| Osteonecrosis of the femoral head is one of the most common diseases in bone and joint surgery,bone destruction and degeneration of the blood supply of femoral head of patients,leading to bone active ingredients can significantly affect the patient's death,shutdown activities,lead to chronic pain,claudication,hip joint dysfunction so,seriously affect the patient's normal life and work,reduce the quality of life of patients.Therefore,it is very important to treat the femoral head necrosis after femoral neck fracture.The application of porous core decompression in the treatment of avascular necrosis of the femoral head is good,Wang Zhiqiang et al.Study shows that the effect of the small diameter core decompression of the femoral head is good for the early avascular necrosis of the femoral head.However,there are few studies on the effect of small diameter porous core decompression on the treatment of femoral head necrosis,femoral neck stability and hip joint function.In this study,we first study the relationship between the changes of blood lipid metabolism and osteopontin(OPN)and the effect of osteonecrosis in patients with femoral head necrosis,and try to find the index for evaluating and predicting ONFH.To further clarify the effect of small diameter porous core decompression on the improvement of femoral head necrosis,the stability of the femoral neck and the function of the hip joint,which will help to find effective treatment methods for the necrosis of the femoral head,so as to improve the curative effect,reduce the pain and improve the quality of life of the patients.Part I:The study of blood lipid metabolism and osteopontin(OPN)level change and the relationship with curative effect for patients with osteonecrosis of the femoral headObjective The relationship between the changes of blood lipid metabolism and osteopontin(OPN)and the effect of osteonecrosis in the patients with avascular necrosis of the femoral head and its relationship with the curative effect were studied to seek for the evaluation and prediction of the index of ONFH.Methods 88 cases of patients with secondary f osteonecrosis of the femoral head in our hospital from January,2013 to June,2015 were selected as observation object,patients were informed of the advantages and disadvantages of various treatment options,and then they chose small diameter multi-channel medullary decompression combined with hip arthroscopy for treatment.All patients were set up as the study group(n=88),and 61 healthy subjects were selected as the control group.The control group received 6ml of venous blood from the elbow,and 3ml was used to detect the serum lipid level with the automatic biochemical analyzer.Blood lipids include triglycerides,cholesterol,low density lipoprotein,high-density lipoprotein,apolipoprotein Al,and apolipoprotein B.If the value is higher than the normal range,the blood fat content should be increased.If the value is lower than the normal range,the blood fat content will be reduced.3ml blood was used to measure the patient's level of serum levels of OPN,The blood were store in 4 ? condition to 3000 r/min,the centrifugal 20 min after collect serum encoded in a-80 ? under test.The serum lipid levels and OPN levels in the two groups were compared.the effective of hip function were counted 1 year after surgery,and the Pearson analysis was used to analyze the changes of blood lipid metabolism and bone bridge protein in patients and their relationship with the curative effect.Results(1)The levels of cholesterol,triglyceride,low density lipoprotein and apolipoprotein B in the study group were(4.80±0.85)mmol/L,(1.85 ±0.79)mmol/L,(2.56 ± 0.83)mmol/L,(0.92 ± 0.27)g/L,which were definately higher than that in the patients of control group,which were(4.32 ±0.81)mmol/L,(0.96 ±0.31)mmol/L,(2.13± 0.51)mmol/L,(0.65± 0.21)g/L(P<0.05).The high-density lipoprotein of study group was(1.30 ± 0.27)mmol/L,and which was significantly lower than that in the control group(1.43 ± 0.37)mmol/L(P<0.05).(2)The serum osteopontin level of patients in the study group was(11.52±4.15)?g/L,and compared with the control group(3.37±0.51)?g/L,it was definately higher(P<0.05).(3)The Harris score was used to evaluate the effect of patients after 1 year postoperative,patients in the range of 90?100 score were seen as optimal effective,patients in the range of 80?89 score were seen as good effective,patients in the range of 70?79 score of patients were divided into general effective,patients in the range of score lower than 70 were seen as poor effective.49 patients were divided into good group and 39 patients were into poor group according to the result.Compared with the poor group,the patients of good group with lower cholesterol,lower triglyceride,lower density lipoprotein cholesterol lower apolipoprotein B and higher high-density lipoprotein cholesterol(P<0.05).(4)The OPN level was significantly lower in the patients with good group,and the level of OPN in the patients of poor group was significantly higher(P<0.05).(5)The results of Pearson analysis showed that patient's cholesterol,triglyceride,low density lipoprotein cholesterol and apolipoprotein B were negatively related with curative effect,and high density lipoprotein and its curative effect in patients with positively correlated relationship(P<0.05).(6)The results of Pearson analysis showed that there was a negative correlation between the OPN and itscurative effect.Conclusion The blood lipid metabolism index is obviously related to the curative effect of femoral head necrosis patients.The OPN level of femoral head necrosis was closely related to its curative effect.The blood lipid metabolism level and the OPN level can be used to evaluate the condition of patients with femoral head.Part II:Study on the curative effect,femoral neck stability and hip joint function of osteonecrosis of the femoral head treated with small diameter multihole core decompressionObjective The effect of small diameter multihole core decompression on the effectiveness of the osteonecrosis of the femoral head,the stability of the femoral neck and the function of the hip joint can help to find effective treatment for the osteonecrosis of the femoral head,thus improving the curative effect,reducing the pain and improving the quality of life.Methods 62 patients with osteonecrosis of the femoral head were selected from January 2013 to June 2015 in our hospital.They were divided into study group(n=31)and control group(n=31)according their own choice after gain all treatment protocols analysis.The study group was treated with small diameter core decompression combined with arthroscopic debridement,while the control group was treated with Traditional macroporous core decompression.The two groups were followed up for at least 1 year.The operation time,compared two groups of bleeding,hospitalization time,postoperative ambulation time,postoperative 1 years after surgery,the treatment efficiency of Harris score of hip joint function 1 years before and after surgery and short form health survey(SF-36),after the collapse of the femoral head,the infection of the femoral head complication rate.Results(1)There was no significant difference in operation time and blood loss between the two groups(P>0.05).Compared with the control group,the number of days of hospitalization and the activity time of the lower limbs were shortened(P<0.05).(2)Compared with the control group,the curative effect of the study group was higher than that of the control group in the last 1 years,and the proportion of patients with poor curative effect was decreased(P<0.05).(3)Compared with the control group,the Harris hip function score and SF-36 score of the study group increased after(P<0.05).(4)There was no significant difference between the study group and the control group in the collapse of femoral head and the complication rate of the infection of the femoral head(P>0.05).Conclusion(1)The treatment of osteonecrosis of the femoral head with small diameter multihole core decompression combined with arthroscopic debridement is effective.(2)The treatment of osteonecrosis of the femoral head with small diameter multihole core decompression combined with arthroscopic debridement is helpful to improve the hip function and quality of life.(3)The stability of osteonecrosis of the femoral head were treated with small diameter multihole core decompression combined with arthroscopic debridement. |
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