| Objectives:As a world-wide intractable obstinate disease at present, femoral head necrosis is a stubborn illness with a high disability rate, a yearly increasing incidence and a high-speed progression rate. It is hard to diagnose at its early period, however, it is often diagnosed at the middle period when the patient is likely to get disabled, mostly in young and middle-aged. So far, there is no effective ways to cure it. The final objectives of treating this disease are to keep the integrity of femoral head, prevent femoral head from collapsing and enable sequestrum to repair and slow or even avoid the replacement of artificial joint. According to this research, it aims at concluding and carrying forward the academic ideas and experience about treatment of this illness from distinguished experienced Chinese medicine professor Tong yunhui in order to think of effective treatment methods for femoral head necrosis, which is of great significance for laying the clinical and theoretical foundation of giving play to the advantage of traditional Chinese medicine treatment.Methods: By mainly adopting the following three methods: literature review, academic thinking and clinical experience and research, this research is going to systematically sort out and study orthopedics academic ideas and experience about treatment of this illness from professor Tong yunhui. In the part of literature review, the method is to conclude and analyze the origin of Pingle Bonesetting Academic School and then rearrange ancient and modern treatment methods. In the part of academic ideas and clinical experience, it tends to conclude and organize orthopedics academic ideas and clinical experience about treatment of this illness from professor Tong yunhui. In the part of clinical experience, firstly, single blinded study is conducted on 80 patients with 118 hip femoral heads; secondly, the patients are treated with fibula support combined with Chinese medicine. Meanwhile, the patients are respectively examined at different time: 3 months, 1 year and 2 years. Finally the overall evaluation is obtained by analyzing Harris hip scores, overall image stability rate, femoral head shape and the necrosis and sac variable area, etc. The method adopted is to study the clinical treatment effect for patients and conclude what the role it plays in the hip keeping treatment.Consequence: Theory and experience summary: From the Tong’s orthopedics academic ideas, we can know the academic origin that is mainly from Pingle Guo Bonesetting Academic School. As the real apprentice of the sixth disciples, Tong has read a world of classics, namely The Golden Mirror of Medicine, Orthopedics Studies and he also absorbs the essence of other masterpieces of Pingle School such as Bonesetting Technique Points, Secret Bonesetting Essence, Pingle Guo Bonesetting Massage Methods, The History of Hereditary Doctor Bonesetting, Practical Bonesetting Studies and Orthopedics Treatment,etc. He is familiar with “Eight Techniques and Twelve Rules” of Pingle Bonesetting, the methods of distinctive small splints fixation and three-period Orthopedics dialectical medication and others that he has mastered in his life. Furthermore, what he has learned has been put into his treatment practice, which gets a better curative effect. Femoral heads have been innovatively classified into four types by Tong: qi stagnation and blood stasis, phlegm turbidity and blood stasis, kidney deficiency, spleen kidney yang deficiency. Under the guidance of ARCO method, the method of Chinese medicine type-targeted dialectical treatment is used to treat patients at I and Ⅱa period. The methods of core decompression, debridement, pedicle and support are employed at Ⅱb and Ⅲc period. According to their age and symptoms at Ⅳ period, the treatment goals are adjusted. At this period, pedicle, support, osteotomy and joint replacement methods are adopted respectively. Combining with traction, crutches and functional exercise and something else, the whole treatment process embodies traditional Chinese medicine treatment methods. All these reflect Tong’s idea of combining traditional Chinese medicine with western treatment as well as diseases differentiation with syndromes differentiation.In clinical research on treating femoral head necrosis with the Tong’s fibula support method, it is found that the number of men is higher than that of women and the ratio stands at 5:1. The average age among patients is 37.9, which shows that this method tends to be designed for young adults. The harris hip score is used in the clinical evaluation. The efficient is 84.7% with excellent results of 49 hips, good results of 51 hips and effective results of 100 hips, which reflects that the patients can get a satisfactory hip that works well by the treatment. By comparing the periodization good rate from ARCO(Association Research Circulation Osseous), the research focuses on the patients at Ⅱ and period and the good rate is over 96% at the Ⅱ Ⅱa and Ⅱb period, over 80% at the Ⅱc and Ⅱa period and over 60% at the Ⅱb period. Within 2mm collapsing area, the smaller the necrosis area is, the better the hip works. To sum up, the overall effect is more satisfactory. The examination after treatment in a year shows 84.1% image stability rate. It is pointed out that the rate is going to decrease after 2 years, but there is no statistics that can support it. It is obvious that that bone graft surgery plays a supporting role for femoral head in a short term, obtaining enough time and space for its recovering. In this study, the number accounts for 13.72 percentage with a sac variable area of over 30% after three months’ treatment and the area is apparently smaller after two years’ treatment than that of one year. After two years’ treatment, the number accounts for 90 percentage without sac variable area and 16.95 percentage with sac variable area of less than 15%. The data shows the function of treatment that is accelerating the repair of necrotic bone and obviously narrowing the sac variable area. It further proves that the fibula support works well and necrotic area is getting more and more stable. Meanwhile, the use of traditional Chinese medicine(TCM) plays a positive role in treating the illness. These two methods combine well to achieve a curative effect.Conclusion:This research aims at systematically summarizing Tong’s ideas about orthopedics treatment and applying overall ideas to the clinical practice where these following principles should be followed, including “overall dialectical thinking, laying equal stress on muscles and bones, combining traditional Chinese and western medicine, pathology focus, admiring classics, exact prescription, harmonious movement and motionless, combining prevention and treatment”. The combination of disease and syndrome differentiation and traditional Chinese and modern western medicine is also advocated. What’s more, based on the guide of modern pathological diagnosis, the curative effect of TCM treatment can be better. Modern surgical techniques can cover the shortage of the treatment of traditional Chinese medicine, while for some diseases, TCM can give full play to its advantage with some methods adopted including basic dialectical treatment, correlation of all four examinations. What the doctors needs to bear some academic ideas in mind is to read classics, give priority to preventive treatment and attach equal importance to traditional Chinese and western medicine.The treatment values overall dialectical thinking, meanwhile, the qi and blood as well as phlegm stagnation is also taken into account. In this process, what the doctor needs to figure out what is principal syndromes and the accompanied syndromes cannot be ignored. Different treatment principals are made after analyzing symptoms fully. Traditional Chinese medicine puts emphasis on "one foundation, two outlooks". The main reason of suffering from this illness is phlegm stagnation. The main syndrome is liver and kidney deficiency and phlegm stagnation is accompanied syndrome, which leads to the following pathogenesis: liver and kidney deficiency, dampness stagnancy due to spleen deficiency, phlegm stagnation and deficiency of qi and blood. These dialectical treatment methods generate a satisfactory curative effect such as "nourishing liver and kidney", "promoting blood circulation", "invigorating spleen and removing dampness" and "yang warming and blood activating", etc. This clinical research further proves the effectiveness of the treatment combining traditional Chinese medicine and fibula support. Furthermore, this treatment tends to enhance the stability of femoral head necrosis area in the hip-keeping treatment. All these prove that traditional Chinese medicine is helpful in accelerating the sequestrum recovering and the treatment is safe and effective. |
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