[1]张家雯,谭彪,颜炎.基于肌骨共病探讨激素性股骨头坏死的病理机制和中医病机[J].中医正骨,2025,37(11):76-80.
点击复制

基于肌骨共病探讨激素性股骨头坏死的病理机制和中医病机()

《中医正骨》[ISSN:1001-6015/CN:41-1162/R]

卷:
第37卷
期数:
2025年11期
页码:
76-80
栏目:
学术探讨
出版日期:
2025-11-20

文章信息/Info

作者:
张家雯1谭彪2颜炎3
1.宁夏张氏正骨医院,宁夏 银川 750001; 2.重庆市中医院,重庆 400020; 3.重庆中医药学院,重庆 402760
关键词:
股骨头坏死 激素类 病理过程 中医病机 骨骼 肌肉 肌骨共病
摘要:
激素性股骨头坏死(steroid-induced osteonecrosis of the femoral head,SONFH)是骨科临床难治性疾病,好发于中青年人群。SONFH的病理机制研究多聚焦于骨,但局限于骨的SONFH病理机制并不能解释SONFH患者临床症状与股骨头病理改变不一致的现象。SONFH的发生并非单一的骨组织病变,而是骨与肌同步衰退的系统性病变。本文对肌骨共病进行了概述,并基于肌骨共病探讨了SONFH的病理机制和中医病机,为临床治疗SONFH提供了参考。

参考文献/References:

[1] ZHANG J,CAO J,LIU Y,et al.Advances in the pathogenesis of steroid-associated osteonecrosis of the femoral head[J].Biomolecules,2024,14(6):667.
[2] DONG Y,YUAN H,MA G,et al.Bone-muscle crosstalk under physiological and pathological conditions[J].Cell Mol Life Sci,2024,81(1):310.
[3] CARIATI I,BONANNI R,ONORATO F,et al.Role of phy-sical activity in bone-muscle crosstalk:biological aspects and clinical implications[J].J Funct Morphol Kinesiol,2021,6(2):55.
[4] KOKKINOPOULOU I,MOUTSATSOU P.Mitochondrial glucocorticoid receptors and their actions[J].Int J Mol Sci,2021,22(11):6054.
[5] 牟虹霖,侯德才,魏波,等.基于筋骨并重理论中医内治法联合髓芯减压+人工骨植骨术治疗股骨头缺血性坏死[J].长春中医药大学学报,2020,36(2):402-405.
[6] HUANG C,WEN Z,NIU J,et al.Steroid-induced osteonecrosis of the femoral head:novel insight into the roles of bone endothelial cells in pathogenesis and treatment[J].Front Cell Dev Biol,2021,9:777697.
[7] SHAO W,WANG P,LV X,et al.Unraveling the role of endothelial dysfunction in osteonecrosis of the femoral head:a pathway to new therapies[J].Biomedicines,2024,12(3):664.
[8] MACLEOD C,HADOKE P W F,NIXON M.Glucocorticoids:fuelling the fire of atherosclerosis or therapeutic extinguishers?[J].Int J Mol Sci,2021,22(14):7622.
[9] 王晓萍,张亚衡,周明旺.激素性股骨头坏死发病机制研究进展[J].陕西医学杂志,2025,54(3):429-432.
[10] LI N.Platelets as an inter-player between hyperlipidaemia and atherosclerosis[J].J Intern Med,2024,296(1):39-52.
[11] 环大维,袁兆丰,窦维强,等.动态对比增强核磁评价股骨头坏死微循环灌注的改变[J].中国组织工程研究,2023,27(36):5864-5869.
[12] 林苗远,杨继滨,闫文强,等.组织工程技术促进股骨头坏死骨组织再血管化的研究进展[J].中国修复重建外科杂志,2021,35(11):1479-1485.
[13] POOLE D C,KANO Y,KOGA S,et al.August Krogh:mu-scle capillary function and oxygen delivery[J].Comp Biochem Physiol A Mol Integr Physiol,2021,253:110852.
[14] DUNFORD E C,MANDEL E R,MOHAJERI S,et al.Metabolic effects of prazosin on skeletal muscle insulin resistance in glucocorticoid-treated male rats[J].Am J Physiol Regul Integr Comp Physiol,2017,312(1):R62-R73.
[15] 丁红,莫茵,丁薇,等.FACT3d脂肪定量技术评估非创伤性股骨头坏死髋周肌肉改变的可行性研究[J].影像研究与医学应用,2025,9(6):60-62.
[16] 李纪书,郭成龙,任行全,等.激素性股骨头坏死相关信号通路及发病机制研究概述[J].现代中医药,2024,44(1):5-10.
[17] KERACHIAN M A,S?GUIN C,HARVEY E J.Glucocorticoids in osteonecrosis of the femoral head:a new understanding of the mechanisms of action[J].J Steroid Biochem Mol Biol,2009,114(3/4/5):121-128.
[18] 首健,陈佩杰,肖卫华.糖皮质激素对骨骼肌代谢的调控及其机制[J].中国药理学通报,2019,35(5):602-606.
[19] ZHU Y,HU Y,PAN Y,et al.Fatty infiltration in the musculoskeletal system:pathological mechanisms and clinical implications[J].Front Endocrinol(Lausanne),2024,15:1406046.
[20] KIRK B,LOMBARDI G,DUQUE G.Bone and muscle crosstalk in ageing and disease[J].Nat Rev Endocrinol,2025,21(6):375-390.
[21] LUO D,GAO X,ZHU X,et al.Identification of steroid-induced osteonecrosis of the femoral head biomarkers based on immunization and animal experiments[J].BMC Musculoskelet Disord,2024,25(1):596.
[22] ZHENG J,YAO Z,XUE L,et al.The role of immune cells in modulating chronic inflammation and osteonecrosis[J].Front Immunol,2022,13:1064245.
[23] PETRACKOVA A,HORAK P,SAVARA J,et al.High cumulative glucocorticoid dose is associated with increased levels of inflammation-related mediators in active rheumatoid arthritis[J].Front Immunol,2024,15:1505615.
[24] 颜炎,李泰贤,傅繁誉,等.针刀刺激肌筋膜疼痛触发点治疗股骨头坏死的疗效观察及作用机制探讨[J].中医正骨,2020,32(11):62-65.
[25] CHOI B C,MIN B W,LEE K J.Factors affecting the elevation of inflammatory markers before primary total hip arthroplasty[J].Arthroplast Today,2025,33:101669.
[26] ZHU C,DING X,CHEN M,et al.Exercise-mediated skeletal muscle-derived IL-6 regulates bone metabolism:a new perspective on muscle-bone crosstalk[J].Biomolecules,2025,15(6):893.
[27] CHEN F,FU J,FENG H.IL-6 promotes muscle atrophy by increasing ubiquitin-proteasome degradation of muscle regeneration factors after cerebral infarction in rats[J].Neuromolecular Med,2025,27(1):3.
[28] 王雨顺,郑鉴锐,罗玉鸿,等.巨噬细胞介导的骨免疫在股骨头坏死中的作用及其机制研究[J].中国修复重建外科杂志,2024,38(1):119-124.
[29] 朱烜烨,梁浩博,张蕾蕾,等.辅助性T细胞17在股骨头坏死发生发展中的作用[J].中国中医骨伤科杂志,2024,32(11):93-96.
[30] KANAI M,GANBAATAR B,ENDO I,et al.Inflammatory cytokine-induced muscle atrophy and weakness can be ameliorated by an inhibition of TGF-β-activated kinase-1[J].Int J Mol Sci,2024,25(11):5715.
[31] CAO Y,ZHOU J,QUAN H,et al.Resistance training alleviates muscle atrophy and muscle dysfunction by reducing inflammation and regulating compromised autophagy in aged skeletal muscle[J].Front Immunol,2025,16:1597222.
[32] 袁颖嘉,易艳梓,李津,等.髋外展肌锻炼对非创伤性股骨头坏死患者三维步态及塌陷率的影响[J].中国组织工程研究,2025,29(33):7211-7216.
[33] LI S,LIU Y,ZHOU G,et al.Pre-collapse femoral head necrosis treated by hip abduction:a computational biomechanical analysis[J].Health Inf Sci Syst,2022,10(1):8.
[34] BUCKTHORPE M,STRIDE M,VILLA F D.Assessing and treating gluteus maximus weakness—a clinical commen-tary[J].Int J Sports Phys Ther,2019,14(4):655-669.
[35] WU Y B,LIU G B,LI H,et al.Three-dimensional distribution of subchondral fracture lines in osteonecrosis of the femoral head[J].J Orthop Transl,2024,47:97-104.
[36] OTAKA K,OSAWA Y,TAKEGAMI Y,et al.Fatty infiltration of periarticular muscles in patients with osteonecrosis of the femoral head[J].Int Orthop,2025,49(5):1073-1080.
[37] GEARY M B,ORNER C A,SHAMMAS H,et al.The surgical destabilization of the abductor muscle leads to development of instability-associated hip osteoarthritis in mice[J].J Hip Preserv Surg,2023,10(3/4):158-165.
[38] LANZA M B,ARBUCO B,RYAN A S,et al.Systematic review of the importance of hip muscle strength,activation,and structure in balance and mobility tasks[J].Arch Phys Med Rehabil,2022,103(8):1651-1662.
[39] JOYNER M J,CASEY D P.Regulation of increased blood flow(hyperemia)to muscles during exercise:a hierarchy of competing physiological needs[J].Physiol Rev,2015,95(2):549-601.
[40] 莫亮,王章正,江梦钰,等.基于血瘀理论探析股骨头坏死骨髓水肿[J].中国中西医结合杂志,2025,45(3):379-384.
[41] ARUWAJOYE O O,PATEL M K,ALLEN M R,et al.Microcrack density and nanomechanical properties in the subchondral region of the immature piglet femoral head following ischemic osteonecrosis[J].Bone,2013,52(2):632-639.
[42] 邱璐,郑清华,郑相颖,等.基于营卫-气血-络脉系统探讨冠状动脉微血管疾病的发病机制[J].中医学报,2025,40(5):1-9.
[43] 王思远,阮艺涛,陈进春,等.基于“肾虚、痰湿、血瘀”的现代生物学基础探讨强直性脊柱炎中医病机的科学内涵[J].风湿病与关节炎,2024,13(5):48-52.
[44] 周静,梅志刚.基于“栓炎反应”探讨缺血性中风瘀热证的生物学实质及中医药防治研究现状[J].中国中药杂志,2024,49(23):6533-6540.
[45] 李泰贤,张彦琼,黄泽青,等.从分子网络解析非创伤性股骨头坏死不同中医证候的生物学基础及其对证方药的作用机制[J].中国实验方剂学杂志,2020,26(16):192-204.
[46] 张楚,王骁汉,马兆臣,等.补肾壮骨方治疗非创伤性股骨头坏死肝肾亏虚证的功效内涵解析及临床验证[J].中医正骨,2024,36(7):10-16.
[47] 丁明乾,瞿倩倩,王然芸,等.股骨头坏死MRI表现与中医证型的相关性分析[J].影像研究与医学应用,2021,5(24):54-56.
[48] 陈志健,张苏雅,丁龙龙,等.从“病-证-方”关联视角探讨熟地强筋丸治疗激素性股骨头坏死的疗效特点和机制[J].中国实验方剂学杂志,2025,31(10):1-16.

相似文献/References:

[1]陈雷雷,张颖.何伟教授采用中医药疗法治疗股骨头坏死的经验[J].中医正骨,2015,27(10):74.
[2]徐西林,赵永兰,张晓峰,等.活骨注射液髋关节腔灌注对兔股骨头坏死模型 血管内皮生长因子表达的动态影响[J].中医正骨,2015,27(08):1.
 XU Xilin,ZHAO Yonglan,ZHANG Xiaofeng,et al.Dynamic effect of intra-articular hip injection of Huogu injection on the expression of vascular endothelial growth factor in rabbit models with femur head necrosis[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2015,27(11):1.
[3]周勇,任菲菲,丰凡翔,等.血管内皮生长因子和骨形态发生蛋白2 在非创伤性股骨头坏死不同区域的表达[J].中医正骨,2015,27(08):7.
 ZHOU Yong,REN Feifei,FENG Fanxiang,et al.Expressions of vascular endothelial growth factor and bone morphogenetic protein 2 in different zones of femoral head with non-traumatic osteonecrosis[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2015,27(11):7.
[4]鲍荣华,王国平,夏晓斌,等.钽棒植入治疗非创伤性股骨头坏死的疗效观察[J].中医正骨,2015,27(02):28.
[5]张兵,马凰富,刘波,等.非创伤性股骨头坏死的舌象定量研究[J].中医正骨,2015,27(04):8.
 ZHANG Bing,MA Huangfu,LIU Bo,et al.Quantitative study on tongue manifestation of patients with nontraumatic osteonecrosis of femoral head[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2015,27(11):8.
[6]李刚,程春生.股骨头坏死血瘀证症状与平乐郭氏正骨方药药物组成 最大频繁关联模式挖掘[J].中医正骨,2015,27(04):21.
 LI Gang,CHENG Chunsheng.Maximal frequent association pattern mining for studying the relationship between BLOOD STASIS syndrome in patients with osteonecrosis of femoral head and drug components of Pingle Guo's orthopedics prescription[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2015,27(11):21.
[7]李文龙,梅沉成,杜贵强,等.微创减压植骨多孔钽棒植入治疗 ARCOⅡ期非创伤性缺血性股骨头坏死[J].中医正骨,2016,28(02):43.
[8]张磊,金红婷,童培建.骨健口服液早期干预非创伤性股骨头坏死的临床研究[J].中医正骨,2016,28(03):14.
 ZHANG Lei,JIN Hongting,TONG Peijian.Clinical study on Gujian Koufuye(骨健口服液)for early intervention of nontraumatic osteonecrosis of femoral head[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2016,28(11):14.
[9]鲍荣华,王国平,夏晓斌,等.直接前入路微创全髋关节置换术治疗晚期股骨头坏死[J].中医正骨,2016,28(03):61.
[10]张超,姚晨,沈计荣.微创髓芯减压打压支撑植骨术结合补肾活血汤口服治疗ARCOⅡ、Ⅲ期股骨头坏死的近期疗效观察[J].中医正骨,2016,28(03):20.
 ZHANG Chao,YAO Chen,SHEN Jirong.[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2016,28(11):20.
[11]沈莹姗,何敏聪,庄至坤,等.激素性股骨头坏死和酒精性股骨头坏死的病理学差异及其分子机制研究[J].中医正骨,2023,35(05):1.
 SHEN Yingshan,HE Mincong,ZHUANG Zhikun,et al.Pathological differences between steroid-induced and alcohol-induced osteonecrosis of the femoral head and their molecular mechanisms[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2023,35(11):1.
[12]简羿,马茂潇,郭珈宜,等.基于多重免疫组化技术探讨股骨头坏死愈胶囊治疗激素性股骨头坏死的作用机制[J].中医正骨,2024,36(02):23.
 JIAN Yi,MA Maoxiao,GUO Jiayi,et al.The mechanism of Gugutou Huaisiyu Jiaonang(股骨头坏死愈胶囊)in treatment of steroid-induced osteonecrosis of femoral head:a multiplex immunohistochemistry technique-based experimental study[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2024,36(11):23.
[13]李威,张博淳,周忠起,等.补肾活血胶囊防治大鼠激素性股骨头坏死的效果及其微生物组学和代谢组学作用机制研究[J].中医正骨,2025,37(05):6.
 LI Wei,ZHANG Bochun,ZHOU Zhongqi,et al.Efficacy of Bushen Huoxue Jiaonang(补肾活血胶囊)against steroid-induced osteonecrosis of the femoral head in rats and its microbiomics and metabonomics mechanisms:an experimental study[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2025,37(11):6.
[14]周婷婷,李华燕,赵云超,等.鹿角胶干预激素性股骨头坏死模型小鼠的效果及作用机制研究[J].中医正骨,2025,37(09):36.
 ZHOU Tingting,LI Huayan,ZHAO Yunchao,et al.Therapeutic effects and mechanisms of cervi cornus colla on model mice with steroid-induced osteonecrosis of the femoral head:an experimental study[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2025,37(11):36.

备注/Memo

备注/Memo:
基金项目:重庆市自然科学基金面上项目(CSTB2023NSCQ-MSX0695); 中国博士后科学基金资助项目(2022M720596)
通讯作者:颜炎 E-mail:yanyan_1029@163.com
更新日期/Last Update: 1900-01-01