| BackgroundOsteonecrosis of femoral head is a chronic and difficult disease in clinic,and in the final stage of the disease,the rate of disability is very high.In recent years,the incidence of femoral head necrosis is gradually increasing.According to the first epidemiological survey of non-traumatic femoral head necrosis in China,there are about 7.5 million to 10 million patients with femoral head necrosis in China.And nearly 300,000 new patients are diagnosed each year,most of them are young and middle-aged.These patients are in the prime of life,if not treated properly,about70-80% of the patients may progress to collapse of the femoral head within 3 years,and the patients may be disabled by the disease.Young patients are active and have high quality of life requirements,in the final stage of the disease,they need total hip arthroplasty to improve their quality of life,which not only brings great physical damage and economic burden to the patients themselves,but also brings unimaginable economic loss to the society and the country.Therefore,for patients with osteonecrosis of femoral head,especially young and middle-aged patients,it is necessary to choose appropriate hip preservation therapy.In recent years,the treatment of femoral head osteonecrosis has been certain development,hip preservation treatment of femoral head osteonecrosis is numerous,including drug therapy,physical therapy and surgical treatment.Currently,there is a lack of standardized opinions on drug and physical therapy for femoral head necrosis in clinical practice,and there are few clinical studies.The curative effect is not as accurate as surgical treatment,so surgical treatment is preferred for early femoral head osteonecrosis.Marrow core decompression is the most widely used and controversial hip preserving surgery in clinical practice.The latest medical evidence indicates that core decompression surgery alone is far less effective than combined with other hip preserving procedures.Allograft bone grafting can provide the corresponding physical support to the femoral head after core decompression and reduce the occurrence of surgical complications.At the same time,it also provides a certain material basis for bone growth.Marrow core decompression with thick passage and allogeneic bone grafting is a simple operation,small trauma,long time to carry out,and has a positive effect on early necrosis of femoral head after operation.In addition,heavy smoking,excessive alcohol consumption,glucocorticoid intake,and obesity were significantly associated with an increased risk of non-traumatic osteonecrosis of the femoral head.Glucocorticoid intake and excessive alcohol consumption were the most common causes of non-traumatic femoral head osteonecrosis.Different studies have shown that patients with femoral head osteonecrosis of different etiologies adopt the same surgical treatment,and there may be differences in postoperative outcomes.ObjectiveTo investigate the recent outcomes of marrow core decompression with thick passage and allogeneic bone grafting in patients with early-stage osteonecrosis of the femoral head,and to evaluate whether there is any difference in the efficacy between corticosteroid and alcoholic femoral head necrosis by using this procedure,so as to provide reference for clinical work.MethodsFrom January 2017 to December 2018,clinical data of patients with corticosteroid and alcoholic femoral head osteonecrosis treated by marrow core decompression with thick passage and allogeneic bone grafting were selected from the orthopedics department of Henan People’s Hospital.A total of 90 patients(112hips)were included for retrospective analysis.35 patients(46 hips)with corticosteroid femoral head osteonecrosis(corticosteroid group),including 21 males(28 hips)and14 females(18 hips),the mean age was(35.8 ±10.1)years old,and the time from taking corticosteroid to symptom onset was 24(6,120)months,ARCO stage: 28 patients with stage Ⅱa(hip)and 18 patients with stage Ⅱb(hip).Alcoholic femoral head osteonecrosis(alcoholicl group)was observed in 55 patients(66 hips),all of whom were male.The mean age was(42.3±10.5)years,the time from drinking to symptom onset was 180(48,480)months,ARCO stage: 39 patients with stage Ⅱa(hip)and 27 patients with stage Ⅱb(hip).At 12 and 24 months after the surgery,Visual Analogue Scale(VAS)and Harris score were used to evaluate the surgical efficacy and hip function of the two groups.CT examination was performed 24 months after surgery to compare the collapse of the femoral head between the two groups.ResultsAfter 24 months of follow-up of 90 patients(112 hips),the preoperative VAS scores in the corticosteroid group and alcoholicl group were(4.41±0.77)and(4.41±0.67).The VAS scores of the two groups 12 months after surgery were(3.00±0.86)and(3.06±0.83),and the VAS scores of the two groups 24 months after surgery were(2.00±1.05)and(1.83±0.95).There was no significant difference in the VAS scores between the corticosteroid group and alcoholicl group(P>0.05).The preoperative Harris scores of the corticosteroid group and alcoholicl group were(67.97±6.29)and(69.12±6.84).The Harris scores of the two groups 12 months after surgery were(79.52±5.50)and(79.42±6.06.).The Harris scores of the two groups 24 months after operation were(83.25±7.55)and(86.46±5.74).There was no significant difference in the Harris scores between the corticosteroid group and alcoholicl group before surgery and 12 months after surgery(P>0.05).There was significant difference in Harris scores between the corticosteroid group and alcoholicl group 24 months after surgery(P<0.05).After 24 months of CT examination,there was no significant difference in the collapse of femoral head between the two groups(P>0.05).ConclusionsMarrow core decompression with thick passage and allogeneic bone grafting can effectively improve the clinical symptoms of corticosteroid group and alcoholicl early osteonecrosis of the femoral head.In the short term,the postoperative efficacy of patients with alcoholic femoral head osteonecrosis is better than that of patients with corticosteroid femoral head osteonecrosis. |
PDF Full Text Request