| Objective:To study the clinical effect of local application of platelet rich plasma(PRP)in femoral head on preventing the continuous progression of osteonecrosis of the femoral head in the early stage of osteonecrosis of the femoral head(ONFH)surgery hip preservation treatment.Method:From October 2015 to February 2019,a total of 47 patients with early stage osteonecrosis of the femoral head admitted to our hospital and treated with hip preservation surgery and received follow-up visits were randomly divided into PRP treatment group(27 cases,28 hips)and control group(20 cases,25 hips).Both groups of patients were treated with core decompression combined with compression bone grafting.The only difference is that,in PRP treatment group,PRP was mixed with allogeneic bone particles and then injected into femoral head and cervical medullary cavity.While in control group,only allogeneic bone particles were injected.All other treatments and rehabilitation processes are the same.Six weeks,three months,one year and one year after the operation were followed up regularly respectively,and Harris Hip Score,(HHS),visual analogue scale(VAS)and imaging changes of the femoral head on the operation side were recorded for all patients in the two groups.The data were statistically analyzed and compared to evaluate the clinical effect of local application of PRP in the femoral head.Results:All patients were followed up for an average of 1 year after hip preservation surgery,and the pelvic positive X-ray plain films were reviewed at regular outpatient clinic every year after 1 year.The follow-up time was 12 to 33 months,averaging 15.8 months.The post-surgery follow-up and analysis showed that the HHS scores of the two groups were higher than those before surgery(p<0.01),and the study group was higher than that of the control group,the difference was statistically significant(p<0.05).Following up for one year for evaluation,the total clinical effective rate in the study group was 78.5%,while that in the control group was 63.8%,with statistically significant difference between the two groups(p<0.05).Before treatment,there was no statistically significant difference in hip pain scores between the two groups(p>0.05).However,the VAS scores of hip pain in the two groups decreased gradiently at 6 weeks,3 months and 1 year after treatment.Compared with before treatment,the difference was statistically significant(p<0.01),and the VAS scores of hip pain in the study group were lower than those in the control group at 6 weeks,3 months and 1 year after treatment,the difference was statistically significant(p<0.01).In terms of postoperative complications,there was no difference in the rates of single complications between the two groups,but the total incidence of postoperative complications in the study group was significantly lower than that in the control group(p<0.01).In the long-term follow-up after surgery,it was found that only 1 case(1 hip)in PRP group failed in hip preservation,while 4 cases(5 hips)in control group failed in hip preservation,thus accepting artificial total hip replacement.Kaplan-Meier survival rate analysis showed significant difference between the two groups(P<0.01).Conclusion:1.Core decompression combined with compression bone grafting has definite short-term effect on the treatment of osteonecrosis of the femoral head.It is helpful to relieve hip joint pain symptoms and improve hip joint function of such patients,and has high clinical application value.2.Core decompression combined with compression bone grafting and local application of PRP in femoral head can effectively improve the success rate of hip preservation treatment for osteonecrosis of the femoral head,and has positive significance for preventing and delaying the progress of osteonecrosis of the femoral head. |
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