| Objective:Objective to compare the clinical effects of surgical dislocation compression and bone graft support and core decompression and fibula support in the treatment of(ARCO)stage Ⅲ osteonecrosis of the femoral head.Methods:From January 2018 to February 2019,41 patients(44 hips)with ARCO Ⅲ An and Ⅲ B osteonecrosis of the femoral head in the Department of Orthopaedics,the first affiliated Hospital of Guangxi University of traditional Chinese Medicine were treated with surgical dislocation compression bone grafting and core decompression and allogeneic fibula support.The patients were divided into two groups:group A(n=20)and group B(n=21).In group A,20 cases(21 hips)were treated with surgical dislocation and bone grafting,and 21 cases(23 hips)in group B were treated with core decompression and fibula support.During the follow-up period of at least 2 years,all patients were treated with Huoxue Bushen recipe for 4 courses after operation,and the hip joint Harris score,VAS score and imaging evaluation were recorded.The excellent and good rates were counted and compared within and between groups.Results:All patients healed well after operation,and there were no complications such as vascular and nerve injury,infection,allogeneic bone rejection,bone nonunion and so on.A total of 41 cases(44 hips)were included in this study,including 1 case of severe collapse of the femoral head in group An and 3 cases of severe collapse of the femoral head in group B during the follow-up period.The final follow-up was completed in19 cases in group A(20 hips in),B group in 18 cases(20 hips).Finally,there was no significant difference in sex,age,etiology,ARCO stage,CJFH classification,preoperative Harris score and preoperative VAS score between the two groups.All patients were followed up from 24 months to 48months(mean 29.3 months).(1)The Harris scores of group A and group B in the last follow-up were higher than those before operation,and the difference was statistically significant(P<0.05).(2)The VAS score of group A and group B at the last follow-up was lower than that before operation,and the difference was statistically significant(P<0.05).(3)The Harris score of group An in the last follow-up was 80.65±6.54,which was significantly higher than that of group B(74.90±8.69).The VAS score of group A was significantly lower than that of group B(P<0.05).Group A was excellent in5 hips,good in 12 hips,and poor in 3 hips.The excellent and good rate in group B was 85%.In group B,the excellent and good rate was 1 hip,good in14 hips,and poor in 6 hips.The excellent and good rate in group A was70%,which was higher than that in group B.(4)Group A Ⅲ A final time follow-up Harris score higher than Ⅲ B stage,the difference is statistically significant(P=0.004<0.05);Group B Ⅲ A final time follow-up score higher than Ⅲ B period,statistically significant difference(P=0.001< 0.05);PhaseⅢ A score between the two groups,there was no statistically significant difference(P=0.102>0.05);Ⅲ B period between group A score higher than that of group B,the difference was statistically significant(P=0.008<0.05).(5)When CJFH belongs to type C or L1,there is no significant difference in Harris score between group An and group B,but when it belongs to type L2 or L3,the score in group An is significantly higher than that in group B(P<0.05).(6)Imaging efficacy evaluation group An improved 8,unchanged8,deterioration 4,failure 1,the treatment effective rate was 76.2% in group B,improvement 3,unchanged 9,deterioration 8,failure 3,and the treatment effective rate was 52.2%.The difference was statistically significant(the treatment effective rate of),A group was higher than that of group B.Conclusion:(1)This study found that surgical dislocation compression bone grafting and core decompression fibula support can improve hip joint function and relieve pain in patients with collapse of 0-4mm acro stage III femoral head necrosis.The clinical effect of the former is better than that of the latter.The two groups have good short-term effect,which can delay or prevent the time of total hip replacement.(2)Femoral head necrosis should be diagnosed as early as possible,and the earlier intervention,the better curative effect,that is,the smaller the degree of collapse,the better the clinical curative effect.For acro Ⅲ a stage of femoral head necrosis,the curative effect of two kinds of hip preserving surgery is similar.The clinical effect of surgical dislocation compression bone grafting in the treatment of femoral head necrosis of acro Ⅲ B stage and classification L2 and L3 with collapse degree of 2-4mm is better than that of core decompression fibula support group.(3)Compared with core decompression and fibula support,surgical dislocation compression bone graft can achieve more stable imaging,correct collapse,more thorough dead bone cleaning and compression bone graft,promote bone necrosis repair,more accurate lateral column support,and prevent femoral head necrosis and collapse. |
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