Retrospective Study Of Hip Arthroscopic Focus Debridement And Core Decompression And Bone Grafting In The Treatment Of Early And Middle Osteonecrosis Of The Femoral Head

Objective: To compare the clinical effects of focus debridement combined with core decompression and autogenous iliac mixed allogeneic bone graft with simple core decompression and autogenous iliac mixed allogeneic bone graft in the treatment of early and middle stage avascular necrosis of the femoral head under hip arthroscopy.to provide a basis for the selection of hip preservation treatment.Methods: The data of patients with avascular necrosis of the femoral head in Yulin Red Cross Hospital from June 2016 to March 2018 were collected.according to the inclusion and exclusion criteria,44 patients who met the requirements were selected on the premise that all operations were performed by the same group of doctors.44 patients were divided into observation group(n = 22)and control group(n = 22)for retrospective study.The observation group was treated with focus debridement plus core decompression and autogenous iliac mixed allogeneic bone graft under hip arthroscopy,while the control group was treated with traditional core decompression and autogenous iliac mixed allogeneic bone graft.The basic preoperative data of the two groups were as follows: 15 males and 7 females in the observation group,6 in stage I,11 in stage II,5 in stage IIIA,6 in alcoholism,5 in steroid,5 in trauma and 6 in idiopathic.The average age was 40.59 ±7.25 years old.The preoperative BMI index and Harris score were 22.75 ±2.75(kg/m2)and 59.18±6.29 respectively,and 11 males and 11 females in the control group.There were 8cases of stage I,8 cases of stage II,6 cases of stage IIIA,7 cases of alcoholic,5cases of steroid,5 cases of trauma and 5 cases of idiopathic.The average age was40.95 ±7.61.The preoperative BMI index and Harris score were 22.92 ±2.62,57.81±6.65 respectively.All patients were followed up for 3 months,12 months,24 months and the last follow-up.The total follow-up period ranged from 24 months to5 years and 9 months,with an average of 46.50 ±1.97 months.The data of preoperative basic data,intraoperative blood loss,operation time,postoperative complication rate and postoperative harris,postoperative head preservation success rate(reexamination imaging changes,improvement of osteonecrosis of the femoral head or no progress in staging)of the two groups were statistically analyzed.Results:The average operation time in the observation group was 140.81 ±13.13 minutes,and that in the control group was 94.22 ±5.88 minutes,which was significantly longer than that in the control group(P < 0.01).Repeated measurement analysis of variance and multivariate analysis of variance showed that the Harris scores of the two groups were significantly improved from pre-operation to 3months after operation to 12 months after operation,and there was no significant difference at 12 months,24 months and the last follow-up.There was no significant difference in Harris score between the observation group and the control group before operation and 3 months after operation.However,from 12 months after operation to the last follow-up,the observation group was significantly better than the control group(P < 0.01).The total head-holding rate of the observation group was better than that of the control group,and the difference was statistically significant.The head-keeping rate of stage I was 100% of that of the two groups(0.262 > 0.05).The head-holding rate of);IIIA was compared(0.080 > 0.05),and the total head-holding rate of the observation group was better than that of the control group(0.031 < 0.05),and the difference was statistically significant.Although the head retention rates of II stage and IIIA stage in the observation group were higher than those in the control group,there was no significant difference in statistics.Conclusion: 1.In the hip preservation treatment of patients with early and middle stage avascular necrosis of the femoral head,hip arthroscopic focus debridement plus core decompression combined with bone grafting and core decompression combined with bone grafting are safe and effective.2.Compared with simple core decompression combined with bone grafting,hip arthroscopic focus debridement plus core decompression combined with bone grafting has a better clinical effect in the hip preservation treatment of patients with avascular necrosis of the femoral head in the early and middle stages.