| Objective:1.To explore the biomechanic mechanism on the collapse of the osteonecrosis of the femoral head(ONFH);2.To evaluate the clinical effect of the advanced core decompression combined with Chinese medicine on the prevention and treatment for the collapse of ONFH.Methods:59 in-patients(70 hips) were diagnosed of ONFH in ARCOⅡ/Ⅲstage (ARCO,Association Research Circulation Osseous)from the center of hip diseases of the first affiliated hospital of Guangzhou university of Chinese Medicine during January 2006 to December 2007.There were 43 males(52 hips) and 16 females(18 hips).Osteonecrosis was related to traumatic hip in 9 hips of 9 patients,steroid-induced in 27 hips of 20 patients,alcohol-induced in 30 hips of 26 patients,and idiopathic in 4 hips of 4 patients.All the patients were given to the joint-preserving procedure of advanced core decompression (including core decompression,nonvascularized fibular grafting and tubular screw fixation) combined with Chinses medicine "Tong Luo Sheng Gu capsule".The follow-up ranged from 12 to 33 months(average 20 months).The clinical effect evaculation was done reffered to the Harris Hip Score preoperation and postoperation,while the image effect evaluation was done according to the radiological image of the latest follow-up reffered to ARCO intertional classification system.All the results are tested by statistical software.Results:(1)In the study the overall good-to-excellent rate of clinical effect is 57.63%,while the overall good-to-excellent rate of image effect is 65.72%.The good-to-excellent rate of clinical and image effect in ARCO? stage are 90%and 88.46%,while ARCOⅢstage are 41.03%and 52.27%(P＜0.05).It means that the clinical and image effect of ARCOⅡstage are better than ARCOⅢ stage.Because ARCOⅢstage accounts for about 66.10%(or 62.86%),so the overall good-to-excellent rate of clinical and image effect of the study are a little lower.(2)The Harris Hip Score rised from 60.27 points of the preoperation to the 77.37 points of the latest follow-up(P＜0.5).It means that our treatment could relieve the clinical symptons and joint function of the patients.(3)The good-to-excellent rate of clinical and image effect in traumatic group are 66.67%and 77.78%,while the non-traumatic group are 56%and 63.93%(P＞0.05).It means that there is no difference of the clinical and image effect between traumatic and non-traumatic group.That might relate to that the number of the traumatic group is not large enough and the rate betweem traumatic and non-traumatic group is not reasonable.(4)The good-to-excellent rate of clinical and image effect in steroid-induced group are 40%and 70.73%,while the alcohol-induced group are 69.23%and 60%.There is statistical difference of the clinical effect between them,while there is no statistical difference of the image effect.It means that the clinical effect of alcohol-induced group is better than steroid-induced group, and there is no difference of the image effect between them.(5)The outcome of the study indicates that our treatment is suitable for the patients of ONFH in pericollapse of ARCOⅡstage and mild collapse of ARCOⅢstage,but not for moderate and severe collapse of ARCOⅢstage.Conclusion:1.The occurrence of the collapse of ONFH is the combined results of biological and biomechanical facters;it happens mostly in the roof and anterior-lateral regions of the femoral head.2.With improving the blood supply and mechanical characteristic of the femoral head as targets,the treatment of advanced core decompression combined with Chinses medicine has a satisfatory clinical effect in prevention and treatment for the collapse of ONFH in early and middle stage;it coule relieve the clinical symptons and joint function of the patients;the clinical and image effect of ARCOⅡstage are better than ARCOⅢstage apparently;the clinical effect of alcohol-induced group is better than steroid-induced group. |
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