Short-term Effect Analysis Of Total Hip Replacement And Core Decompression Combined With Bone Grafting In Treatment Of Osteonecrosis Of The Femoral Head In FicatⅢ In Adults

Objective:To explore the advantages,disadvantages and short-term clinical effects of total hip replacement and core decompression combined with bone grafting in the treatment of Osteonecrosis of the femoral head in FicatⅢ in adults.Method:The study included the clinical data of 83 patients diagnosed as FicatⅢ Osteonecrosis of the femoral head admitted to the orthopedic department of our hospital from January 2015 to January 2020 were retrospectively studied.They were divided into two groups according to the different surgical methods.Group A was a total of 43 patients who volunteered to receive total hip replacement;A total of 40 cases in group B were treated voluntarily with core decompression and bone grafting.Group A: 28 males and 15 females,with an average age of(55.68±13.77)years.The average Harris score before operation was(64.35 ±4.58);Group B: 26 males and 14 females,with an average age of(55.17±11.50)years.The average Harris score before operation was(64.25±4.57)points.The general data of 83 patients,the time of hospitalization,the time of hospitalization,the time of operation,the length of surgical incision,the amount of intraoperative bleeding,the number of intraoperative C-arm X-ray fluoroscopy,the score of visual analogue scale for pain 3 days after operation,the time of partial weight bearing after operation,the complications after operation,the secondary operation and survival were recorded.The hip function of all patients was evaluated by Harris scoring system before,3 months,6 months,12 months and the last follow-up.Through statistical analysis and comparison of the recorded data of the two groups of cases,the clinical effects of the two surgical methods were comprehensively evaluated.Results : All 83 patients were followed up for 12～15 months(mean12.55±0.87 months).The incisions in both groups healed well;There was no significant difference between the two groups in general data before operation(P>0.05);There was no significant difference in the preoperative waiting time between the two groups(P>0.05).Comparison of postoperative data between the two groups,operation time,surgical incision length,intraoperative bleeding,hospital stay and visual simulation score of pain 3 days after operation: Group A was worse than Group B,while the time of partial weight bearing after operation and the number of C-arm X-ray fluoroscopy during operation in Group A were better than Group B,and the difference was statistically significant(P<0.05).Comparison of postoperative complications(excluding related diseases before operation): 11 patients in Group A had postoperative complications,including 6 cases of pneumonia,4 cases of deep venous thrombosis of lower limbs,and 1 case of urinary tract infection;In group B,there were 4 patients with postoperative complications,including 3 cases of pneumonia and 1 case of deep venous thrombosis in the lower extremity.There was no urinary tract infection in this group.The incidence of postoperative complications in group A was 25.58%,higher than that in group B(10.00%).The difference was statistically significant(χ2=4.270,p=0.039<0.05)。 The secondary operation rate of Group A and Group B was 2.33% and 0 respectively,and there was no statistical difference between the two groups in terms of secondary operation rate(χ2=0.942,p=0.332>0.05)。 Harris score of the hip joint at 3 months,6 months and 12 months after operation in both groups was significantly higher than that before operation,and group B was better than group A,with statistical difference in paired comparison(P<0.05);At the last follow-up,according to Harris scoring standard of hip joint,the excellent and good rate of hip joint function in Group A and Group B was 92.50% and90.00% respectively.There was no statistical difference between the two groups in the excellent and good rate of hip joint function at the last follow-up(χ2=0.306,P=0.580>0.05)。 At the last follow-up of all patients,the Harris score of hip joint reached excellent in 49 cases,good in 24 cases,fair in 6 cases and poor in 4 cases.The average Harris score was(92.10±7.74),the excellent rate was 87.95%,and the overall effective rate was 95.18%.Conclusion:Core Decompression combined with bone grafting can preserve the patient’s own hip joint,and has the characteristics of short operation time,less trauma,less bleeding,quick postoperative recovery,high hip Harris score,fewer complications,and easier acceptance of patients,etc.,which is of great significance in the treatment of young active patients.However,for patients over 65 years old,because it is not suitable to stay in bed for a long time,and revision and other issues do not need to be considered,Total Hip Replacement is recommended as the first choice.