Effectiveness Of Hip Arthroscopy Combined With Core Decompression And Ceramic Rod In The Treatment Of Middle-term Non-traumatic Femoral Head Osteonecrosis

Objective:To investigate the clinical efficacy of hip arthroscopy combined with core decompression plus ceramic rod in the treatment of middle-term non-traumatic femoral head necrosis by comparing with simple core decompression plus ceramic rod.In order to provide reference for the clinical treatment of hip preservation.Methods : Using the method of retrospective cohort study,the Department of Orthopaedics,Affiliated Hospital of Zunyi Medical College was collected from January 2013 to December 2017.A total of 81 patients with avascular necrosis of the femoral head who met the inclusion criteria were enrolled in this study.During hospitalization and follow-up in our hospital,27 patients were excluded for various reasons.Finally,clinical data of 54 patients with avascular necrosis of the femoral head were collected completely,of which 24 patients were treated with core decompression combined with hip arthroscopy + ceramic rod surgery(Group A),and30 patients were treated with core decompression alone.Pressure + ceramic rod surgery(group B).The preoperative imaging data of the two groups were staged according to the Association Research Circulation Osseous(ARCO).Group A included 15 patients with stage II(5 patients with stage IIB and 10 patients with stage IIC),9 patients with stage III(8 patients with stage IIIA and 1 patient with stage IIIB),and group B included 15 patients with stage II(3 patients with stage IIB and 12 patients with stage IIC)and 15 patients with stage III(13 patients with stage IIIA and2 patient with stage IIIB).The general data(age,sex,BMI,etiology,stage,etc.),operation-related safety(operation time,intraoperative blood loss,postoperative hospital stay,complications),Harris hip score(1 month,6 months,18 months,24months)and VAS score(resting state in the first 3 days after operation)of the two groups were statistically analyzed.The imaging data of the two groups at 24 months after operation were compared with the preoperative imaging data to evaluate the success rate of head preservation in the two groups.Results:There were no significant differences between the two groups in terms of gender,age,etiology,BMI,preoperative ARCO stage,preoperative VAS score,Harris score and other general data(P > 0.05),and the data were comparable.In terms of operation safety,there were no significant differences in intraoperative bleeding volume,postoperative complications and postoperative hospital stay between the two groups(P > 0.05),but the operation time of group A(129.92 ± 24.75)was significantly higher than that of group B(87.87 ± 24.94),and the difference was statistically significant(P < 0.05).The VAS scores in the first three days after operation in both groups were significantly lower than those before operation,and the VAS scores in group A were lower than those in group B in the resting state in the first three days after operation,the difference was statistically significant(P < 0.05).The Harris scores of the patients in group A were superior to those in group B at all time points of 1 month,6 months,12 months,18 months and 24 months after operation,and the difference was statistically significant(P<0.05).Finally,at 24 months after surgery,according to the success rate of head-preservation with or without imaging progress,the success rate of 24 patients with hip-preservation in group A was 87.5%(21/24),including 93.3%(14/15)for phase II,77.8%(7/9)for phase III,63.3%(19/30)for group B,including 73.3%(11/15)for phase II,and 77.8%(7/9)for phase III.The success rate was 53.3%(8/15).The overall success rate of head protection in group A was higher than that in group B,and the difference was statistically significant(P<0.05).Conclusion: 1.Hip arthroscopy combined with core decompression and ceramic rod is a safe and feasible method in the treatment of middle-term non traumatic necrosis of the femoral head.2.In the treatment of mid-term non traumatic necrosis of the femoral head,compared with the simple core decompression + ceramic rod support,hip arthroscopic core decompression + ceramic rod support can more quickly and effectively relieve the pain symptoms of patients,and has better short-term efficacy.