基于肝肾同源探讨股骨头坏死“肝肾-肌骨”协同下的骨吸收不均匀沉降-多维复合弓弦体系的发病机制  

Discussion on the Pathogenesis of Osteonecrosis of the Femoral Head Underthe System of Non-uniform Settlement During Bone Resorption andMultidimensional Composite Bowstring Working in Coordination withthe Theory of Liver-Kidney and Muscle-Bone Based on the Conceptof Liver and Kidney Sharing the Common Source

作　　者：张桂鑫 杨锋 张乐 刘杰[3] 陈志健 彭磊 符恩龙 刘树华 王常德 龚春柱[1] ZHANG Gui-Xin;YANG Feng;ZHANG Le;LIU Jie;CHEN Zhi-Jian;PENG Lei;FU En-Long;LIU Shu-Hua;WANG Chang-De;GONG Chun-Zhu(Shenzhen Pingle Orthopedic Hospital,Shenzhen 518010 Guangdong,China;Hunan University of Chinese Medicine,Changsha 410218 Hunan,China;Guangzhou University of Chinese Medicine,Guangzhou 510405 Guangdong,China;Zhanjiang Chinese Medical School,Zhanjiang 524094 Guangdong,China)

机构地区：[1]深圳平乐骨伤科医院,广东深圳518010 [2]湖南中医药大学,湖南长沙410218 [3]广州中医药大学,广东广州510405 [4]湛江中医学校,广东湛江524094

出　　处：《广州中医药大学学报》2024年第1期239-246,共8页Journal of Guangzhou University of Traditional Chinese Medicine

基　　金：广东省中医药局科研项目(编号:20231290);深圳市科技计划项目(编号:JCYJ20190813113201660)。

摘　　要：从中医学肝肾同源的生理基础出发,综合中医的“肾主骨”“肝主筋”“经筋理论”及现代骨科学的骨吸收塌陷学说、不均匀沉降理论和下肢肌骨弓弦结构理论,探讨股骨头坏死(ONFH)“肝肾-筋骨”协同下的骨吸收不均匀沉降-多维复合弓弦体系的发病机制。认为ONFH病机关键在于肝肾亏虚,肾之阴阳失衡导致了成骨细胞与破骨细胞介导的骨形成-骨吸收动态平衡的打破,表现为骨代谢水平的升高及股骨头局部的骨吸收活动的增强,进而导致股骨头的坏死和塌陷;肾主骨、肝主筋,筋骨共同构成髋关节的肌-骨-关节动静态系统,而塌陷的出现破坏了原本平衡的肌-骨-关节系统,同时肝血失养、肌肉筋脉失于濡养进一步加剧了髋周的软组织失衡,加速了肌-骨-关节动静态系统的崩塌,加快了股骨头塌陷进程,最终导致不可逆的结局。基于该发病机制,ONFH的中西医结合系统治疗当以中医整体观念为指导原则,通过不同方式促进股骨头内外的血液循环的局部改善,重建关节功能的协调性;同时应重视患者自身体质的调养,通过补肾调肝以恢复成骨-破骨水平的平衡,重构肌-骨-关节系统,从而有效延迟甚至避免ONFH的发生。From the perspective of the physiological basis of liver and kidney sharing the common source in traditional Chinese medicine(TCM),and by integrating the theory of kidney dominating bone,liver dominating tendon,and meridian sinew of TCM as well as the bone resorption and collapse theory,and non-uniform settlement theory and lower-limb musculoskeletal bowstring structure theory of modern orthopedics,the pathogenesis of osteonecrosis of the femoral head(ONFH)under the system of non-uniform settlement during bone resorption and multidimensional composite bowstring working in coordination with the theory of liver-kidney and muscle-bone was explored.The key to the TCM pathogenesis of ONFH lies in the deficiency of the liver and kidney,and then the imbalance of kidney yin-yang leads to the disruption of the dynamic balance of bone formation and bone resorption mediated by osteoblasts-osteoclasts,which manifests as the elevated level of bone metabolism and the enhancement of focal bone resorption in the femoral head,and then leads to the necrosis and collapse of the femoral head.It is considered that the kidney dominates bone,liver dominates tendon,and the tendon and bone together constitute the muscle-bone-joint dynamic and static system of the hip joint.The appearance of collapse destroys the originally balanced muscle-bone-joint system.Moreover,the failure of liver blood in the nourishment of muscles and tendons further exacerbates the imbalance of the soft tissues around the hip joint,accelerates the collapse of the muscle-bone-joint dynamic and static system,speeds up the process of femoral head collapse,and ultimately results in irreversible outcomes.Based on the above pathogenesis,the systematic integrative treatment of ONFH should be based on the TCM holistic concept,focuses on the focal improvement of internal and external blood circulation of the femoral head by various approaches,so as to rebuild the coordination of joint function.Moreover,attention should be paid to the physical constitution of the patients,

关 键 词：股骨头坏死 肝肾同源 肾主骨 肝主筋 经筋 骨吸收塌陷 不均匀沉降 弓弦结构 

分 类 号：R274.39[医药卫生—中医骨伤科学]