| Background Osteonecrosis of the Femeral Head(ONFH)is a common and frequently occurring disease in orthopedics.In the head-saving treatment of early femoral head necrosis,core decompression can reduce the pressure of the femoral head core and improve the blood supply of the femoral head,thus delaying or reversing the disease process of early femoral head necrosis.This surgical method is widely used in current clinical practice.After core decompression,implanted β-tricalcium phosphate porous bioceramics rod+particles,biological ceramic rod can guide the blood supply of femoral head,to reconstruct the blood supply of femoral head and the material has good bone conductibility and biocompatibility,biodegradation,into the subchondral bone ceramic particles degradation speed match the speed of new bone formation,formation of new biomechanics of bone strength than its normal bone strength high,formation of new bone for the subchondral bone provides a strong mechanical support,to prevent the collapse of the femoral head.Alprostadil belongs to the natural prostaglandin class,and its effective component is prostaglandin E1,which is a vasodilator and a drug to inhibit platelet aggregation.It is widely used in the treatment of peripheral vascular and cerebrovascular diseases,and has achieved satisfactory treatment effect.Was found in previous studies this topic now ARCO Ⅱ period patients pulp core decompression bioceramics rod + particle after implantation,to lead to treatment,can effectively alleviate pain,improve the function of hip joint,then the front,whether can improve the blood supply of femoral head,based on this aspect to consider this topic is proposed to mainly investigate the ARCO stage Ⅱ options were bone necrosis,application of pure core decompression β-tricalcium phosphate bioceramics rod + particle implantation and core decompression β-tricalcium phosphate bioceramics rod + particle implantation combined with Alprostadil,the treatment effect.Objective Explore pure core decompression β-tricalcium phosphate bioceramics rod + particle implantation and core decompression β-tricalcium phosphate bioceramics rod + particle implantation combined with Alprostadil to ARCO Ⅱ treatment period of the clinical effect of femoral head necrosis.Methods Select The First Affiliated Hospital of Xinxiang Medical College Orthopedic Surgery ward 2 between September 2017 and October 2018 admitted during the period of ARCO Ⅱ options were 32 patients(41 hips),using core decompression β-tricalcium phosphate bioceramics rod + particle implantation combined with Alprostadil treatment as observation group,using pure core decompression β-tricalcium phosphate bioceramics rod + particle implantation treatment as control group.By the staging of Association Research Circulation Osseous(ARCO),there were 17 cases(22 hips)in the observation group: 13 males(17 hips)and 4 females(5 hips)in the observation group.The age ranged from 24 to 48 years old,with an average of 35.27±8.58 years old.Causes: alcohol in 6 patients(8 hips),hormone in 8 patients(10 hips),unknown in 3 patients(4 hips).15 patients(19 hips)in the control group: 10 males(13 hips)and 5 females(6 hips).The age ranged from 23 to 49 years old,with an average of 34.74±8.23 years old.Causes: alcohol 7 patients(9 hips),hormone 5 patients(7 hips),unknown causes 3 patients(3 hips).The control group was treated with core decompression β-tricalcium phosphate bioceramics implantation,and the observation group was treated with Alprostadil on this basis,and both groups were treated continuously for 1 month.Patients in the 2 groups were followed up for 1 year to compare the differences in imaging progress,Harris score and visual analogue scale(VAS)scores between the two groups before and after treatment.The occurrence of adverse reactions in 2 groups was observed.Results 1.If the imaging indication is improved or unchanged,the imaging is successful.After 1 years follow-up,the success rate of imaging of the observation group was 95.5%(21/22);In the control group,the overall success rate of imaging was 68.4%(13/19);According to Fisher’s accurate test results(P=0.036),the observation group was significantly higher than the control group(P<0.05).2.32 cases(41 hips)patients were followed up for 1 year,the observation group and control group of patients with hip pain VAS scores respectively by preoperative 7.32±1.21 points and 7.11±1.15 and significantly reduce the postoperative 1 month of 4.18±1.37 points and 5.11±1.10 points,after 6 months of 3.36±1.18 points and 4.21±1.27 points,after 1 year of 2.18±1.01 points and 3.15±1.67 points,and the difference was statistically significant compared to preoperative(P < 0.05);There was no significant difference in preoperative VAS score between the two groups(P >0.05),and VAS pain score in the observation group was significantly lower than that in the control group at 1 month,6 months and 1 year after surgery(P < 0.05).3.The Harris score of hip joint in the observation group and the control group increased significantly from 59.64±5.74 points and 60.74±5.78 points before the operation to 86.05±4.19 points and 81.58±5.47 points 6 months after the operation and 90.14±4.13 points and 85.47±3.66 points 1 year after the operation,and the difference was statistically significant compared to preoperative(P < 0.05).There was no significant difference in preoperative Harris score between the two groups(P >0.05),while the Harris score in the observation group was significantly higher than that in the control group 6 months and 1 year after surgery(P < 0.05).4.During the follow-up period,no significant adverse reactions occurred in the two groups.Conclusion 1.In the stage of ARCO Ⅱ femoral bone necrosis,core decompression combined with tricalcium phosphate bioceramic rod + particle implantation can effectively relieve the pain symptoms of patients with early femoral head necrosis and improve the hip joint Harris functional score2.In stage ARCO Ⅱ femoral bone necrosis,this operation combined with Alprostadil was superior to the operation group in improving the success rate of imaging,relieving the pain symptoms of patients with early femoral head necrosis,and improving the Harris function score of the hip joint,and Alprostadil did not cause significant adverse reactions. |
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