The Clinical Observation Of The Liquid Electric Shock Waves In Vitro Combined With Decompression Bone Graft Surgery In The Prevention And Treatment Of Early ANFH

Objective:1.To study the clinical observation of the Liquid electric shock waves in vitro combined with Decompression bone graft surgery in the prevention and treatment of Pro-elder hip postoperative ANFH.2.through the observation liquid electric shock waves in vitro combined decompression with simple decompression using bone graft prevention and treatment of early avascular necrosis of femoral head using bone graft clinical curative effect and related indicators, discusses combination therapy in the treatment of early avascular necrosis of femoral head important position, for clinical prevention and treatment of early avascular necrosis of the new scheme is put forward.Methods:Subject standards in accordance with choice of our hospital orthopedic ward of 60 cases, according to the random single blind method will be divided into two groups: control group for simple decompression group, the experimental group using bone graft for liquid battery extracorporeal shock wave combined decompression bone graft surgery group, each group of 31 cases, observe the changes of two groups of indexes before and after treatment. Preoperative and postoperative patients were pelvic MRI of X or hip, Harris score, conforms to the inclusion criteria in the grouping, seriously comply with the treatment cycle.Control group:the operation method:patients after anesthesia by using a special operation bed take supine, limb, about 15 degrees outward and inward turning routine disinfection shop towels, take the femoral lateral tuberosity (rotor) under 2 cm in vertical incision for about 4 cm, layered cut under the skin, fascia and periosteum, slight periosteal stripping parts, keep periosteal layer to as much as possible and protect the blood supply; Under the monitoring of the c-shaped arm X-ray machine to femoral head center slow down needle (needle and neck stem Angle exactly parallel), along the needle placement along the locator locator sawing into outer ring to cartilage down about 5 mm advisable; In turn to take out the locator and the needle, and then placing the inner ring within the outer ring saw saw even remove bone column, remove the trephine in expanding pressure reducer (according to the degree of femoral head necrosis choose to use a single edge or double edge) a thorough decompression; With a curet clear necrosis of skeletal, remove before can once again use the autograft and allograft bone and cut into about 2-3 mm small bone grain, then stir inside the container, the funnel-shaped implanted bone artifacts slowly even implant, and step by step to play, finally the fibula in tunnel. Check equipment, after having confirmed a large number of physiological saline flushing the wound, layered suture, never put off till tomorrow what you can. The patients after anesthesia to safely back ward. Postoperative to tanshinone II sodium sulfonate static drop 40 mg/day, a bone melon extract static drop 20 ml/day,10 consecutive days to promoting blood circulation to remove blood stasis, regulating bone metabolism; To the bone peptide oral 0.9 g/time,3 times/day, a fairy bone remains capsule oral 1.5 g/time,3 times/day,4-6 weeks for a period of treatment with tonic kidney, strong gluten JianGu, promoting bone healing.Shock wave therapy group (joint):according to the postoperative patients in stable condition, in 2-3 days start with shock wave therapy:patients with first side or prone position, determine the femoral head surface projection area (femoral greater trochanter highs and sacral canal in the attachment of the Chinese and foreign third intersection point slightly above) and tag in body surface, according to local skin condition selected impact point; Local coated cha medical coupling agent, the second liquid battery extracorporeal shock wave (ESWT) vertical alignment and fixed in the impact point, head through the coupling agent treatment combined with skin fully (must avoid the great vessels and nerves concentration areas); Voltage in accordance with the patients pain tolerance degree advisable, general shock therapy 12 kv voltage of 5 kv-, each discharge time,800-1000, about 15 minutes each time interval of two to four days, a total of treatment 6-8 times.Preoperative and postoperative observation and evaluation indicators mainly include:main Harris evaluation, VAS score, pelvic plain film, etc. Observation time both in postoperative 1,6,9 and 12 months follow-up.Results:Into the trial group, group of cases, a total of 31 cases, fall off in 1 case,1 case, 29 cases of complete tests; The control group into the group of 31 cases, fall off in 1 case,2 cases,28 cases to complete the test. Patients postoperative femoral head collapse 0 cases, control group of postoperative femoral head collapse occurred in 2 cases. Experimental group and control group has not been postoperative infection occurs, incision healing, allograft rejection and other adverse events. The application of SPSS statistical software package processing, count data by chi-square test; Measurement data using mean ± standard deviation (X ± S) said, normal distribution using t test, non-normal distribution by using rank and inspection. Adopt bilateral test, P< 0.05 for the difference was statistically significant.1. In terms of indicators, such as symptoms before and after the treatment, Harris score, X-ray, VAS visual analog pain score statistics analysis, etc, confirmed that there is a difference between the two groups before and after treatment.2.The experimental group after treatment symptoms, function improved significantly, the same period of femoral head collapse rate is significantly lower than the control group, a sink time extended obviously.3. To explore a set of joint scheme for the treatment of early avascular necrosis of femoral head.Conclusion: The Liquid electric shock waves in vitro combined decompression treatment of early avascular necrosis of femoral head using bone graft (experimental group) remission of symptoms, Harris score increased significantly, VAS score significantly reduced; X ray film performance basic keep in the same period, and have to early cases, not present femoral head collapse, a collapse of extended time significantly. That combination therapy group is better than simple decompression bone graft surgery group.