| ObjectivesHip-preserving Treatment of Osteonecrosis of the Femoral Head (ONFH) has been implemented for in 20 years in China, and its unique effect has been confirmed by plenty of clinical practice. However, there are still no convincing scientific data to support this method for the disease, one of the main reasons is lack of specifications of the collection and storage of follow-up data. The data are incomprehensive and not well managed, which affect the utilization of these data and affect the credibility of the conclusion derived from them as well. At present, there are about 7.50-10 million patients with ONFH in China, and the number of neopathy cases increases almost 300,000 each year. If the follow-up management is well done which meet the requirements of the evidence-based medicine (EBM), then the result should be pretty convincing, and achieve objective evaluation of the curative effect and improve the weakness of clinical affairs. Meanwhile, doctors are responsible for patients'follow-up work. The in-patient treatment just last for a period of time, we should follow-up work so as to assure the therapeutic plan and the effect of the treatment, and direct the following relevant therapy. So great follow-up work is not only benefit to the improve patients'condition, but also improve doctors treating level as well. With the development of computer technique and database technology, the Database Management System (DBMS) has been used in medical domain for more than twenty years. In Western countries, it has been proved that the application of specialized follow-up database management system greatly promoted their surgical techniques and improved the scientific research level. However, there isn't any follow-up database management system for ONFH patients in China right now, which neither can provide complete and regular follow-up service for these patients, nor give efficient data support to the doctors doing follow-up work. Therefore, this study tries to build up a follow-up database which can reflect the process of clinical follow-up and the orthopedic features for non-traumatic ONFH patients and doctors. This database include the function of data input, inquiry, statistical analysis, image quantization and database maintenance, so it realize the objective of data storage, output, and intellectual statistical analysis. Through obtaining the clinical epidemiology characteristics, analyzing the relevant factors which influence the prognosis of ONFH and objectively evaluating the hip-preserving treatment effect effectively and completely, this data can provide support for the making of hip-preserving treatment scheme and improving the effect of this treatment, which may save medical resource for the whole society. Meanwhile, it can promote multi-center cooperation and resource sharing among the orthopedic department around the country for the preventing and treating of ONFH so as to reduce the damage of this disease, and provide convincing data for scientific research and reaching as well.MethodsFollow-up work is quite complicated and strict. In different department or for different disease, the requirement, procedure and regulation of follow-up work are also not the same. So the design of follow-up database should reflect the specialization features and the patients'real condition as well. The joint department of the First Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine is the only priority speciality of hip-joint disease which has been approved by the state administration of Traditional Chinese Medicine in 1997. The in-patient number of ONFH is over 1500 each year, and the operation number of is over 1000, more than 500 are hip-preserving operation, so plenty of cases can be followed-up. The department has scheduled its own follow-up scheme according to the features of the disease, and considered the establishment of follow-up net work database of ONFH as an important information construction for the department. Its a new tool for the department which utilize the computer technology, database technology and network technology to manage the data of the ONFH cases. As for the design of this database, we referred the follow-up procedure, related information and data of the joint department of the First Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine, and then make systematical analysis, functional analysis and workflow analysis of the follow-up data. After that, design the clinical follow-up form and related information forms of pericollapse stage of non-traumatic ONFH cases. The database is designed as nine separate tables based on the above table set which contains a total of 800 fields. The Non-traumatic ONFH (NONFH) follow-up network database was made through the combination of software as visual studio 2005, SQL 2005 and Photoshop CS and network programming techniques, graphic processing technology and database technology. Meanwhile, it also integrated the NONFH online image analysis function, so that we can strive for collecting as much related information as possible, and quantitative the graphs to meet the requirements of clinical follow-up and scientific research.ResultsSQL Server 2005 is a flexible and visualized website database whose security, affair handling and error controlling capacity is quite good. Based on the SQL Server 2005 database, we Initially established a NONFH follow up database which has the logical three-layer structure (B/S system) of user's browser, Web server and database servers. And we not only completed the interface design for the login, registration, entry, inquiry and graphics processing, but also formulated the clinical follow-up case report form (CRF), related information form and follow-up flow charts, which realizes the purpose of flexible entry of the patients'information, multiple functional inquiry, and achieve the function of automatic scoring, imaging data quantization and intellectual inquiry of NONFH patients. So it's fully satisfied the clinical surgeons'requirements for the flexible utilization and imaging quantization during the follow-up process, and ensures the integrity and specification of the data as well. The database management system highlights the specialized subject characteristics in contents, and it use dynamic web page which is conducive to communicate with other centers and to information updating, project extension and information sharing. Also, it can generate intuitive and clear statements which can improve the utilization efficiency of follow-up data for clinical doctors, researchers and teaching staffs, and it's hopeful to extend to lager clinical application before long. ConculsionsThe establishment of follow-up network database for NONFH can ensure the data integrity and conform to international regulation. We use paging style to input the data which can save the screen space and be rapid. Also, we apply strict input rules to avoid repeated input or data whose form is not confirm to the rules. What's more, the system provide mature inquiry function, flexible statistical analysis function, and multiple styles of data input/output function, which and it's possible for further analyzing or handling of the data. The establishment of this NONFH database can achieve multi-center information sharing and paperless follow-up management, and the integrated NONFH online image analysis software can quantity the necrosis features in real-time and do contribution to the modernized follow-up method for ONFH cases, and provide a new tool for the scientific research for ONFH which may provide solid basis and assurance for the clinical and scientific research for this disease. The operation of the system can do contributions for the scientific decision of hip-preserving scheme, improving the curative effect of this scheme and saving social medical resources. Right now the system runs fluently and doesn't have serious mistakes, but some function may need further debug during the clinical application so as to be much more stable and utilizable.
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