Correlational Research Between BME And Imaging Change Of Osteonecrosis Of Femoral Head Treated By Comprehensive Hip-preserving Of Chinese Medicine

ObjectiveOsteonecrosis of femoral head (ONFH) is a common and refractory disease, which affect young aged 30-50. Preserving the femoral head (hip-preserving therapy) is becoming important in ONFH study. Bone Marrow Edema (BME) is the associated sign in the ONFH progresses showing in MRI, but the mechanism is not well known. Besides, the related researches between BME and the prognosis of the hip-preserving therapy are not so much. So, the study is designed in order to analyze the influence of BME to the imaging change after the comprehensive hip-preserving therapy of Chinese medicine, discuss the mechanism of BME and find the suitable therapy when BME appears in MRI.MethodsUsing retrospectively analysis, we collected 73 cases of patients who were diagnosed ONFH and treated with the comprehensive hip-preserving therapy of Chinese medicine in the First Affiliated Hospital of Guangzhou University of Chinese Medicine from September 2010 to October 2013. The cases were divided into two groups according to BME sign in MRI, among which 41 hips were mild,32 hips were severe. After an average of 28.07±6.33 months (19-43) following-up, the differences between the two groups were analyzed in age, gender, traditional Chinese Medicine(TCM) Syndrome-types classification, operation method, survival time, depression of the last follow-up of femoral head, postoperative progress of femoral head about X-ray (matching degree between femoral head and acetabulum, stability of hip joint). SPSS 19.0 was used for statistics analysis and P<0.05 was considered as the significant difference.ResultsThe BME degree was statistically difference between the TCM Syndrome-types classification (P<0.05). The statistical differences of the postoperative degree of collapse in anteroposterior (AP) and frog-leg X-ray were found between the different BME degree (P<0.05). There were statistical differences of the postoperative degree of collapse in AP and frog-leg X-ray between the different BME degree in the minimally invasive surgery. In the mild BME group, the significant differences of the 4 postoperative factors were found between the capsulotomy and the minimally invasive surgery. In the severe BME group, there were statistical differences of the postoperative degree of collapse in frog-leg X-ray and stability of hip joint between the two surgeries. There was no significant difference between BME and age, gender (P>0.05) or statistical difference between BME degree and femoral head survival curve (P>0.05). No statistical difference of the postoperative factors were found out between the different BME degree in the capsulotomy (P>0.05).Conclusion1. BME results from the abnormal mechanical stress of the ONFH repair, and it may relate with the instability of the femoral head and the bone trabecula fractures.2. BME influence the efficacy of the treatment in preserving of ONFH, the more severe BME gets the worst result than the mild ones.3. Some certain measures must be taken promptly in order to prevent them from getting worse, when the severe BME is found.