Researching The Relationship Between The Integrity Of The Lateral Column And Anterolateral Column Of The Femoral Head And The Efficacy Of Fibular Support Surgery Based On Microscopic Syndrome Differentiation Of Chinese Medicine

ObjectiveBy measuring the indexes related to the integrity of the lateral column and the anterolateral column of Osteonecrosis of Femoral Head(ONFH),quantitatively research the relationship between the integrity of the lateral column and the anterolateral column of femoral head and the degree of femoral head collapse after fibular support surgery.It provides a new quantitative reference index for microscopic syndrome differentiation and treatment of ONFH.MethodsA retrospective analysis was performed on 53 patients(65 hips)with nontraumatic ONFH who underwent hip preservation treatment by fibula support surgery in the First Affiliated Hospital of Guangzhou University of Chinese Medicine from January 2017 to December 2018.The preoperative indicators reflecting the integrity of the lateral column and anterolateral column of the femoral head were measured,including the lateral femoral head index(LHI),lateral wall index(LWI),anterolateral head index(ALHI),anterolateral wall index(ALWI),lateral necrosis index(LNI),and anterolateral necrosis index(ALNI).Meanwhile,the degree of femoral head collapse during postoperative follow-up was measured to evaluate the surgical efficacy.Finally,statistical methods were used to analyze the relationship between the integrity of the lateral column and anterolateral column of the femoral head and the degree of femoral head collapse after fibular support surgery.Results1.Among 53 patients(65 hips)in this study,the mean age was 33.35±9.09 years old,and the follow-up time was 25.00(23.00,27.00)months.The number of male hips was 53(81.54%),and the number of female hips was 12(18.46%).The number of right hips was39(60.00%)and the number of left hips was 26(40.00%).Among the etiologies,26 cases(40.00%)were alcoholic,31 cases(47.69%)were drug-induced,and 8 cases(12.31%)were idiopathic.In the degree of postoperative collapse,34 cases were <2mm,accounting for52.31%,14 cases were 2-4mm,accounting for 21.54%,17 cases were >4mm,accounting for 26.15%.In the progression of postoperative collapse,34 hips(52.31%)advanced to the early stage(collapse ≤2mm),and 31 hips(47.69%)advanced to the late stage(collapse >2mm).2.According to the degree of femoral head collapse < 2mm,2-4mm and > 4mm,were divided into three groups.Statistical analysis showed that there were significant differences in LHI,LWI,ALHI,ALWI,LNI and ALNI among different groups,and P values were all less than 0.001.Comparison among groups showed significant differences in LHI,LWI,ALHI,ALWI,LNI and ALNI between <2mm group and 2-4mm group or between <2mm group and >4mm group,with P values less than 0.001.However,there were no significant differences in LHI,LWI,ALHI,ALWI,LNI and ALNI between 2-4mm group and >4mm group,with P values greater than 0.05.3.According to the criteria of ARCO staging in 2019,the patients were divided into two groups according to the degree of postoperative progression: early stage(collapse≤2mm)and late stage(collapse > 2mm).Statistical analysis showed that there were significant differences in LHI,LWI,ALHI,ALWI,LNI and ALNI between the two groups,with P values less than 0.001.The ROC curve analysis of each index showed that the cutoff values of LHI,LWI,Al HI,Al WI,LNI and Al NI were 0.243,0.189,0.192,0.140,0.538 and0.510,respectively.AUC values were 0.916,0.890,0.873,0.861,0.964 and 0.906,respectively.LHI,LNI,and ALNI had a high predictive value(AUC > 0.9)for the advanced stage ONFH(collapse >2mm)after fibular support surgery,while LWI,ALHI,and ALWI had a moderate predictive value(0.8< AUC< 0.9).4.Univariate COX regression analysis showed that the risk of LHI ≥0.243 postoperative advanced stage(collapse >2mm)was 0.141 times higher than LHI <0.243.LWI ≥0.189 had a 0.101 times greater risk of postoperative advanced stage progression than LWI <0.189.ALHI ≥0.192 had a 0.255-fold greater risk of postoperative advanced stage progression than ALHI <0.192.The risk of ALWI ≥0.140 postoperative advanced stage was 0.355 times higher than ALWI <0.140.LNI ≥0.538 had a 9.865 times greater risk of postoperative advanced stage progression than LNI <0.538.ALNI ≥0.510 had a12.604 times greater risk of postoperative advanced stage progression than ALNI <0.510.In multivariate COX regression analysis,the risk of advanced stage postoperative progression to LHI ≥0.243 was 0.268 times higher than LHI < 0.243(stepwise multivariate COX regression)and 0.168 times higher than LHI <0.243(control baseline multivariate COX regression).the risk of advanced stage postoperative progression to ALNI ≥0.510 was 7.421 times higher than ALNI <0.510(stepwise multivariate COX regression)and 9.997 times higher than ALNI <0.510(control baseline multivariate COX regression).Conclusion1.The indicators related to the integrity of the lateral column and the anterolateral column of the femoral head can predict the degree of collapse and the progression of the disease after the fibular support surgery,and have good predictive value,which can provide a new quantitative reference index for the microscopic syndrome differentiation and treatment system of ONFH.2.LHI,LWI,ALHI and ALWI can quantitatively reflect the thickness of the necrotic lateral and anterolateral remaining normal bone of the femoral head,namely,the thickness of the lateral wall and the anterolateral wall.The relevant measures were inversely associated with the risk of collapse after fibular support surgery.The thicker the lateral wall and the anterolateral wall have lower the risk of advanced collapse after fibular support surgery.3.LNI and ALNI can quantitatively reflect the necrotic range of the lateral and anterolateral columns of the femoral head.The relevant measures were positively correlated with the risk of collapse after fibular support surgery.That is,the greater the range of necrosis of the lateral and anterolateral columns of the femoral head,the higher the risk of advanced collapse fibular support surgery.