The Correlation Research In The Prediction Of Collapse In The Osteonecrosis Of The Femoral Head From Specimen X-ray And Ct Scan And The Optimal Operation Method

Objective: Osteonecrosis of the femoral head (ONFH),with the clinicalmanifestations of hip pain and dysfunction, is a common and frequently-occurring disease. The pathogenesis of ONFH still remains controversial inthe field of orthopedic medicine and remains further study. The choice ofsuitable operation method is of crucial importance to the optimal outcomes. Itexerts significant influence on the prognosis to hold the surgical indicationstrictly and take the appropriate treatment measures on the basis of the stage ofONFH, especially the choice between saving femoral and hip replacementsurgery. Aim of this study is to further discussing the theory of the savingfemoral surgery and hip replacement through comparing images of the side ofsuffered and healthy combined with X-ray and CT based on the analysis of thefemoral head amputated in the hip replacement surgery.Method: A total of86patients(age50±18years;male55cases)withunilateral osteonecrosis of the femoral head(FICAT stage Ⅲ50cases, FICATstage Ⅳ36cases; left side46cases, right side40cases)undergoing total hipreplacement were included in our study. X-ray(Pelvis AP)and CT scan wereperformed1week before surgery. We cut the femoral head off specimensIntraoperatively and open it fthe along middle longitudinal line along thecoronal plane with the electric swing saw to determine the femoral head centerpoin(thc). Draw a X line between femoral head vertex and femoral neck alongthe longitudinal through the femoral head center point (X), a Y linePerpendicular to.X through hc(Y), and a Z line within X and Y with a45degree angle.The distance between HC and femoral head vertex is respectivelyb,c,a in X,Y, and Z. a represents the actual height of femoral head collapse inthw middle, b in the medial, and c in the lateral. Measurement data and the corresponding X line a ', b', c 'and CT on a" b" c" values were compared. a anda '," set to group A; b and b', b" is set to group B; c and c ', c" is set to C group.We use SPSS13.0statistical software (SPSS Inc., USA) to analyze thedata.mean±standard deviation (X|-±S),analysis of variance was used for thedata in groups and between groups if normality and homogeneity of variancetest was met,if not, Non-parametric test was used,and the SNK test was usedfor pairwise comparisons. P <0.05was considered statistically significant.Result: There was no significant difference between a and b in group A(P>0.05, and there was significant difference between a and c,b andc(p<0.05). There was no significant difference between a' and b' in group B(P>0.05, and there was significant difference between a' and c',b'andc'(p<0.05).There was no significant difference between a" and b" in group C(P>0.05, and there was significant difference between a" and c",b" andc"(p<0.05).There was no significant difference between A group and B group,A and C group, B and C group, D and E group. There was significantdifference between B and D group, C and E group.Conclusions:1Necrosis of femoral head collapse first appeared in the outer upper quadrantmuch more than, including on the quadrant and middle parts of the head, Thisis because the more pressure the upper outer quadrant beared.2X-ray and CT scan both have high precision and accuracy for theprediction of ONTH to in choose the proper operation methods.3Hip replacement surgery was priorly recommended for patients with lessthan2mm loss of the height of femoeal head and CT image of Cartilagepeeling.4The method of recognizing hc is easy and accurate to perform in measuringthe loss of height of femoral head, which can be put forward widely.