Research On The Relationship Between The Thickness Of The Lateral Wall Of The Femoral Head Of The NONFH With The Non-surgical Conservative Treatment Of The Hip And The Related Biomechanics

PurposeThrough a retrospective study of clinical cases,the relationship between the thickness of the lateral wall of the femoral head and the non-surgical femoral head necrosis(NONFH)non-surgical hip preservation prognosis was determined;the three-dimensional finite element mechanical analysis model of the hip joint was used to determine the retention of the lateral wall of the femoral head.The effect of thickness on the biomechanical conduction of the hip to clarify the importance of the outer wall of the femoral head for non-surgical hip protection of NONFH.Methods1 Retrospective study of clinical casesRetrospective analysis was performed from June 1996 to December 2012 at the First Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine,and there were regular follow-up visits for non-traumatic femoral head necrosis.JIC Cl cases were analyzed separately.All patients underwent non-surgical hip-protection therapy with traditional Chinese medicine combined with physical therapy.The patients underwent hip-repair surgery or total hip arthroplasty as the end point.The hip function score was used to evaluate the clinical symptoms of patients before and after hip protection.The ARCO staging and JIC staging of femoral head necrosis were used to evaluate the imaging progress of patients before and after hip protection.The thickness of the lateral wall of the femoral head was quantitatively analyzed by the lateral femoral head index and the femoral head lateral wall index,and the hip function score was analyzed by statistical methods.Correlation between the thickness of the lateral wall of the femoral head.2 Biomechanical study of non-traumatic femoral head necrosisA case of JIC Cl non-traumatic femoral head necrosis was selected to improve the hip X-ray,CT and MRI of the case.Based on the above imaging data,Mimics software was used to establish the normal position of the hip and the position of the abduction.The three-dimensional finite element mechanics analysis model is applied,and the human gravity load is applied to the model.The stress distribution of the hip joints of the above two models is compared.Results1 Retrospective study of clinical cases1.1 Results of the overall case studyThis study successfully followed 64 cases of 93 hip non-traumatic femoral head necrosis,including 63 hip ARCO stage Ⅱ,30 hip Ⅲ;25 hip JIC type B,68 hip C,followed up from 2.24 to 21.11 The average follow-up was 6.64 years.At the last follow-up,36.51%of cases(23 hips/63 hips)ARCO stageⅡ progressed to stage Ⅲ,15.87%of cases(10 hips/63 hips)progressed to stage Ⅳ;13.33%of ARCO Ⅲ Stage(4 hips/30 hips)progressed to stageⅣ.24.00%of JIC type B cases(6 hips/25 hips)progressed to type Cl,none of cases(0 hips/25 hips)progressed to type C2;8.62%of cases of JIC C1 type(5 hips/58)Hip)progressed to type C2;40.00%of cases with JIC C2(4 hips/10 hips)were repaired to type C1.There were 12.70%(8 hips/63),3.33%(1 hip/30 hips)of ARCO stage Ⅱ and Ⅲ cases undergoing total hip arthroplasty,and articular surface collapse(63 hips)occurred during the course of the disease,with 14.29%(9 hips/63 hips)underwent total hip arthroplasty;4.00%(1 hip/25 hips),5.17%(3 hips/58 hips),50.00%(5 hips/10 hips)of JIC B All patients with C1 and C2 underwent total hip arthroplasty.The overall survival rate of the femoral head in five,ten,fifteen,and twenty years was 97.39%(95%confidence interval:89.95%to 99.34%)and 85.84%(95%confidence interval:69.48%to 93.79%).56.33%(95%confidence interval:24.95%～78.87%),56.33%(95%confidence interval:24.95%～78.87%);Log-rank statistical test,ARCO phase Ⅱ cases have better survival rate than stageⅢ The survival rate of the cases,but the difference was not statistically significant(P=0.8994).The survival rate of JIC type B cases was better than that of type C cases,and the difference was statistically significant(P=0.0006).After treatment,the overall(93 hips)HARRIS score increased from(89.05±5.58)points to(91.23±13.94)points,the difference was not statistically significant(P=0.146);no total hip arthroplasty or femoral head necrosis was maintained.In the 84 hips of the operation,the HARRIS score increased from(89.12±5.78)points to(93.73±11.04)points,the difference was statistically significant(P=0.001);the femoral head joint surface collapsed but no total hip joint was observed during the course of the disease.In the 54-hip case of replacement surgery or femoral head necrosis for hip surgery,the HARRIS score after treatment was(92.89±6.54)points.After treatment,the overall case LHI increased from(45.16%±15.46%)to(46.60%±16.72%),the difference was not statistically significant(P=0.481);LWI increased from(20.57%±6.78%)to(43.35%±18.62%),the difference was statistically significant(P=0.000).There was a positive correlation between LHI,LWI and HARRIS scores after the above treatment(r=0.325,P=0.001;r=0.289,P=0.005).1.2 Results of JIC C casesThis study successfully followed 50 patients with 68 cases of JIC C non-traumatic femoral head necrosis in the collapsed period,including 41 hip ARCO Ⅱ,27 hip Ⅲ cases,followed up for 2.24 to 18.38 years,with an average follow-up of 6.72 years.At the last follow-up,22.41%(13 hips/58 hips)of JIC C1 type were repaired as type A,and 37.93%(22 hips/58 hips)were repaired as type B with 31.03%(18 hips/58 hips).The case is still C1,with 8.62%(5 hips/58 hips)progressing to C2;33.33%(11 hips/33 hips)of ARCO stageⅡ progress to stage Ⅲ,with 15.15%(Cases of 5 hips/33 hips progressed to stage Ⅳ,with 16.00%(4 hips/25 hips)of ARCO stage Ⅲ progression to stage Ⅳ.40%(4 hips/10 hips)JIC C2 cases were repaired as Cl,60%(6 hips/10 hips)were still C2;62.50%(5 hips/8 hips)ARCO Ⅱ Cases progressed to stage Ⅲ,with 37.50%(3 hips/8 hips)progressing to stage Ⅳ,with none(0 hips/2 hips)of ARCO stage Ⅲ progressing to stage IV.There were 5.17%(3 hips/58 hips),50%(5 hips/10 hips),JIC C1 and C2 cases,total hip arthroplasty,femoral head survival period(2.24 to 6.05)years,mean survival time It is 3.31 years.In addition,there were 8 hip ARCO Ⅱ and 4 hip Ⅲcases progressing to stage Ⅳ,but the hip joint space was good.The HARRIS score was between(76 and 92)points.There was no total hip arthroplasty or femoral head necrosis.Hip surgery.The five-,ten-,and fifteen-year survival rates of the femoral head in this group were 89.68%(95%confidence interval:79.57%～94.94%),87.19%(95%confidence interval:75.57%～93.50%),and 87.19%.(95%confidence interval:75.57%～93.50%);Log-rank statistical test showed that the survival rate of JIC C1 cases was higher than that of C2 cases,the difference was statistically significant(P<0.0001).The HARRIS scores of patients with JIC type C(68 hips)increased from(88.03±5.53)to(89.28±15.61),the difference was not statistically significant(P=0.097);the overall case before and after treatment was LHI(42.11%±15.50%)increased to(45.59%±18.00%),the difference was not statistically significant(P=0.271);LWI increased from(19.64%±6.58%)to(41.74%±17.24%),the difference was statistically significant(P=0.000).In the 60 hip cases without total hip arthroplasty or femoral head necrosis,the HARRIS score increased from(87.95±5.76)points to(93.97±6.52)points,the difference was statistically significant(P=0.000);LHI From(44.68%±15.20%)to(47.24%±17.30%),the difference was not statistically significant(P=0.365);LWI increased from(20.04%±6.80%)to(45.34%±16.35%),the difference Statistically significant(P=0.000).The overall case of LHI,LWI and HARRIS scores were correlated(r=0.474,P=0.000;r=0.516,P=0.000);56 cases of HARRIS score>80 points,before treatment LHI,LWI The mean values were 43.93%(95%confidence interval:40.17%～47.67%)and 20.43%(95%confidence interval:18.60%～22.26%).The one-sided 90%reference range of the above two indicators was(26.01%)·～),(11.68%～);in the 8-hip case of patients undergoing total hip arthroplasty,the mean values of LHI and LWI were 25.62%and 17.02%,respectively,and LHI was lower than the lower limit of the 90%reference range of the above one side.2 Biomechanical study of non-traumatic femoral head necrosisIn the standing position model,the overall stress of the hip joint is mainly distributed at the junction of major joints,such as the sacroiliac joint area,the head joint of the hip joint,and the area of the femur at the upper end of the femoral shaft.In the acetabular side of the hip joint,the stress is mainly concentrated in front of the acetabulum,and the stress concentration area of the femoral head of the femur,that is,the outer wall region of the femur,is the initial site of the femoral head necrosis area at the femoral head joint surface.In the hip outreach model,the overall stress of the hip joint is mainly distributed in the sacroiliac joint region;the stress distribution intensity is weaker than the standing position.On the acetabular side of the hip joint,the stress is still mainly concentrated in front of the acetabulum,and also corresponds to the stress concentration area of the femoral head of the femur,ie the lateral wall area of the femur;however,the above stress distribution is also significantly lower than that in the standing position model.related data.ConclusionThe thickness of the thickness of the lateral wall of the femoral head can affect the biomechanical distribution of the hip joint,and is positively correlated with the prognosis of non-surgical hip protection for femoral head necrosis.It can be used to guide the clinical hip-preservation treatment of non-traumatic femoral head necrosis.