Comparision Of The Efficacy Of Gluteus Medius Muscle-pedicle Bone And Core Decompression With Bone Graftin The Treatment Of Early ANFH

Background:Avascular necrosis of the femoral head(ANFH)is a progressive disease,containing a series of symptoms,which is caused by impaired blood supply to the femoral head.When the disease progresses to the collapse of the femoral head,the repair of bone and cartilage tissue can not restore the function of the hip to the pre-collapse level.According to current reports,any treatment for protecting the femoral head is basically ineffective at this stage.The best result is to undergo joint replacement surgery,so early diagnosis and treatment of ANFH is particularly important.In recent years,some surgical procedures for hip repair have been reported to obtain good postoperative outcomes,such as core decompression,osteotomy,transplantation of bone flap with or without vascular pedicles and muscle-pedicle bone graft.The purpose of these treatment options is to improve the hip joint function while at the same time to delay the progression of ANFH and help to prevent the collapse of the femoral head.However,the surgical operation of the osteotomy has a high degree of difficulty and the clinical application is poor.The operation of vascularized free bone grafts and others are also related to the limitations of clinical applications,because of the microscopic vascular anastomosis,the delicate and complex surgical procedures,and the long operation time.In the traditional head-saving operation,core decompression with bone graft and muscle-pedicle bone graft are often used for clinical treatment.Objective:To investigate the patients with Ficat stage II ANFH who underwent gluteus medius muscle-pedicle bone graft and core decompression with bone graft in our hospital and collect data about the patients using these two surgical procedures.The operation time,intraoperative blood loss,final follow-up Harris score,radiological and survival difference were compared to achieve a comprehensive evaluation of the efficacy of these two surgical procedures for the treatment of Ficat ⅡANFH.Methods:We retrospectively analyzed the basic data of ANFH patients treated with gluteus muscle-pedicle bone graft and core decompression with bone graft in our hospital from January 2013 to March 2017,including the patient’s age,gender,history of alcohol consumption and hormone use,weight,auxiliary examination,and surgical data,The patients eligible for enrollment were followed up.At the 3rd,6th,and 12th months after the operation and then the patients were followed up by telephone or clinic once a year.The postoperative pain degree and motor function were recorded.The hip scores were scored according to the Harris score and the radiographs were regularly reviewed.Statistical analysis of the general data,operative time,intraoperative blood loss,radiological difference and Harris score of the last follow-up were performed to evaluate the clinical efficacy of the two groups.The Kaplan-Meier survival analysis was performed on the survival difference of the femoral head using the total hip arthroplasty as the end point.Results:A total of 54 patients(61 hips)were eligible for enrollment,25 in the gluteus medius muscle-pedicle bone graft group(28 hips),and 29 in the core decompression with bone graft group(33 hips).The average age is 41.6 years(range 26-59 years old).There were 40 males and 14 females.There were 30 cases on the right,17 cases on the left,and 7 cases involved bilaterally.Fifteen patients(17 hips)had a history of hormone use,30 patients(33 hips)had a long history of heavy drinking,and 9(11 hips)had no associated risk factors.The patients were followed up for 11-59 months and the average follow-up time was 33.1 months.There was no significant difference in general data such as sex ratio,age,weight,preoperative Harris score,hip site,and pathogenic factors between the two groups(P>0.05),indicating that the general data of the two groups were comparable.The preoperative Harris scores of the gluteus medius muscle-pedicle bone graft group and core decompression with bone graft group were 62.39 and 63.21,respectively.The final Harris scores were 88.82 and 76.45,respectively.Significantly improved before(P<0.05),but Harris scored gluteus medius muscle-pedicle bone graft group was better than core decompression with bone graft group(P<0.05).The operation time and intraoperative blood loss in the gluteus muscle-pedicle bone graft group were higher than those in the core decompression with bone graft group(P<0.05).The imaging success rate of the two groups was 78.6%(22/28)in the gluteus maximus muscle flap group and 51.5%(17/33)in the core decompression with bone graft group.There were statistical differences between the two groups.Significance(P<0.05).The survival rate of the femoral head after operation in the two groups was 92.9%(26/28)in the gluteus medius muscle-pedicle bone graft group and 72.7%(24/33)in the core decompression with bone graft group,according to the Kaplan-Meier survival analysis.In comparison,the difference in femoral head survival rate between the two groups was statistically significant(P<0.05).Conclusion:In the treatment of Ficat stage II ANFH,the gluteus medius muscle-pedicle bone graft and core decompression with bone graft can effectively improve the hip function and relieve pain,and obtain more obvious postoperative therapeutic effect.Although the gluteus muscle-pedicle bone graft was more inferior than core decompression with bone graft in the operation time and bleeding volume.In the comparision of Harris hip score,radiological and survival difference,gluteus medius muscle-pedicle bone graft is significantly better than the core decompression with bone graft,and the gluteus medius muscle-pedicle bone graft can achieve better clinical efficacy.