机和预后情况都有自己的特点,有必要根据这些特点建立一套新的分期系统来指导治疗,判断预后。 股骨颈骨折后股骨头坏死的早期诊断和治疗具有非常重要的意义,中医理论认为早期活血化瘀,后期补肾壮骨对促进骨折愈合及预防股骨头坏死都有积极作用。通络生骨胶囊(曾用名:生脉成骨胶囊)是袁浩教授结合多年临床实践,精心筛选出来的治疗股骨头坏死的有效药物,自1982年以来单独或配合手术应用,已经治愈大批股骨头坏死患者,前期的大量临床和实验研究表明该药具有确切的疗效。但在早期的临床应用中,本药也显示出对骨折愈合有良好的促进作用,为了继续开发本药的适应症,需要对骨折的药效进行实验研究。 本课题的实验部分选用新西兰白兔130只,雌雄各半,随机分为六组,正常对照组为10只(仅作血生化和血流变检测对照用),其余每组24只。适应性饲养一周后开始造模。建立标准的兔桡骨骨折模型,观察通络生骨胶囊对骨折愈合的促进作用。①血生化的分析表明,通络生骨胶囊可以有效的调节血中钙、磷离子浓度,促进钙离子的沉积,同时明显提高ALP的活性。②微循环和血液流变学关系密切,骨折后的血液流变学异常和出现的微循环障碍是影响骨折愈合的重要机制之一。通络生骨胶囊可以降低骨折后兔的全血粘度、血浆粘度和红细胞压积,改变血液粘稠状态,改善局部微循环。③生物力学测试结果,治疗组的最更多还原

【Abstract】 Trauma induced osteonecrosis of femoral head (TONHT) typically happens to the patients who previously suffers from femoral neck fracture, dislocation of hip joint or femoral intertrochanteric fracture etc. There are a few cases that orgininated from hip joint trauma but the pathology has not been fully understood.In recent years, some new characteristics have been found of ONFH induced by femoral neck fracture. Firstly, as the number of the aged people and traffic accidents, violence increases, more patients have been diagnosed as TONFH that originates from increasing number of femoral neck fracture cases.Secondly, statistic data shows that with the significant improvement in operation techniques and joint materials, the cure rate of the bone fracture is improved. But with this improvement, the number of cases of TONFH has not been reduced. It is still around 10%~30% among the related cases. How to reduce the TONFH rate becomes one of the hottest fields in research. Thirdly, recent anatomy results from hip joint and deep understanding on blood circulation and blood vessel regeneration help doctors to understand more about the pathology of TONFH. Based on all those information, It is necessary to do a thorough analysis and summary. Lastly, the therapy for TONFH was mainly adapted from the treatment for non trauma ONFH. But non trauma ONFH has its very specific pathology and clinic symptoms. It has its own unique characteristics in terms of therapy and recovering. It is really necessary to develop a new set of procedures to guide the therapy and treatment for TONFH based on these characteristics.In this paper a total of 65 clinic cases were studied and analyzed based on patients’ age, dislocation of the bone, treatment period, treatment method, post treatment recovering etc. That could affect the treatment of TONFH. Compelling evidence supports that TongLuo ShengGu capsule will help the recovering of TONFH patients in terms of reducing the pain in the treatment and helping recovering in walking after operation.This study combines the western and eastern methods in treating TONFH. It has been found to be able to improve the recovery rate of femoral neck fracture cases and reduce the likelihood of TONFH occurring rate as well.Early diagnosis and treatment of TONFH is very crucial. In traditional Chinese medicine practices, promoting blood circulation to remove blood stasis in the early stage and tonifying kidney to strengthen the bone afterwards are considered important to help preventing and treating of TONFH. Based on Dr. Hao Yuan’s rich clinic experience, TongLuo ShengGu capsule has been developed to effectively treat TONFH. Since 1982, it has been used to successfully cure a lot of patients who suffered TONFH. A lot of clinic trails and research support the effectiveness of this medicine in TONFH treatment. This medicine is also used in successfully treating some bone fracture cases. Further research needs to be conducted to find if it can help treatments in other cases.In our experiments, a total of 65 female and 65 male New Zealand rabbits were used. They were randomly divided into 6 groups. One group that used as a reference group has 10 rabbits while all other groups have 24 rabbits each. The study model was created after the first week. The standard rabbit models of radius fracture are used to study how TongLuo ShengGu capsule assists the recovery of bone fracture.The blood analysis results show that TongLuo ShengGu capsule can effectively adjust the density of calcium, phosphor ions in the blood and help the accumulation of calcium ions and effectively improve the activeness of ALP. There is strongly related between blood micro circulation and hemorrheology. Abnormity in blood circulation and blood micro circulation are one of the main factors in affecting the recovery of bone fracture. TongLuo ShengGu capsule can help rabbits with bone fractures lower its blood viscosity, plasma viscosity, volume of packed red blood cells, improve micro circulation of rabbits with bone fractures. The bio-mechanical tests show improvement in the maximum dislocation and maximum bending force, which proves the toughness and density of bones are improved. The direct evidence from x-ray and tissue microscopy support TongLuo ShengGu capsule can help cartilage grow, bone early regenerate and bone density increase.The Guangzhou university of Chinese medicine affiliated No. 1 Hospital department of orthopaedics is the research center of Chinese medicine practice on hip disease. Since it was established more than 10 years ago, it has accumulated rich experience in treating hundreds of TONFH patients. In this paper, some treatment knowledge and practices will be summarized.更多还原