| Objective: To explore the indications of ARCOII hip preservation for femoral head necrosis based on CT double-wall theory,in order to more accurately treat femoral head necrosis with hip preservation.Selection methods: between January 2019 and September 2021 in the first affiliated hospital of guangxi medical university bone disease of orthopaedic trauma diagnosis of 49 patients with femoral head necrosis ARCOII period,A total of 76 hip,all patients were follow-up CT scan records of hip joint visits for the first time,based on the CT double-wall theory will be divided into 3 groups,group A for double-wall intact;Group B was single wall affected type.Group C was double-wall affected.There was no significant difference in the general clinical data of patients in the three groups(P>0.05),and the observation indexes were VAS score,Harris score and imaging score 6,12 and 24 months after treatment.Spss22.0 system software was used.The number of cases was used for counting data,and rank sum test was used for comparison between groups.Measurement data were expressed as X ±S,and comparison between groups was performed by T test,P<0.05 was statistically significant.Results: According to diagnostic criteria,inclusion criteria,exclusion criteria,and shedding criteria,a total of 49 patients(76 hips)were included in the study,48 patients(74 hips)were followed up,2 hips were lost,and a total of 74 hips(58 males,16 females)were followed up.Among them,31 were involved in single wall(19 were involved in cross section,12 were involved in coronal plane,10 were involved in left side,21 were involved in right side,25 were male,6 were female).37 hips(30 in male and 7 in female)were involved in both walls.Biwall intact 6 hips(4 hips in males and 2 hips in females);Follow-up was 6-24 months.Forty-nine patients(41 males and 11females)were followed up for 24 months,of which 27 were bimural affected,18 were unimural affected and 4 were bimural intact.Sixty-three hips were followed up for 12 months,of which 34 were biwall affected,24 were single wall affected and 5 were biwall intact.Seventy-four hips were followed up for6 months,of which 37 were bimural,31 were unimural,and 6 were bimural intact.Harris score(84.65±6.12)was higher than that before treatment(75.32±2.21)(P<Harris score(75.68±8.94)was higher than that before treatment(69.08±5.11)(P<0.05),Harris score(81.67±3.78)was higher than that before treatment(78.67±1.63),the difference was statistically significant.VAS score of single-wall group(3.16±0.93)was lower than that before treatment(3.61±0.72)(P< 0.05),VAS score(3.92±1.30)in double-wall group was lower than that before treatment(5.30±1.05)(P<0.05),VAS score of intact double-wall group(2.67±1.21)was slightly lower than that before treatment(3.17±1.60).Imaging scores in the single-wall group decreased from2.94±0.25 to 1.97±0.95,in the double-wall group from 4.43±0.77 to3.59±1.17(p < 0.05),and were statistically significant,in the double-wall intact group from 1.35±0.45 to 1.25±0.12(P > 0.05).There was no statistical significance.Harris score(87.00±8.02)was higher than that before treatment(75.04±2.18)(P < 0.05),Harris score(79.24±10.56)was higher than that before treatment(69.09±5.22)(P<0.05),Harris score(82.8±4.66)was higher than that before treatment(78.81±1.79)(P < 0.05),the difference was statistically significant.VAS score of single-wall group(2.83±1.27)was lower than that before treatment(3.58±0.78)(P<0.05),VAS score in double-wall group(3.38±1.62)was lower than that before treatment(5.32±1.09)(P <0.05),VAS score in double-wall intact group(2.60±1.52)was lower than that before treatment(3.40±1.67)(P < 0.05),the difference was statistically significant.Imaging scores decreased from 3.58±0.78 to 2.83±1.27(P < 0.05)in the single-wall group and from 4.47±0.79 to 2.91±1.36(P < 0.05)in the double-wall group.The double-walled intact type decreased from 1.20±0.45 to0.82±0.34(P < 0.05),which was statistically significant.After 24 months of follow-up,Harris score(91.22±6.20)of single-wall involvement group was higher than that before treatment(74.94±2.36)(P<Harris score(82.67±10.76)was significantly higher than that before treatment(68.85±4.73)(P<Harris score(85.0±.7.07)was higher than that before treatment(77.25±1.50)(P<0.05),which was statistically significant.VAS score of single-wall group(1.89±1.02)was lower than that before treatment(3.67±0.84)(P<VAS score(3.38±1.62)in double-wall group was lower than that before treatment(5.32±1.09)(P<0.05),the VAS score of the double-walled intact group(1.60±0.82)was lower than that before treatment(2.75±0.96),with statistical significance.Imaging scores decreased from 2.96±0.20 to 1.29±0.81 in the single-wall group and from4.63±0.49 to 2.22±1.81 in the double-wall group.The score difference was statistically significant(P < 0.05),and the double-walled intact type decreased from 1.35±0.45 to 0.50±0.58,which was statistically significant.The results showed that the Harris score,VAS score and imaging score of ONFH patients in the three groups at 6,12 and 24 months after treatment were better than those before treatment for single-wall involvement and double-wall involvement.The imaging improvement of double-wall intact patients was not obvious at 6 months after treatment,but began to improve significantly at 12 months after treatment.Conclusion: Patients with intact double wall were treated with traditional Chinese medicine conservatively and with controlled weight bearing.Patients with single-wall involvement were treated with minimally invasive hip saving surgery;Patients with bimural involvement are treated with arthrotomy.Ct-based dual-wall theory guided hip preservation program has a better effect on hip preservation treatment of patients and delays the progression of femoral head necrosis. |
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