| Objective:Osteonecrosis of the femoral head(ONFH)is a progressive disease caused by the death of bone cells and bone marrow components caused by abnormal blood supply of the femoral head,which leads to the collapse of the femoral head and serious joint destruction,causing joint pain and joint dysfunction.It is a common and refractory disease in orthopaedics.The vast majority of untreated patients will inevitably collapse of the femoral head.This study retrospectively analyzed the clinical efficacy of thick channel core decompression,compression and bone grafting combined with artificial bone support rod in the treatment of osteonecrosis of the femoral head(ARCO stage Ⅰ,Ⅱ,Ⅲ stage),and compared the degree of symptom improvement and the effect of operation.Methods:Twenty-six patients(35 hips)with early osteonecrosis of the femoral head treated in the Department of Orthopaedics of the first affiliated Hospital of Kunming Medical University from March 2019 to March 2020 were selected,including 15 males(22 hips)and 11 females(13 hips)with an age of 34.73±10.27 years.ARCO staging,China-Japan Friendship Hospital classification and modified necrotic index were performed before operation.All patients were treated with thick channel core drilling decompression,compression and bone grafting combined with artificial bone support rod implantation.All patients were followed up.In this study,Harris hip score was used to evaluate the improvement of clinical symptoms and hip joint function before and after operation,and VAS pain visual analogue scale was used to evaluate the improvement of pain.The pelvic X-ray films and MRI images taken before operation,3 months,6 months,1 year and the last follow-up were compared to evaluate whether the shape of the femoral head collapsed and whether the necrotic area was repaired or progressed.The end point was the collapse of the femoral head>4mm or hip arthroplasty.Kaplan-Meier survival analysis was used to analyze the survival rate of femoral head after hip salvage surgery.Results:The postoperative follow-up period ranged from 9 to 24 months,with an average of 18.4 months.The results of clinical evaluation were as follows:21 hips of steroid-induced osteonecrosis of femoral head,3 hips of idiopathic osteonecrosis of femoral head and 11 hips of alcoholic osteonecrosis of femoral head.ARCOI(7 hips),ARCOⅡ(20 hips),ARCOⅢ(8 hips),modified necrotic range index ≤ 33 group(11 hips),34-66 group(17 hips),≥ 67 group(7 hips),China-Japan Friendship Hospital(5 hips),type C(8 hips),L1 type(11 hips),L2 type(7 hips)and L3 type(4 hips).There was no significant difference in male to female ratio,average age and etiology among different stages,different necrotic ranges and different types(P>0.05).1.Most patients had good curative effect after hip preservation,VAS score decreased from 4.83± 1.65 points preoperatively to 2.20±0.95 points in the last follow-up(P<0.05),Harris score increased from 64.66±7.23 points preoperatively to 85.46±6.23 points in the last follow-up(P<0.05),with an excellent and good rate of 80%.At the last follow-up,most of the patients were stable in postoperative imaging examination,but 8 hips showed imaging progress(cystic degeneration,sclerosis band,and crescent sign),among which 6 hips failed to protect the hip(articular surface collapse>4mm).The overall survival rate of the femoral head after surgery was 82.9%.2.According to ARCO stage,the VAS score at the last follow-up was 1.01±0.39,2.32±0.75 and 3.80±1.43 in ARCO stage Ⅱ and ARCO stageⅢ respectively.Harris score was 93.03±3.04 at the last follow-up,85.88±5.97 at ARCOⅡ stage and 77.88±5.37 at ARCOⅢ stage.The VAS score of patients in ARCOⅠ stage was lower and Harris score was higher than other two groups(P<0.05).The VAS score of ARCOⅡ stage Ⅱ patients decreased by 3.04±0.71 points and Harris score increased by 21.76±4.69 points,which was more obvious than that of stage Ⅰ patients(p<0.05).At the end of ARCOⅢ follow-up,VAS score was the highest among the three groups,and Harris score was the lowest among the three groups(p<0.05).Imaging findings showed that 1 hip progressed 0 hips failed in ARCO stageⅠ,2 hips failed in stage Ⅰ,and 4 hips failed in stage Ⅲ 5 hips.Kaplan-Meier survival curve related to ARCO stage showed that the survival rate of stage Ⅲ(50%)was significantly lower than that of stage Ⅰ(100%)and stage Ⅱ(90%)(P<0.05).3.According to the classification of China-Japan Friendship Hospital,the VAS scores of M type,C type,L1 type,L2 type and L3 type in the last follow-up of China-Japan Friendship Hospital were 1.60 ±0.55,1.88±0.64,2.09±1.04,4.29±2.13,3.01±1.41.The last VAS score of L2 group was significantly higher than that of M type,C type and L1 type(P<0.05).There was no significant difference between L2 group and L3 type.At the last follow-up,the Harris scores of type M,type C,type L1,type L2 and type L3 were 88.69±2.19,88.20±3.15,86.30±6.90,75.18±9.15 and 80.01 ±7.95.The Harris scores of patients with type L2 were significantly lower than those of type M,type C and type L1 at the last follow-up,but there was no significant difference between type L2 and type L3.On imaging,0 hips of type M progressed,1 hip of type C failed,1 hip of L1 type failed,4 hips of L2 type failed,and 1 hip failed in 2 hips of L3 type.the Kaplan-Meier survival curve related to the classification of China-Japan Friendship Hospital showed that the survival rate of L2 type(42.9%)was significantly lower than that of M type(100%),C type(100%),L1 type(90.9%)and L3 type(75%)(P<0.05).4.In terms of modified necrosis index,the VAS score at the last follow-up was 1.91±1.14 in the group with modified necrosis index ≤33,2.12±0.97 in the group with modified necrosis index 34-66,and 4.43±1.99 in the group with≥67.The VAS score at the last follow-up was the highest in the group with≥67(P<0.05).The Harris score at the last follow-up was 88.17±4.37 in the ≤33 group,84.93±5.56 in the 34-66 group,and 74.77±7.79 in the ≥67 group.The Harris score at the last follow-up in the≥67 group was the lowest among the three groups(P<0.05).Imaging results showed 1 hip failure in 2 hips progression(≤33 groups),1 hip failure in 34-66 groups,and 4 hips failure in 5 hips progression(≥67 groups).Kaplan-Meier survival curve related to improved necrosis index showed that the survival rate of ≥67 group(42.9%)was significantly lower than that of ≤33 group(90.9%)and 34-66 group(94.12%)(P<0.05).Conclusions:1.Thick channel core decompression,compression and bone grafting combined with artificial bone support rod implantation is an effective method for the treatment of early osteonecrosis of the femoral head,with good clinical efficacy and surgical safety.2.In the treatment of early osteonecrosis of the femoral head with thick channel core decompression,compression and bone grafting combined with artificial bone support rod,the curative effect and prognosis of patients with ARCOI stage were better than those of Ⅱ and Ⅲ stage,and the curative effect of ARCOⅢ stage patients was worse and the failure rate of hip preservation was higher.3.The patients classified as type L2 in China-Japan Friendship Hospital had poor curative effect and high failure rate of hip preservation.4.The curative effect of the operation was poor and the failure rate of hip preservation was higher in patients with modified necrotic range index≥ 67. |
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