Research On Treatment Of Femoral Head Necrosis Using Femoral Head Centesis Combined With Injection Of Tetramethylpyrazine

ObjectivesTo investigate the effectiveness and feasibility of treatments of rabbit femoral head necrosis induced by steroid injection using core decompression combined with injection of tetramethylpyrazine, and to provide the primary foundation for the further research. To evaluate the effectiveness of treatments of femoral head necrosis caused by different pathogeny using core decompression combined with injection of tetramethylpyrazine, and provides the primary datum for the further clinical application.MethodsThe study was divided into two parts. Part I was animal experiment, and part II was clinical study.Part I:The establishment of rabbit femoral head necrosis caused by steroid.48 adult New Zealand rabbits were injected with Prednisolone acetate 8mg/kg/time, twice one week,16 times totally. Penicillin and Gentamicin were injected meanwhile to prevent infection. Blank group was injected with equal dose of saline at the same time. The animals were divided into four groups after the successful induction. Group A: blank group. Group B:model group. Group C:core decompression group. Group D:core decompression combined with injection of tetramethylpyrazine. The animals in group C were managed with core decompression subtrochanterly at immediately after induction and 2,4,6 week. The animals in Group D were managed with core decompression plus injection of tetramethylpyrazine at the same time. Core decompression and injection of drug were not managed in animals in Group A and B. Three animals in all groups were sacrificed at 1,3,5 and 7 weeks after management. The femoral heads were prepared for observation of tectology, new formation of bone by computation analysis, blood vessels account and area by immunity histochemistry with VEGF.Part II:Collecting 65 patients with 78 hips of femoral head necrosis from 2002 January 2002 to January 2007 in Orthopedic Department of accessory hospital of Chengdu University of Tradition Chinese Medicine.38 patients with 47 hips were male and 27 patients with 31 hips were females. The average age were 48.9 ranged from 20 to 73. The mean following-up was 3.5 years ranged from 1.5 to 6.5 years. The patients were managed with core decompression subtrochanterly and injection of tetramethylpyrazine every week.4 week was a period of treatment, and the next period of treatment started after two months rest. Generally the patients received 2～3 periods of treatment. The assistant function exercise was carried out at during the treatment. Clinical effectiveness was observed periodically with Oxford Hip Joints Evaluation System, and radiology effectiveness with ARCO Stage and Type System.All datum were dealt with SPSS11.5 statistical software.ResultsAnimal study results①Histology:The structure of Group A femoral head was normal. Necrosis was found in Group B femoral head, and there was no changes with time elapsed. In Group C, the necrosis of femoral head was ameliorated after core decompression. The necrosis of femoral head in Group D was ameliorated gradually, and the structure of femoral head was nearly normal at 7 week after treatment.②The area of new bone formation:There was no significant difference between Group A and Group B (P>0.05),and there was significant difference between Group D and Group B and C (P<0.05) there was significant difference in Group D at time 5 week and 7 week (P<0.05).③Blood vessels and area:There was no significant difference between Group B and C at all times (P>0.05).There was significant difference between Group D and Group B and C at all times (P<0.05).There was significant difference in Group D at all times (P<0.05)Clinical observation results①Clinical effectiveness results: excellent 24.4%(19hips), good 37.2%(29 hips), moderate 25.6% (20 hips), unacceptable 12.8%(10hips), total choiceness rate 61.6%; By stages choiceness rate:stageⅠ72.7%(11 hips), stageⅡ67.6%(34 hips), stageⅢ56.0%(25 hips), stageⅣ37.5% (8hips); By types choiceness rate:type A73.1%(26 hips), type B 63.7%(22 hips), type C 57.1%(21hips);②Radiology effectiveness results:excellent 11.5%(9 hips), good 41.0%(32hips), moderate 30.8%(24hips), unacceptable16.7%(13 hips), total choiceness rate 52.6%(70 hips)。By stages choiceness rate:stageⅠ63.6%(11 hips), stageⅡ55.9%(34 hips), stageⅢ52.0%(25 hips), stageⅣ50.0% (8v); By types choiceness:type A 57.7%(26 hips), type B 59.1% (22 hips), type C40.9%(22 hips)ConclusionsCore decompression combined with injection of etramethylpyrazine can increase the positive expression of VEGF in endothelium, promote the formation of blood vessels and new bone, by which mechanism the femoral head was repaired. Core decompression combined with injection of etramethylpyrazine can improve the function of hips significantly in femoral head necrosis patients, and promote the repair of femoral head, prevent the dent of femoral head or delay the process of dent, which provides the theoretical foundation for further clinical application in some extent.