Prospective Study Of Peri-collapse Stage Of Osteonecrosis Of The Femoral Head Treated By Hip-preserving Therapy

Objective:To perform a prospective study on the treatment of pericollapse stage(ARCOⅡ~Ⅲa stage)necrosis of femoral head by Intervention treatment with traditional Chinese medicine(T.C.M.)therapy and core-decompression with bone grafting and traditional Chinese medicine(T.C.M.),and investigate the effectiveness of hip-preserving treatment and compare the efficacy difference between two treatment methods,so as to seeking the effective and feasible hip-preserving treatment for peri-collapse stage necrosis of femoral head.Methods: Filter the patients in Xinan Medical University Affiliated Hospital of Traditional Chinese Medicine according to the criteria of inclusion,exclusion,elimination and dropping from January 2010 to December 2014.A total of 70 patients(80 hips)were included,they were divided into Chinese medicine interventional perfusion group(intervention group,35 cases,40 hips)and core decompression with bone grafting group(decompression group,35 cases,40 hips)according to the different methods of treatment,After 1 year of follow-up,recorded the result of patient’s peri-operative indicators(length of hospital stay,operative time,intraoperative blood loss,the total cost in hospital),harris hip score and imaging evaluation.SPSS17.0 software was used for statistical analysis.All the measurement data were expressed as(x±S).Chi-square test was used for enumeration data,t test was used for normal distribution,with P<0.05 as the significant level.Results:All the cases were followed up for 12-23 months,with an average duration of13.6 months.A total of 80 hips including intervention group and decompression group,but there are 4 hips accepted the hip arthroplasty by the illness aggravation during the follow-up and 1 hip lost to follow-up,finally a total of 75 hips.Conclusion in four aspects as follows : 1.Perioperative indicators:no statistical difference was found in length of hospital stay between two groups(t=2.514,P>0.05);Intervention group was superior to decompression group in the operation time,intraoperative blood loss and total medical costs(t=15.224,P< 0.05;t=13.247,P < 0.05;t=10.329,P < 0.05).2.Overall effecacy:Harris hip score showed that 47 hips were excellent,and excellent rate was 62.67%,14 hips were good,and good rate was 18.67%,6 hips were moderate,account for8.00%,8 hips were poor,poor rate was 10.67%,the excellent and good rate was81.33 %.Radiographic evaluation:There were 56 hips stable and 19 hips aggravation among the 75 hips of intervention group and decompression group,the stability rate was 74.67% and the aggravation rate was25.33%.3.Comparsion between groups by clinical stage:(1)In ARCOⅡ stage:The harris hip score of intervention group is higher than decompression group with Significant difference(x~2= 5.249,P=0.033)while the imaging stablity rate had no significant difference between two groups(c 2=1.687,P=0.073);(2)In ARCOⅢa stage:The imaging stablity rate of intervention group is lower than decompression group(c 2=2.416,P=0.044)while The harris hip score had no significant difference between two groups(x~2=1.541,P=0.077).4.Comparison ingroup by clinical stage:(1)In intervention group:The harris hip score as well as the imaging stablity rate in ARCOⅡstage was higher than that of ARCO Ⅲa stage with signifcant difference(c 2=6.337,P=0.035),(c 2=9.247,P=0.034);(2)In decompr-ession group:The imaging stablity rate in ARCOⅡstage was higher than that of ARCO Ⅲa stage with signifcant difference(x~2=6.47,P=0.031)while the harris hip score had no signifcant difference between ARCOⅡstage and ARCOⅢa stage(x~2=2.006,P=0.057).Conclusion:1.Intervention treatment with traditional Chinese medicine(T.C.M.)therapy and core-decompression with bone grafting and traditional Chinese medicine(T.C.M.)can both improve the clinical symptoms,signs and stabilize the imaging performance of Osteonecrosis of femoral head during peri-collapse stage;2.This study preliminarily shows that the short-term effect of intervention treatment with traditional Chinese medicine(T.C.M.)therapy had no significant difference to core-decompression with bone grafting and traditional Chinese medicine(T.C.M.),but ntervention treatment with traditional Chinese medicine(T.C.M.)therapy is superior to core-decompression with bone grafting and traditional Chinese medicine(T.C.M.)in improving patients’ pain and joint function;3.Choosing the appropriate staging,making the reasonable hip-preserving treatment will obtain satisfactory effecacy,This study shows interventional treatment achieves satisfactory effecacy for patients in ARCOⅡstage,while core decompression with bone grafting has a better effect for patients in ARCOⅢa stage;4.The effecacy assessment of ONFH should combine Harriship score function evaluation and imaging evaluation,so as to make the assessment more objective and comprehensive;5.Interventional treatment for Osteonecrosis of femoral head has advantages of low cost,minimal invasion,simple operation and improve the blood supply obstacles of femoral head rapidly,while core decompression with bone graft can not only improve the blood supply obstacles of femoral head but also correct the biomechanical unstablity of femoral head.