| Objective: The clinical effect of core decompression combined with bone support rod grafting in patients with femoral head necrosis in our department was retrospectively analyzed.To evaluate the optimal timing of surgery,the improvement of hip function,symptom and operative effect were compared in patients with different ranges of necrosis.Methods: Thirty-seven patients(hip 45)admitted to the Department of Orthopedics,the First Affiliated Hospital of Kunming Medical University from June 2020 to January 2022 and diagnosed as femoral head necrosis(ARCO stage II)were collected.All patients were treated by the same doctor with core decompression,compression bone grafting combined with artificial bone support rod implantation.The patients were classified according to the degree of femoral head necrosis.The classification criteria were based on the modified necrosis range index,and the necrosis index was divided into the following three groups according to the measured results: Group A: index ≤33;Group B: Index 34-66;Group C: Index ≥67.All patients were followed up in the outpatient department after surgery,and the preoperative and postoperative general conditions,imaging changes,Harris functional scores and VAS scores of patients were compared and evaluated.Results: General information: A total of 37 patients(45 hips)were enrolled in this study,including 21 males(27 hips)and 16 females(18 hips).All patients were followed up from 12 months to 27 months,with an average follow-up time of 16.7±6.4 months.No postoperative complications,such as infection,lower limb vein thrombosis,delayed or non-union wound healing,or ectopic ossification,occurred during follow-up.Imaging results: All the affected hips were healed with bone graft,and most of the patients showed stable lesions on X-ray and MRI during follow-up.The density of femoral head of 39 hips increased compared with that before surgery,and the shape of femoral head showed no significant change.37 The total lesions in the necrotic area of hip did not increase significantly compared with that before surgery.6 hips showed progressive manifestations of femoral head necrosis,mainly manifested as crescent sign progression,uneven density of femoral head and overall expansion of necrotic area,among which 4 hips showed appearance changes or even collapse of femoral headHarris score results: By the end of the last follow-up,the Harris score of the three groups was significantly higher than that before surgery,and the difference was statistically significant(P < 0.05).The test of the final postoperative score among the three groups showed statistically significant difference(P < 0.05),and the test of variance showed no significant difference in the increase of mean value(P > 0.05).The overall good and good rate of affected hip increased from 33.3% before operation to82.2% at the last follow-up.Chi-square test showed significant difference in the excellent and good rates of group A and group B before and after surgery(P < 0.01),while there was no significant difference in the excellent and good rates of group C before and after surgery(P > 0.05).VAS scores results: Up to the last follow-up,hip pain scores were improved in all groups.The final VAS scores and improvement values among the three groups were significantly different by variance test(P < 0.01).There was no significant difference in the mean of pain improvement between group A and group B(P > 0.05).There was no significant difference between the last score and the preoperative score in group C(P >0.05).The overall good and good rate of affected hip increased from 35.6% before surgery to 84.4% at the last follow-up.Chi-square test showed significant difference in the excellent and good rates of group B before and after surgery(P < 0.01),and no significant difference in the excellent and good rates of group A and group C before and after surgery(P > 0.05).Conclusion: 1.Core decompression bone grafting combined with artificial bone support rod implantation is especially suitable for patients with clinical stage ARCOIIwith modified necrosis index between 34 and 66,and is equally effective for patients with modified necrosis index less than 33,but patients with modified necrosis index above 67 should be carefully selected.2.For patients with early necrosis of femoral head,core decompression combined with artificial bone support rod bone grafting has a definite effect,which can greatly improve patients’ symptoms and hip joint function,reduce pain,and delay the progression of necrosis.It is a safe and feasible hip saving surgery. |
PDF Full Text Request