Steriod-induced osteonecrosis of femoral head (SIONFH) cystic degeneration have a "double-edged sword" effect. The method of activating blood and dredging collate is effective in the treatment of early SIONFH, but its regulatory effect on bone resorption/angiogenesis/osteogenic protein in cystic degeneration remains unclear.

To investigate the effect of activating blood and dredging collate method on serum bone resorption/angiogenesis/osteogenic protein in patients with cystic degeneration of SIONFH.

Sixty patients with SIONFH admitted to the Hip Joint Research Center of Guangzhou University of Traditional Chinese Medicine from January 2019 to January 2021 were included as the study subjects and divided into the control group and treatment group according to random number table method, with 30 cases in each group. Another 30 volunteers with normal physical examination in hospital at the same period and no history of hormone use were selected as the normal group. The treatment group was treated with Huoxuetongluo capsule (2 g/time, 3 times/day) and calcium carbonate (600 mg/time, 1 time/day), the control group was treated with the same amount of calcium carbonate, and the course of treatment of both groups was 12 months, simultaneously limiting weight-bearing on the affected limb. Fasting serum was collected, and the expression levels of nuclear factor κB receptor activating factor ligand (RANKL), platelet-derived growth factor-BB (PDGF-BB), vascular endothelial growth factor A (VEGFA), osteoprotegerin (OPG) and cadherin-associated protein (CTNNB1) in serum were detected by enzyme-linked immunosorbent assay. The patients were followed up twice at the 6th and 12th month after discharge, and the collapse of femoral head was defined as the end event. Hip pain visual analogue score (VAS), hip function (Harris) score and necrotic area score were used to evaluate the efficacy.

Baseline RANKL, PDGF-BB, OPG and CTNNB1 levels were compared among the three groups, and the differences were statistically significant (P<0.05). The results of intergroup comparison showed that RANKL and PDGF-BB in the control group and treatment group were higher than those in the normal group, while OPG and CTNNB1 were lower than those in the normal group, the difference was statistically significant (P<0.05). Repeated measurement ANOVA results showed that time and group had interaction effects on RANKL, PDGF-BB, VEGFA, OPG and CTNNB1 levels (P<0.05), time and group had significant main effect on RANKL, PDGF-BB, VEGFA, OPG and CTNNB1 levels (P<0.05). The level of RANKL in the treatment group was higher than that in the control group at the 6th month, the level of PDGF-BB in the treatment group was higher than that in the control group at the 12th month, and the levels of VEGFA, OPG and CTNNB1 were higher than those in the control group at the 6th and 12th months (P<0.05). At the 12 months after treatment, the hip VAS and necrotic area score of the treatment group were lower than those of the control group, and the hip Harris score was higher than that of the control group (P<0.05). The results of intragroup comparison showed that at 12 months after treatment, hip VAS and necrotic area score in the treatment group were lower than those before treatment, and hip Harris score was higher than that before treatment (P<0.05) ; hip VAS and hip Harris score in the control group were higher than those before treatment (P<0.05) .

Activating blood and dredging collate method can up-regulate the protein expression levels of RANKL, PDGF-BB, VEGFA, OPG and CTNNB1 in patients with SIONFH, effectively promote bone repair and improve clinical symptoms of SIONFH patients. It is hypothesized that this drug can promote the bone repair of cystic degeneration through the "bone resorption/angiogenesis/osteogenesis" repair network.