Relativity Study On Alcohol-Induced Osteonecrosis Of The Femoral Head Treated By Hip-Preserving

Background:Osteonecrosis of the femoral head is aworldly difficult to treat,in the event,if there is no effective intervention,the vast majority of lesions become heavier to carry out their own little chance of improvement.Outcome of disease is varying degrees of femoral head collapse,thus affecting the hip joint function,most patients need to artificial arthroplasty ultimately. Non-traumatic ONFH occurs in 20 to 50-year-old,and young and middle-aged patients with artificial joint replacement is still difficult to predict the long-term efficacy;a considerable number of patients will face two or more of the replacement in lifetime.Patients will suffer to enormous economic and physical burden undoubtedly.Therefore,early necrosis of the femoral head, medium of choice for treatment is the hip-preserving.Reported in the literature,10%-74%of NONFH in patients have long-term history of alcohol abuse.2004-2007 year in the focus of hip disease specialist department of our hospital,there are 529 cases of NONFH treated in patients,266 of which cases have a long history of alcohol abuse,accounting for 50.28 percent.At the same time,TCM Syndrome type of alcohol-induced ONFH is between phlegm and stasis,but steroid-induced ONFH is between deficiency and stasis,there are differences between the pathogenesis of which may affect its hip-preserving efficacy.Therefore,we need to study AIONFH in isolation.We designed a minimally invasive bone marrow decompression with pressure bone graft and internal bracket implanting surgery integrating Chinese medicine to treat AIONFH,to evaluate the prognosis of AIONFH and hip-preserving efficacy,analysis the related factors that effect the hip-preserving.Influence "treatment between phlegm and stasis" of AIONFH in patients with blood lipid levels and blood hemorrheology,to explore incidence relations between the "interrelation between phlegm and stasis" and AIONFH, the role in "treatment between phlegm and stasis" of AIONFH.Methods:1.Clinical study of pressure bone graft and internal bracket implanting surgery integrating Chinese medicine to treat the AIONFH93 patients(123 hips) were hospitalized in Department of hip-disease of the ist affiliated hospital of Guangzhou University of Chinese Medicine who were recruited strictly in the light of diagnosis criteria,bringing into criteria and excluding criteria devised in the project from January 2004 to December 200?,who treated with a minimally invasive bone marrow decompression with pressure bone graft and internal bracket implanting surgery integrating Chinese medicine.Investigate the impact of factors including:age,side of other phases is being frog-bit sub-type(necrotic parts),are frog-bit sub-type combinations,the pain index,bone marrow edema,the total range of motion,Harris score,necrotic area,is situated frog-bit collapse the degree of pain and time.EXCEL 2000 for the use of data entry,SPSS 13.0 for statistical analysis.Measurement data using t test,variance analysis,count data using chi-square test,class rank and test data used,two variables related to the use of Spearman and Pearson correlation analysis,multi-variable related to the use of multiple linear regression analysis,two sets of data dependence analysis the use of canonical correlation analysis,survival curve analysis using Log-rank test and Cox proportional hazards regression analysis.2.The influence "treatment between phlegm and stasis" of AIONFH in patients with blood lipid levels and blood hemorrheology58 patients were hospitalized in Department of hip-disease of the 1st affiliated hospital of Guangzhou University of Chinese Medicine who were recruited strictly in the light of diagnosis criteria,bringing into criteria and excluding criteria devised in the project from July 2008 to February 2009, of which 17 patients of traumatic osteonecrosis(control group),41 patients of AIONFH(treatment group),who take Chinese medicine of eliminating phlegm andstasis.Before treatment all patients were hemospasia detected peripheral lipid and hemorheology in early morning;treatment group was given Chinese medicine of eliminating phlegm and stasis,after two weeks they were hemospasia detected peripheral lipid and hemorheology in early morning again.The measured value of SPSS 13.0 statistical software using paired t inspection to mean±standard deviation((?)±s) indicated. Results:1 Clinical study of pressure bone graft and internal bracket implanting surgery integrating Chinese medicine to treat the AIONFH1.1 Observing correlative analysis before and after operation,results showed that:①Pre-operative greater range of motion,then the higher pre-operative Harris score;②Pre-operative more severe degree of bone marrow edema and necrosis of the greater range,the index of the higher pre-operative pain;③Pre-operative Harris score the higher the index the more pre-operative pain in light,the smaller the necrotic area,the higher score after Harris;④Severe pre-operative staging,pre-operative typing is situated for the C2, frog-bit pre-operative patients with more severe collapse,then the relationship between post-operative acetabular head the more discordant,more severe cartilage degeneration;⑤Older,poorer pre-operative Harris classification,the higher post-operative pain index;⑥Pre-operative staging of patients with more severe post-operative pain index lower;⑦Post-operative pain index was significantly lower than pre-operative;⑧Post-operative Harris scores and the grading score was significantly higher than that pre-operatively.1.2 Analysis of survival curve of the femoral head1.2.1 the survival time of the femoral head following-up the clinical. The average follow-up of 36.4 months,the survival rate is 82.2%of the femoral head,the average survival time of 56.624 months.1.2.2 Discussion of the pre-operative and post-operative indicators of the impact on the survival curve(Log-rank test) We can see:①Survival curves of age on the impact of the femoral head,25 to 35-year-old,36 to 45-year-old age are higher than the age above 46-year-old in the survival rate of the femoral head;②Pre-operative frog-bit sub-type of head impact on the survival rate curve, frog-bit pre-operative classification of the femoral head for the C1 frog survival rate is greater than for the C2-bit sub-type of the survival of the femoral head;③A number of factors after operation affecting the survival curve,the higher post-operative pain index,after the more serious the degree of orthotopic collapse,after collapse of the extent of frog bit more serious,the first disharmony acetabulum,joint instability,cartilage degeneration,the more serious,the lower the survival rate of the femoral head.④Most pre-operative factors(other side,pre-operative pain index,the degree of pre-operative bone marrow edema,pre-operative total range of motion, pre-operative staging,pre-operative typing is situated,before being frog-bit sub-type combination of necrotic area,pre-operative value of orthotopic collapse,collapse pre-operative frog-bit value,pain and time, pre-operative Harris score,etc.) of the femoral head had no effect on the survival rate curve.1.2.3 COX proportional hazards regressionthe higher post-operative pain index,the greater probability of failure of the hip;its corresponding relative risk was 3.102 on a pain index for each additional level of security risk of hip failure is 3.102 times the original.2.The influence "treatment between phlegm and stasis" of AIONFH in patients with blood lipid levels and blood hemorrheology:①Contrast to traumatic osteonecrosis of the femoral head,to some extent, AIONFH is relationship with lipid metabolism,TG,ApoB and ApoB/ApoA are higher, while HDL and ApoA is reduced;②The patients with AIONFH after treatment is to make better lipid levels, CHOL,HDL,LDL,ApoA,ApoB and ApoB/ApoA are reduced;③The patients with AIONFH contrast to the patients with traumatic ONFH,there is no significant difference in blood hemorrheology;④The patients with AIONFH after treatment with Chinese medicine have improved in the blood hypercoagulable state,200/S,30/S,3/S,HCT(X),Arbe,ηc,EPT,HRV and IR are reduced,while ESR and K are increased.Conclusion:1 Clinical study of pressure bone graft and internal bracket implanting surgery integrating Chinese medicine to treat the AIONFH①Pressure bone graft and internal bracket implanting surgery integrating Chinese medicine to treat AIONFH,clinical follow-up of 36.4 months,the survival rate of the femoral head is about 82.2%,Harris score was 90.99± 7.325 points,an excellent rate of 92.53%,achieved satisfied with the efficacy of hip-preserving,to verify our choice of treatment options and indications are reasonable.②In clinical,more than 46 years of age and necrosis frog-bit is located in the C2-type in patients,we recommend the use of other methods of hip-preserving,or even artificial hip replacement may be considered.③Grasping correctly on the hip-preserving indication(including age,stage, site of necrosis,necrotic area,etc.),adhere to integrate Chinese medicine with western medicine,to improve the surgical techniques,to enhance patient cooperation in order to enhance hip-preserving efficacy,to reduce the patient's economic and emotional burden with playing an important role on social significance.2 The influence "treatment between phlegm and stasis" of AIONFH in patients with blood lipid levels and blood hemorrheology:①"Interrelation between phlegm and stasis" is the key pathological in AIONFH;②"Treatment between phlegm and stasis" is to improve hyperlipidemia and high blood viscosity state.③"Treatment between phlegm and stasis" provide the clinical basis for the "not sick" and "anti-change disease".