基于断裂力学探讨病证结合防控骨质疏松性髋部骨折的力学机制研究

The overriding goal of preventing osteoporosis is to avoid fractures. " Integration of Disease and Syndrome " is a vital strategy and diagnosis-treatment model for the treatment of osteoporosis in Chinese Medicine field. As to the different syndromes osteoporosis, however, the specific differences and scientific mechanisms of that to manage hip fracture still have not been elucidated. The pathological outcomes of different syndromes osteoporosis have commonality and individuality. It is precisely the difference in individuality that determines the integration of "disease" and "syndrome". Based on the previous finding that the use of fracture mechanics to evaluate the effect of kidney-tonifying method on osteoporotic hip fractures in rats was reliable, this study is proposed to① simulate the bones of rats with osteoporosis in Kidney-yin deficiency /Kidney-yang deficiency by Finite Element Analysis, showing the whole process from deformation, damage to fracture failure, in order to observe the characteristics of damage element, fracture index and crack propagation law,② consider the relationship between Kidney-yin deficiency/Kidney-yang deficiency and fracture toughness KIC in rats with osteoporosis by biomechanical study. We try to establish an objective relationship between the microscopic structural evolution of different syndromes osteoporosis and the macroscopic fracture mechanics response of hip fractures, thus further revealing the scientific of integration of disease syndrome manage osteoporotic hip fractures, to provide a new experimental basis for improving the clinical diagnosis and treatment level of osteoporotic hip fractures and the creation of new drugs.

防控骨质疏松症的首要目标是避免骨折的发生。“病证结合”是中医药界治疗骨质疏松症的重要策略和诊疗模式，但对不同证型的骨质疏松症，其防控髋部骨折的具体差别和科学机制仍然尚未阐明。不同证型骨质疏松症的病理结局有共性和个性，恰恰是个性的差异决定了“病”和“证”需要相结合。本研究基于前期发现运用断裂力学评价补肾法影响大鼠骨质疏松性髋部骨折的手段可靠，拟通过①有限元分析仿真大鼠骨质疏松症肾阴虚证与肾阳虚证的骨骼从变形、损伤到断裂破坏的全过程以观察损伤基元的特征、断裂指标及裂纹扩展规律；②生物力学实验研究大鼠骨质疏松症肾阴虚证与肾阳虚证和断裂韧度KIC的关系。试图在不同证型骨质疏松症微观结构演化与髋部骨折宏观断裂力学响应之间建立起客观性联系，从而进一步揭示病证结合在防控骨质疏松性髋部骨折的科学性和阐明其力学机制，为提高骨质疏松性髋部骨折的临床诊治水平和新药创制提供新的实验基础。

防控骨质疏松症的首要目标是避免骨折的发生。“病证结合”是中医药界治疗骨质疏松症的重要策略和诊疗模式，但对不同证型的骨质疏松症，其防控髋部骨折的具体差别和科学机制仍然尚未阐明。不同证型骨质疏松症的病理结局有共性和个性，恰恰是个性的差异决定了“病”和“证”需要相结合。本研究基于前期发现运用断裂力学评价补肾法影响大鼠骨质疏松性髋部骨折的手段可靠，拟通过①有限元分析仿真大鼠骨质疏松症肾阴虚证与肾阳虚证的骨骼从变形、损伤到断裂破坏的全过程以观察损伤基元的特征、断裂指标及裂纹扩展规律；②生物力学实验研究大鼠骨质疏松症肾阴虚证与肾阳虚证和断裂韧度的关系。试图在不同证型骨质疏松症微观结构演化与髋部骨折宏观断裂力学响应之间建立起客观性联系，从而进一步揭示“病证结合”在防控骨质疏松性髋部骨折的科学性，为提高骨质疏松性髋部骨折的临床诊治水平和新药创制提供新的实验基础。. 项目通过动物实验、力学实验及有限元仿真，证实了①肾阴虚证、肾阳虚证去势骨质疏松大鼠骨小梁微观结构及骨代谢指标存在显著差异。与肾阳虚证大鼠相比，肾阴虚证骨质疏松大鼠股骨近端骨小梁呈现“量多、质密、体薄”的形态特点，且肾阴虚证骨质疏松大鼠骨代谢过程明显加快。②在相同载荷下，与肾阴虚证相比，肾阳虚证骨质疏松性骨小梁抗应变能力明显减弱，更容易发生脆性骨折。③右归丸对肾阳虚大鼠股骨显微结构和生物力学性能有显著影响，右归丸能显著增强肾阳虚大鼠股骨骨组织体积、骨小梁厚度和断裂韧性，而右归丸对肾阴虚组大鼠股骨力学参数无显著影响。上述结果表明，不同证型的骨质疏松症存在系统性病理生理差异，中医药治疗骨质疏松症须遵循“病证结合”的诊疗模式。. 项目共发表相关论文2篇（其中SCI 1篇，北大中文核心1篇），外审SCI 1篇；共培养已毕业及待毕业硕士研究生4名。本研究基于断裂力学理论，利用药物反证法、有限元法，探究了不同证型骨质疏松症骨骼从变形、损伤到断裂破坏的全过程特征、断裂指标及裂纹扩展规律，对骨质疏松性髋部骨折进行宏细微观相结合的描述，从而揭示"病证结合"在防控骨质疏松性髋部骨折的科学性和作用机制，为临床提高防治不同证型骨质疏松症的效果和开发新的中药复方提供理论基础。

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