Analysis Of Early Effect Of Extensive Core Decompression And Bone Grafting For Reconstruction Of Bone Density In Osteonecrosis Area On Early Femoral Head Necrosis

Osteonecrosis of femoral head(ONFH)is a common orthopaedic disease and one of the common diseases leading to dysfunction or even loss of function of the hip.Although the disease is well known,its specific pathogenesis is still not clear.The disease has the characteristics of etiology diversity,early diagnosis difficulty,and large individual differences in disease progression.Most patients have to undergo artificial hip replacement surgery when the disease progresses to the later stage.Although the research on artificial hip joint prosthesis has made great progress in recent years,the long-term effect after artificial joint replacement is not ideal due to the service life of the prosthesis,and there are also long-term complications such as loosening and sinking of the prosthesis.It is often necessary to perform two or more surgical revisions later,which is more difficult.Therefore,the clinical application is limited for young patients.Recent years,clinicians advocate early intervention to prevent femoral head collapse for early-stage osteonecrosis of femoral head,especially for young patients,the preservation of femoral head treatment has great significance.Core decompression remains the most widely used method for early treatment of the disease.The operation has the advantages of simple operation,small trauma,short time,short recovery time,and is easy to carry out in clinical practice and has a certain postoperative effect on early-stage osteonecrosis of femoral head.ObjectiveTo analyze the early clinical efficacy of core decompression with thick passage combined with allogeneic bone implantation on early-stage osteonecrosis of femoral head.To explore the effect of different disease stages on the clinical efficacy of the procedure,and to evaluate effect of the bone mineral density in the bone necrosis area of the procedure.Materials and MethodsRetrospective analysis of clinical data of patients with early-stage osteonecrosis of femoral head treated with core decompression with thick passage combined with allogeneic bone implantation included 42 patients(56 hips),including 30 males and 12 females.The average age of the patients is 27.3(20 to 45)years old.According to the International Society of Circulatory Research(ARCO)femoral head necrosis stage,all hips were divided into: I-A(15 hips),I-B(22 hips),II-A(5 hips),and II-B(14 hips).Harris score,visual analog(VAS)score,X-ray and bone mineral density were measured before and 1 year after surgery.Harris score,visual analog(VAS)score and bone mineral density were analyzed before and 1 year after operation.The short-term clinical efficacy of the procedure was analyzed.In addition,covariance analysis was used to analyze the effects of different staging of femoral head necrosis on Harris score and visual analog(VAS)score after 1 year postoperatively.ResultsAll patients' symptom with 1-year follow-up were relieved or disappeared,and the hip function was significantly improved.No infection and rejection occurred.One year after operation,the X-ray showed no collapse of the shape of the femoral head.Compared with the preoperative X-ray,osteogenic phenomenon(new bone column appeared)occurred in the postoperative core decompression channel.The Harris score and bone mineral density of the patients at the 1st year after operation were significantly higher than those before surgery.The VAS scores were significantly lower than those before surgery,and the difference was statistically significant.Covariance analysis showed that the effects of different staging of femoral head necrosis on Harris score and VAS score at 1 year postoperatively were statistically significant(p<0.05).The comparison between the two groups showed that the Harris scores of I-B,II-A and II-B were lower than those of I-A,and the difference was statistically significant.The VAS scores of stage II-A and stage II-B were significantly higher than those of stage I-A.The VAS scores of stage II-A were significantly higher than those of stage I-B.The difference was statistically significant.ConclusionsThe early effect of the core decompression with thick passage combined with allogeneic bone implantation for early stage ONFH is good;the bone mineral density of osteonecrosis area has a good clinical evaluation value for postoperative femoral head necrosis;different disease stages are significant The surgical effect of affecting femoral head necrosis.