The Differential Diagnosis Basis Of Treating Osteonecrosis Of Femoral Head By Removing Stasis: The Aspect Of Bone Marrow Edema

Objects:It is critical to choose suitable cases with intensive knowledge if preserving treatment is considered.Beyond surgery,traditional Chinese medicine(TCM) is a kind of important treatment on osteonecrosis of the femoral head.The stasis is an outstanding factor in TCM theory about osteonecrosis, while sometimes there is few clinical symptoms.On osteonecrosis of femoral head,MRI is used for diagnosing early,judging site and extent of lesion. Now that MRI represents the character of tissue well,this study is to find more information by MRI for clinical decision. Methods:20 femoral heads of osteonecrosis were chosen randomly after total hip arthroplasty.The pathological sections were made and the reacting regions were divided into two groups according to the BME on STIR image.Every section was observed 5 times randomly and the pathologic changes were recorded such as necrotic bone,disintegrated bone,fat tissue,hemopoietic tissue, granulation tissue and fibrous tissue.There were 30 cases(54 hips) included in the clinical study.Such factors were observed as demographic character(age, gender),baseline diseases,ARCO classification,sclerotic band in X-ray, level of bone markers(TRACP 5b,osteocalcin),VAS scores,range of motion. The pain scores and range of motion were regarded as the main symptoms of bi syndrome.The influence of the clinical factors on BME was analyzed.SPSS13.0 software was used for statistics and p＜0.05 was considered as significant difference.Results:The histopathology study showed the granulation tissue in BME group was more common than non-BME group(p＜0.05).The fat tissue in non-BME group were more common than BME group(p＜0.05).The necrotic and disintegrated bone and fibrous tissue were similar in both group(p＞0.05).Cases in collapsed stage had more edema,the more serious edema was,the higher level the TRACP 5b was,with significant difference(p＜0.05).Although osteocalcin level decreased with edema,the result had no significant difference(p＞0.05).While age more than 30 years group showed more serious edema than younger group, but there was no significant difference(p＞0.05).Furthermore,there was no significant difference between the groups with sclerosis band;the groups with gender and the groups with steroid use.Pain was more serious and range of motion was more poor in collapsed stage(P＜0.05).Although pain was positively related to the BME(p＜0.05),there was no significant difference in negative correlation between range of motion and BME(P＞0.05). Conclusions:This study suggests that common MRI can show the progress of repair and unstable condition,which is connected with the histopathology, bone marker(TRACP 5b),radiology classification and clinical information (pain is a main symptom of bi syndrome).BME in MRI is some kind of reference for Traditional Chinese Medicine treatment based on stasis theory.It is practical to prognosis and treat ONFH based on syndrome differentiation referring to MRI signal character.The presentation of BME...