Observation And Management Of Adductor Muscle Of Vastus Medialis Contracture Of Patients With Femoral Head Necrosis Undergoing Hip Replacement

Objectives: To study the effect of hip replacement on adductor femoris contracture of patients with femoral head necrosis undergoing hip replacement,to develop the evaluation criteria for adductor femoris contracture,to identify the factors affecting adductor femoris contracture of patients with femoral head necrosis undergoing hip replacement,to study the effects of tibial tubercle traction before hip replacement and post-operative systematic functional exercise of patients with femoral head necrosis following hip replacement on adductor femoris contracture,to discuss the relationship between degree of adductor femoris contracture and efficacy of hip replacement,to select a proper surgical method according to self-made adductor femoris assessment,and to study the therapeutic method for different degrees of concurrentadductor femoris contracture following hip replacement.Methods: Part 1:Theadductor femoris contracture of 136 patients with femoral head necrosis from September 2014 to September 2015 was retrospectively analyzed.An adductor femoris contractureassessment scale was made and its diagnosticaccordance rate was examined.This scale was employed to observe the degrees of adductor femoris contracturebefore and after hip replacement.Part II: Among these 136 patients,95 with no adductor femoris contracturebefore hip replacement were observed,and univariate and multivariate analyses were carried out on the potential causes of adductor femoris contracture.Part III: 1.39 patients with femoral head necrosis from October 2015 to December 2015 were additionally selected.The patients undergoing preoperative strict tibial tubercle traction before operation and postoperative functional exercise(treatment group)were compared with 39 patients who were randomly selected previously without using this method(control group)to understand the adductor femoris contracture of the two groups following hip replacement.2.136 patients with femoral head necrosis from September 2014 to September 2015 were reviewed and divided into the following groups according to the score of adductor femoris contractureassessment scale: group A(0-4point),group B(5-13 points),group C(14-22 points)and group D(23-30points).The Harris scores,self-made adductor femoris scores,intraoperative blood loss and surgical time before and 3 months after hip replacement of the two groups were observed to determine which degree of adductor femoris contracture need to take further treatment measures.Then,the patients who needed other further treatment measures from January 2015 to June 2016 were divided into treatment group(adductor femoris cutoff + hip replacement)and control group(single hip replacement).The Harris scores,self-made adductor femoris scores,intraoperative blood loss,surgical time and complications before and 6 months after hip replacement of the two groups were observed.3.139 patients undergoing hip replacement from September 2014 to September 2015 were observed by groups according to treatment method and adductor femorisscore to evaluate the relationship between different degrees of adductorfemoriscontracture and treatment method.Results: Part 1: About 65% of patients with femoral head necrosis had concurrent adductor femoriscontracture before hip replacement and such figure was increased to 85% after hip replacement;the diagnostic accordance rate of adductor femoriscontracture in the self-made adductor femoriscontracture scale was greater than 85%;the adductor femoriscontracture score after hip replacement was increased by 8 points compared with that before hip replacement;the Harris score of patients with severe adductor femoriscontracture after hip replacement was 80.93,showing statistically significant difference with those of other patients.Part II: Univariate and multivariate analyses indicated that the factors affecting adductor femoriscontracture included cause of disease,degree of limb shortening,surgical approach,effectiveness of traction,history of surgery at the same site,systematic functional exercise or not,etc.Part III: 1.The adductor femoriscontracture score of the treatment group(traction + functional exercise)three months after hip replacement was 13.95±8.266,and that of the control group was 16.08±7.991;the Harris score of the treatment group was 89.89±4.701,and that of the control group was 87.51±5.465,showingstatistically significant differences.2.There were statistically significant differences between group D and the other three groups in term of surgical time,intraoperative blood loss and Harris score,and intraoperative treatment should be implemented;the Harris score of the treatment group was92.10±4.412,better than that of patients undergoing hip replacement alone,and there were no statistically significant differences in terms of operative time and intraoperative blood loss.3.Among patients with adductor femoriscontracture after hip replacement,the patients with 14-22 points had no change in Harrisscore following physical treatment and functional exercise,while the Harris score of patients with 23-30 points undergoing adductor femoris cutoff was89.82±4.722,which was better than the physical treatment group,showing a statistically significantdifference.Conclusion: 1.Hip replacement can cause or worsen the adductor femoris contracture of patients with femoral head necrosis.2.The cause of disease,degreeof limb shortening,surgical approach,effectiveness of traction,history of surgery at the same site,systematic functional exercise,etc.3.Strictly performing the preoperativetibial tubercle traction and postoperativesystemic functional exercises can effectivelyreduce the adductor femoris contracture degree of patients undergoing hip replacement,and improve the hip joint function.4.Severeadductor femoris contracture will influence the curative effects of the hip replacement.By undergoing adductorfemoris amputation + hip replacement,the postoperativejointfunction will be improved.5.The patients with femoral head necrosis combined with cocurrent adductor femoris contracture after hip replacement can be treated with physical therapies or function exercises if the situation is moderate,while adductor femoris amputation should be performed if the condition is medium.6.The self-madeadductor femoris contracture scale allows us to understand the degree of adductor femoris contractureintuitively and quantitatively,and provides guidance on clinical treatment.