| PART Ⅰ A clinical study on the treatment of early osteonecrosis of the femoral head by beta tricalcium phosphate bioceramics rod systemObjective To evaluate the short-term clinical efficacy on the treatment of early osteonecrosis of the femoral head by beta tricalcium phosphate bioceramics rod system.To study the relativity between the preoperative factors(age,BMI,course of time,cause,necrosis range,bone marrow edema classification,preoperative Harris hip score and preoperative hip pain VAS score)and the clinical efficacy of beta tricalcium phosphate correlation of bioceramic rod implantation.Method Postoperative short-term observation and follow-up on 34 cases(35 hips)undergone beta tricalcium phosphate bioceramic rod implantation of osteonecrosis of femoral head between April 2015 and August 2015.The Harris hip score and hip pain VAS score between the pre-operation,the postoperative 6months,12 months,18 months were statistically analyzed.Radiological evaluation between the postoperative 6 months,12 months,18 months weremade.To analysis the relativity between the factors(age,BMI,course of time,cause,necrosis range,bone marrow edema classification,preoperative Harris hip score and preoperative hip pain VAS score)and the postoperative Harris hip score and hip pain VAS score.Result All patients were followed up to 18 months after surgery.(1)Harris hip scores between pre-operation and postoperation Postoperative Harris hip scores at all time points,compared with preoperative Harris hip score had improved significantly(P < 0.05);Preoperative excellent rates of Harris hip score had improved.(2)Hip pain VSA scores between pre-operation and postoperation Postoperative Hip pain VSA scores at all time points,compared with preoperative Hip pain VSA scores had reduced significantly(P<0.05).(3)Relations between preoperative factors and preoperative Harris hip scores There were no correlations between the factors(age,BMI,course of time,cause,necrosis range,bone marrow edema classification and preoperative hip pain VAS score)and the preoperative Harris hip score(P>0.05).(4)Relations between preoperative factors and preoperative Hip pain VSA scores There was a positive correlation between bone marrow edema classification and preoperative Hip pain VSA scores(P<0.05),there were no correlations between other factors and preoperative Hip pain VSA scores(P>0.05).(5)Relations between preoperative factors and postoperative Harris hip scores There was a positive correlation between the factors(age,BMI,necrosis range and preoperative Harris hip score)and postoperative Harris hip scores(P< 0.05),there were no correlations between other factors and postoperative Harris hip scores(P>0.05).(6)Relations between preoperative factors and postoperative Hip pain VSA scores There was a positive correlation between the factors(BMI and necrosis range)and postoperative Hip pain VSA scores(P < 0.05),there were no correlations between other factors and postoperative Hip pain VSA scores(P>0.05).(7)Radiological result According to ARCO stage,radiographic assessment were made on 35 hips that 24 hips was stable and the stability rate was 68.57% at postoperative 6th months,that 27 hips was stable and the stability rate was 77.14% at postoperative 12 th months,and 31 hips was stable and the stability rate was88.57% at postoperative 18 th months.Hip-preserving rate was 91.43%,femoral heads of 3 hips had collapsed at postoperative 18 th months.Conclusion Using beta tricalcium phosphate bioceramic rod for treatment of early ONFH,can improve the function of hip joint,relieve symptoms,prevent the radiological progress,obtain a higher rate of hip-preserving and the satisfying short-time clinical efficacy.The factors(age,BMI,necrosis range and preoperative Harris hip score)need to be considered,when evaluating the clinical efficacy and selecting the surgery indications.PART Ⅱ A biomechanical study on the treatment of early osteonecrosis of the femoral head by beta tricalcium phosphate bioceramics rod system based on three-dimensional Finite element AnalysisObjective With three-dimensional finite element analysis method,to establish different finite element models of femoral head necrosis lesions and beta tricalcium phosphate bioceramics rod system implantment and analyze biomechanical effects of early osteonecrosis of femoral head by beta tricalcium phosphate bioceramics rod system implantment,in order to provide biomechanical theoretical basis on the treatment of early osteonecrosis of femoral head by Beta tricalcium phosphate bioceramics rod system.Method To establish a finite element model of normal proximal femur by using thin layer CT scanning and the finite element software for a healthy male adult,then to establish three-dimensional finite element models of femoral head necrosis area located in the anterior laterosuperior 15%and 30%,the posterior laterosuperior 15% and 30%,2 mm and 4mm collapse of weight-bearing area and early osteonecrosis of femoral head by beta tricalcium phosphate bioceramics rod system implantment,to load the ONFH model weight-bearing area under the mechanical loading of the walking,slow running,rapidly running and analyze the equivalent stress and displacement of the femoral heads before and after treatment by beta tricalcium phosphate bioceramics rod system,and estimate the collapse risking of femeral head under the different gaits.Result(1)Under gaits of the normal walking,slow running and rapidly running,compared with the pre-operation,the pre-operational stress concentration phenomenon of femoral head was improved and the pre-operational stress value and the overall displacement value of femoral head,the weight-bearing area stress value and the collapse value,the necrotic area stress value and the displacement value obviously decreased(P<0.05)。Under the three kinds of gaits,the stress value and the overall displacement value of femoral head,the weight-bearing area stress value and the collapse value,the necrotic area stress value and the displacement value were gradually increased.(2)According to the collapse criterion,under the three kinds of gaits,the collapse risk of the preoperative and postoperative femoral head necrosis range 30% was bigger than 15%,the collapse risk of femoral head 4mm collapse was bigger than 2mm,and the collapse risk was gradually increased,with the load increasing.Between the anterior laterosuperior and the posterior laterosuperior,the collapse risk of femoral head necrosis range 30% and 15% had no obvious differences.Conclusion(1)Finite element model can simulate biomechanical changes of beta tricalcium phosphate bioceramics rod system filling procedure accurately.(2)Beta tricalcium phosphate bioceramics rod system can effectively enhance the supporting ability of weight-bearing area of ONFH,reduce the compressive stress of necrotic area,and improve the internal biomechanical environment of ONFH,finally reduce the collapse risk of femoral head.(3)The biomechanical supporting ability of beta tricalcium phosphate bioceramics rod system is limited,so,With the lord gradually increasing,the collapse of femoral head is gradually increasing.Therapeutic effect of femoral head small necrosis range is better than the big necrosis range,and therapeutic effect of femoral head slight degree collapse is better than heavy degree.(4)Evaluating the curative effect from the perspective of biomechanics provides biomechanical theoretical basis on the treatment of early osteonecrosis of femoral head by beta tricalcium phosphate bioceramics rod system. |
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