| Objective:To observe the clinical efficacy and imaging changes of surgical dislocation,head and neck fenestration,necrosis bone removal,ILIAC bone graft support(open operation),minimally invasive core decompression,bone graft,allograft fibular support(minimally invasive operation)in the treatment of ARCO III stage femoral head necrosis with ONFH classification based on three-column structure,the success rate of hip preservation was evaluated by the new standard of Professor Li Zirong.Methods:The study included Onfh Arco III patients who underwent both operations between January and March 2017 in the Second Department of orthopaedics of the Guangxi University of Chinese Medicine.All patients were divided into two groups: Group A and Group B,20 patients with stage a ARCO III,20 hips,aged [35.2 ± 8.8] years,including 18 males,18 females,2hips,according to the causes,11 hips were alcoholic,5 hips were hormonal and 5 hips were idiopathic;according to Cjfh,7 hips were L1 type,4 hips were l2 type,9 hips were L3 type;Group B included 20 ARCO III B patients(22 hips,age [43.0 ± 10.4] years),including 17 males(19 hips),4 females(4hips),alcohol(12 hips),hormone(7 hips),idiopathic(3 hips),and JFC-H(5 hips),l2 Type 3 hip,L3 type 14 hip,according to the surgical method can be divided into open surgery treatment of 10 hip,minimally invasive surgery treatment of 12 hip.Patients in both groups were treated with ONFH preparation and limited weight-bearing by oral administration of Traditional Chinese medicine.Both groups were followed up for more than 12 months.Harris hip function score and standard score of ONFH were observed at 6,9and 12 months before and after treatment,the imaging changes were compared before operation and 12 months after operation,and the success rate of hip preservation was evaluated according to the new standard of Professor Li Zirong,including postoperative complications,adverse drug reactions,etc..Results:A total of 3 hips were lost in the two groups,of which 1 hip was lost in group A.Two hips were lost in group B.All the other patients completed the follow-up on time.The follow-up results were statistically analyzed as follows:1.Statistical results of Harris score(1)In group A,the preoperative Harris score of open surgery and minimally invasive surgery was(78.9±2.2)and(78.7±1.9),respectively,and the Harris score of 12 months after surgery was(89.7±6.3)and(85.8±8.0).In group B,the preoperative Harris score of open surgery and minimally invasive surgery was(69.8 ± 10.6)and(67.1 ± 8.4),respectively,and the Harris score of 12 months after surgery was(82.9±5.7)and(81.5± 5.3),respectively.Harris score of the two treatments in group A and GROUP B 12 months after surgery was significantly different from that before surgery(P <0.05).(2)Comparison between group A and group B showed that the Harris score of group A was higher than that of group B at 12 months follow-up(P <0.05).There was no significant difference in minimally invasive surgery between group A and group B(P > 0.05).2.Imaging efficacy evaluation resultsIn group A,the effective rate of hip preservation was 78% in patients with open surgery,70% in patients with minimally invasive surgery,and 74%in group A.The effective rate of hip preservation was 56% in group B with open surgery,36% in group B with minimally invasive surgery,and 46% in group B overall.3.New standard results for hip retention successAccording to Professor Li Zirong’s new standard for hip preservation,the success rate of patients in group A and GROUP B was 47% and 15%respectively.Conclusion:1.Surgical head and neck fenestration,necrotic bone removal,compression bone grafting,iliac bone flap support combined with oral Chinese medicine,minimally invasive core decompression,compression bone grafting,allograft fibula support combined with oral Chinese medicine are all effective in the treatment of PATIENTS with ARCO ⅲ A and ARCO ⅲ B ONFH.The therapeutic effect of ONFH ARCO ⅲ A was better than ONFH ARCO ⅲ B.Open hip preservation surgery is better than minimally invasive treatment.2.Imaging evaluation criteria: The effective rate of ARCO ⅲ A was 74%,and that of ARCO ⅲ B was 46%.The hip preservation effect of these two operations was better than that of ARCO ⅲ B patients.3.For professor Li Zirong’s new criteria for hip preservation success,the results of this study were difficult to meet the criteria,mainly reflected in the difficulty of reaching 90 points in Harris score.However,some patients with "survival with collapse" whose Harris score did not reach 90 points had higher quality of life and satisfactory clinical efficacy. |
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