• 대한의용생체공학회:학술대회논문집
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• 대한의용생체공학회 1997년도 춘계학술대회
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• pp.374-378
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• 1997

Operative procedures such as core drilling with and without fibular bone grafting have been recognized as the treatment methods for osteonecrosis of femoral head(ONFH) by delaying or preventing the collapse of the femoral head. In addition, core drilling with cementation using polymethylmethacrylate (PMMA) has been proposed recently as another surgical method. However, no definite treatment modality has been found yet while operative procedures remain controversial to many clinicians In this study, a finite element method(FEM) was employed to analyze and compare various surgical procedures of ONFH to provide a biomechanical insight. This study was based upon biomechanical findings which suggest stress concentration within the femoral head may facilitate the progression of the necrosis and eventual collapse. For this purpose, five anatomically relevant hip models were constructed in three dimensions : they were (1) intact(Type I), (2) necrotic(Type II), (3) core drilled only(Type III), (4) core drilled with fibular bone graft(Type IV), and (5) core drilled with cementation(Type V). Physiologically relevant loading were simulated. Resulting stresses were calculated. Our results showed that the volumetric percentage subjected to high stress in the necrotic cancellous region was greatest in the core drilled only model(Type III), followed by the necrotic(Type II), the bone graft (Type IV), and the cemented(Type V) models. Von Mises stresses at the tip of the graft(Type IV) was found to be twice more than those of cemented core(Type V) indicating the likelihood of the implant failure. In addition, stresses within the cemented core(Type V) were more evenly distributed and relatively lower than within the fibular bone graft(Type IV). In conclusion, our biomechanical analyses have demonstrated that the bone graft method(Type IV) and the cementation method(Type V) are both superior to the core decompression method(Type III) by reducing the high stress regions within the necrotic cancellous bone. Also it was found that the core region filled with PMMA(Type V) provides far smoother transfer of physiological load without causing the concentration of malignant stresses which may lead to the failure than with the fibular bone graft(Type IV). Therefore, considering the above results along with the degree of difficulties and risk of infection involved with preparation of the fibular bone graft, the cementation method appears to be a promising surgical treatment for the early stage of osteonecrosis of the femoral head.

• IMMUNE NETWORK
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• 제22권3호
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• pp.25.1-25.11
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• 2022

IL-34 can promote osteoclast differentiation and activation, which may contribute to steroid-induced osteonecrosis of the femoral head (ONFH). Animal model was constructed in both BALB/c and IL-34 deficient mice to detect the relative expression of inflammation cytokines. Micro-CT was utilized to reveal the internal structure. In vitro differentiated osteoclast was induced by culturing bone marrow-derived macrophages with IL-34 conditioned medium or M-CSF. The relative expression of pro-inflammation cytokines, osteoclast marker genes, and relevant pathways molecules was detected with quantitative real-time RT-PCR, ELISA, and Western blot. Up-regulated IL-34 expression could be detected in the serum of ONFH patients and femoral heads of ONFH mice. IL-34 deficient mice showed the resistance to ONFH induction with the up-regulated trabecular number, trabecular thickness, bone value fraction, and down-regulated trabecular separation. On the other hand, inflammatory cytokines, such as TNF-α, IFN-γ, IL-6, IL-12, IL-2, and IL-17A, showed diminished expression in IL-34 deficient ONFH induced mice. IL-34 alone or works in coordination with M-CSF to promote osteoclastogenesis and activate ERK, STAT3, and non-canonical NF-κB pathways. These data demonstrate that IL-34 can promote the differentiation of osteoclast through ERK, STAT3, and non-canonical NF-κB pathways to aggravate steroid-induced ONFH, and IL-34 can be considered as a treatment target.

• 대한한방내과학회지
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• 제41권1호
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• pp.88-96
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• 2020

Objectives: Osteonecrosis of the femoral head (ONFH) is caused by a circulatory disorder. If symptoms are not present, the patient's progress is observed, but if symptoms are present, non-surgical methods or total hip replacement are performed. Several case reports have described the effects of Korean Medicine treatment on ONFH, but the number of cases is still small, and few studies have used blood stasis-based herbal medicines like Hwaeo-jeon (HEJ). This study reports the effectiveness of Korean Medicine treatments, including HEJ, on a case of ONFH. Methods: A patient diagnosed with ONFH by CT and MRI was treated with Korean Medicine treatments consisting of herbal medicine including HEJ, bee venom pharmacopuncture, acupuncture, cupping, and physical therapy. The improvement of pain was assessed using a numerical rating scale. Inflammation levels were determined by blood tests conducted during hospitalization. Results: Korean Medicine treatment, including herbal medicine, resulted in good clinical improvement responses, including reduced pain, improved mobility, and reduced inflammatory levels in the blood tests. Conclusions: Korean Medicine treatments, including HEJ, may be effective for ONFH patients. Further studies are needed to determine the recovery of osteonecrosis and the improvement of post-operative aftereffects using Korean Medicine treatments, as well as the reduction of pre-operative pain.

• 대한정형외과학회지
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• 제54권3호
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• pp.281-286
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• 2019

무혈성 골괴사는 골조직 및 골수 조직의 허혈성 상태로 인한 괴사로 정의될 수 있으며, 외상성 및 비외상성으로 구분할 수 있다. 무혈성 골괴사는 대퇴골 골두, 상완골 골두와 같이 장골의 골단 부위에서 주로 발생한다. 기존의 무혈성 골괴사는 대부분 대퇴골 골두에 한정된 증례에 대한 보고 및 연구가 이루어져 왔다. 근위 대퇴골의 무혈성 괴사의 존재는 인공 고관절 전치환술 이후 생물학적 고정 실패의 원인이 된다. 본 저자들은 대퇴골 골두로부터 대퇴골 경부, 간단부 간부 및 원위부에 이르는 골수강내 부위의 대퇴골 전 영역의 무혈성 골괴사가 관찰된 56세 남자 환자에서 인공 고관절 전치환술을 시행하고 2년 추시 결과를 문헌 고찰과 함께 보고하고자 한다.

• Journal of Acupuncture Research
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• 제39권4호
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• pp.239-248
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• 2022

To determine the effect of Korean medicine treatment of avascular necrosis of the femoral head (ANFH) this study reviewed both single ingredients and bioactive compounds in the treatment of ANFH in a rat model. Literature was retrieved from PubMed and Google Scholar using the keywords "femur head necrosis," "natural extract," and "rat." The data from studies analyzed included: rats' characteristics, development methods of ANFH, natural extracts administration, observation methods, and outcome indicators. Two independent researchers screened all articles retrieved and 26 studies were chosen. The most used rat species was the Sprague Dawley rat (76.9%). To induce ANFH, steroid injections (46.2%), and oral gavage (53.8%) were typically used. Studies focused mainly on factors affecting bone formation (65.3%), and apoptosis (53.8%). Research on ANFH focused on using traditional natural substances mentioned in classical literature to confirm its effectiveness against anti-inflammation, osteogenesis, and cell death. ANFH has a diverse etiology, therefore research models such as genetic analysis of human-derived samples from ANFH patients may shed more light on the condition. Moreover, research into herbal medicines and pharmacoacupuncture treatment of ANFH should precede.

• 생명과학회지
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• 제18권4호
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• pp.427-434
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• 2008

대퇴골두무혈성괴사증은 다원적인 질병으로 특정 집단의 경우 더 많은 위험성을 내포하고 있다. 특히 스테로이드의 과용과 알코올 남용 등으로 인한 지질대사의 변화는 골괴사증의 주요 원인 중 하나이다. 본 연구는 골괴사 환자와 대조군 사이에서 HMG-CoA reductase 유전자의 다형성과 질환발생과의 연관성에 대해 알아보았다. 24명의 한국인을 대상으로 HMG-CoA reductase 유전자를 시퀀싱하여 5곳의 유전자 다형성을 확인하였다. 349명의 남성 환자와 300명의 남성 대조군을 대상으로 네 곳(-6933C>T, -6045T>G, +12673G>A, +18128C>T)의 유전자다형성의 빈도를 비교하였다. 그 결과 HMG-CoA reductase 유전자의 다형성과 질환발생 및 혈장 지질농도와는 어떠한 상관관계도 보이지 않았다.

• 대한의용생체공학회:학술대회논문집
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• 대한의용생체공학회 1997년도 추계학술대회
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• pp.245-248
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• 1997

Operative interventions for the management of osteonecrosis of the femoral head (ONFH) include core drilling, with or without vascularized fibular bone grafting. Nevertheless, their clinical results have not been consistently satisfactory. Recently, a new surgical procedure that incorporates cementation with polymethylmethacrylate (PMMA) after core drilling has been tried clinically. In this study, a biomechanical analysis using a finite element method(FEM) was undertaken to evaluate surgical methods and their underlying surgical parameter. Our finite element models included five types. They were (1) normal model (Type I), (2) necrotic model (Type II), (3) core decompressed model (Type III). (4) fibular bone grafted model (Type IV), and (5) cemented with PMMA model (Type V). The geometric dimensions of the femur were based on digitized CT-scan data of a normal person. Various physiological loading conditions and surgical penetration depths by the core were used as mechanical variables to study their biomechanical contributions in stress transfer within the femoral head region. In addition. the peak von Mises stress(PVMS) within the necrotic cancellous bone of the femoral head was obtained. The fibular bone grafted method and cementation method provided optimal stress transfer behaviors. Here. substantial increase in the low stress level was observed when the penetration depth was extended to 0mm and 5mm from the subchondral region. Moreover, significant decrease in PVMS due to surgery was observed in the fibular bone grafted method and the cementation method when the penetration depths were extended up to 0 and 5mm from the subchondral region. The drop in PVMS was greater during toe-off than during heel-strike (57% vs. 28% in Type IV and 49% vs. 22% in Type V). Both the vascularized fibular bone grafting method (Type IV) and the new PMMA technique (Type V) appear to be very effective in providing good stress transfer and reducing the peak Von-Mises stress within the necrotic region. Overall results show that fibular bone grafting and cementation methods are quite similar. In light of above results, the new cementation method appears to be a promising surgical alternative or the treatment of ONFH. The use of PMMA for the core can be less prone to surgical complication as opposed to preparation of fibular bone graft and can achieve more immediate fixation between the core and the surrounding region.

• 한방재활의학과학회지
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• 제32권3호
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• pp.37-53
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• 2022

Objectives This study was conducted to investigate a randomized controlled trial study on the clinical treatment of herbal medicines for avascular necrosis of the femoral head. Methods By March 2022, the China National Knowledge Infrastructure (CNKI) was reviewed about randomized controlled trial studies on the herbal treatment of avascular necrosis of the femoral head through. The publication year, evaluation criteria, treatment period, treatment method and effectiveness were analyzed for articles published from 2017 to 2022. Results 16 articles were selected and 14 kinds of herbal medicines were used. In most studies, Western medical treatments such as injection therapy, oral drug administration, traction therapy and mid-frequency electric therapy were treated alone in the control group, and a combination of Western medical treatment and herbal treatment was administered to the experimental group. Conclusions In China, there have been many studies on herbal treatment for avascular necrosis of the femoral head. In Korea, more clinical studies on the herbal treatment of avascular necrosis of the femoral head are needed. This study will be helpful for future research in Korean medicine on avascular necrosis of the femoral head.

• 한방재활의학과학회지
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• 제31권1호
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• pp.195-204
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• 2021

Objectives The purpose of this study is to report the effects of Korean medicine treatments including Chuna manual therapy, pharmacopuncture and acupuncture for two patients who have pain in hip joint diagnosed with avascular necrosis of the femoral head. Methods The treatment effect was evaluated with a numeric rating scale (NRS), range of motion (ROM), physical examination (Patrick test), and score of Harris hip score (HHS). Results After treatment, symptoms of the two patients such as hip joint pain and gait dysfunction were improved. The NRS decreased from 8 (right [Rt.]), 7 (left [Lt.]) to 4 (Rt.), 3 (Lt.) in case 1 and from 9 to 2 in case 2. Also the patients showed improvement in ROM and score of HHS increased from 55.5 to 88.5 in case 1 and from 63.5 to 85.5 in case 2. In addition, positive Patrick test improved to negative. Conclusions Korean medicine treatments including Chuna manual therapy, pharmacopuncture and acupuncture can be effective in relieving pain and recovering the fucnction of hip joint associated with avascular necrosis of the femoral head, even when surgery is recommended. Although further study such as controlled studies is needed.

• 대한핵의학회지
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• 제28권2호
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• pp.206-213
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• 1994

연구배경 : 대퇴골두 무혈성 괴사는 그 병기에 따라 단순 X선과 뼈스캔, MRI상에서 다양하게 보이며 초기에는 X선과 뼈스캔상에서 발견할 수 없는 경우가 흔히 있다. 뼈스캔의 대퇴골두 무혈성 괴사는 그 병기에 따라 다른 형태로 보일 수 있으며 진행된 병변에서는 다른 관절질환과 감별하기 어려울때가 많다. 이에 저자들은 대퇴골두 무혈성 괴사의 병기에 따른 뼈스캔의 유형을 분류하고 다양하게 보일 수 있는 원인을 분석하고자 하였다. 대상 및 방법 : 대상환자는 고관절통과 보행장애를 주소로 내원한 90명의 179개의 대퇴골두를 대상으로 하였고 이들 환자에서 단순 X선과 뼈스캔, MRI가 모두 시행되었으며 후향적 조사에 의하여 비교하였다. 결과: 1) 179개의 대퇴골두 중 156개의 골두는 무혈성괴사를 가지고 있었다. 36개의 대퇴골두는 MRI상 조기 병변이었고 120개는 진행병변이었다. 90명의 환자에서 22명이 한쪽의 병변을 가지고 있었으며 68명이 양측성의 병변을 가지고 있었다. 2) 단순 X선과 뼈스캔의 대퇴골두 무혈성 괴사의 진단율은 MRI를 기준으로 하였을 때 각각 85%, 91.6%였다(Table 1). 3) 9개의 대퇴골두가 뼈스캔상에서 초기의 무혈성 괴사소견(1, 2형)을 보였으나 단순 X선상에서 정상이었다. 이외의 병변들에서는 뼈스캔과 단순 X선의 병기 사이에는 비교적 일치하는 소견을 보였다(Fig. 2). 4) 뼈스캔에는 정상이었으나 13개의 대퇴골두가 MRI상에서는 조기 병변을 보였고, MRI에서 조기병변을 보이는 경우는 뼈스캔상에서 대개 1이나 2의 유형을 보였고 진행병변은 뼈스캔상에서 2, 3, 4형에 해당하였다(Table 2). 5) 뼈스캔상에서 정상소견을 보였으나 MRI에서 무혈성괴사 소견을 보였던 병변은 그 병변의 크기가 1/4에서 1/5정도로 작은 병변이며, 이 작은 병변이 대개는 대퇴골두의 전상방에 위치하며, MRI상의 저신호 강도 띠와 함께 지방골수 신호강도변화를 보였다(Table 3). 6) 뼈스캔상에서 비전형적인 유형을 보인 대퇴골두 무혈성 괴사병변의 단순 X선 소견은 대개가 단순 X선 병기 4와 5에 해당하였고, MRI에서 병변의 크기가 1/2이상의 큰 병변 이었으며 많은 관절삼출액, 심한 관절강 연조직 및 관절막 비후 또는 이차성 골관절염등을 동반하고 있었다(Table 2). 결론 : 결론적으로 뼈스캔은 초기 대퇴골두 무혈성괴사는 단순 X선 보다는 높고, MRI보다는 낮은 진단율을 보였다. 그 원인으로는 초기 병소의 크기와 위치에 따라 다를 것으로 추정된다. 진행성 병변은 MRI상에서 주위의 충혈 정도, 관절삼출액의 정도, 주위의 퇴행성 변화 또는 관절내 연조직 비후의 정도에 따라 다양하게 보이는 것으로 생각된다.