| BackgroundOsteonecrosis of the femoral head(ONFH),also known as avascular necrosis(Van)or aseptic necrosis(ASN),is mainly caused by steroid,alcohol or traumatic factors that cause nourishment of blood vessel damage and cancellous bone and bone tissue in the femoral head Ischemic necrosis,degeneration,necrosis and collapse of subchondral bone,and gradually progress to osteoarthritis,which in turn affects the daily activities of patients.At present,hip-sparing treatment is still a major problem for orthopedics.Once the disease progresses to the advanced stage,total hip arthroplasty(THA)is the only effective treatment.The disease is more common in patients aged 20-50 years,and its onset is younger.Therefore,for young or patients with large sports needs,although THA has resolved clinical symptoms,it may face infection,loosening,and multiple revisions in the future.For the treatment of this disease,early detection,early diagnosis,and early treatment are the key.At present,early surgical treatment methods mainly include core decompression(CD),CD and Bone Grafting,CD and bioceramic rod and particle implantation.CD removes necrotic tissue and relieves intramedullary hypertension,while also losing support for the subchondral bone plate,increasing the risk of collapse.Therefore,to strengthen the support of subchondral bone plate and find suitable materials is a hot issues in the current research.Bone Grafting and bioceramic rod and particle implantation currently commonly used in clinical implant materials.β-TCP porous bioceramics rod and particle is emerging bioceramic materials.Many scholars have demonstrated the clinical efficacy of CD and bioceramic rod and particle implantation for the treatment of early femoral head necrosis.But compared with the commonly used CDand Bone Grafting,the analysis of clinical effect is less.In this study,we conducted a systematic review of the clinical effect of Bone Grafting and bioceramic rod and particle implantation in the treatment of early femoral head necrosis,in order to compare the efficacy of the two methods in the treatment of early femoral head necrosis and guide the clinical treatment.ObjectiveTo explore the clinical effect of the treatment of early femoral head necrosis by Bone Grafting and bioceramic rod and particle implantation.MethodFrom January 2016 to January 2018,we collected the clinical data of patients with early femoral head necrosis treated by the above two operations in our hospital.Sixty patients with stage Ⅱ early femoral head necrosis in accordance with the classification of the association research circulation osseous(ARCO)were selected and divided into two groups according to the surgical method.The control group was enrolled into 30 patients(34 hips)for CD and Bone Grafting,30 patients(33 hips)in the observation group underwent CD and bioceramic rod and particle implantation,the clinical data of the two groups of patients in terms of gender,age,and ARCO stage were not statistically significant(P>0.05).They were comparable,and all operations were operated by the same surgical team.All enrolled patients were followed up for 12 months after operation,the Harris scores of the two groups of patients before and after operation were recorded and compared,and according to the Harris score grading,compared the efficiency and excellent rate.Recorded the operation status of the two groups of patients,compared the operation time,intraoperative bleeding volume and early and late complications.Two groups of patients underwent X-ray examinations of the hip joint before operation,1 week,3 months,6 months,and 12 months after operation to observe the new bone growth.Before and after 12 months of operation,hip joint MRI examinations were performed to observe the progress of osteonecrosis and evaluate the clinical efficacy.Results1.The Harris scores of the two groups were significantly higher than those before surgery,and the difference was highly statistically significant(P<0.01).2.The postoperative excellent and good rate was higher in the observation group than in the control group,and the difference was statistically significant(P<0.05).There was no significant difference in the postoperative efficiency between the two groups(P>0.05).3.The operation time of the observation group was significantly shorter than that of the control group.The intraoperative bleeding volume was significantly lower than that of the control group.The Harris score was significantly higher than that of the control group after surgery.The difference was highly statistically significant(P<0.01).4.No complications such as infection,neurovascular injury,trochanteric bursitis,and deep vein thrombosis occurred during and after the operation in both groups.5.According to imaging results,in the control group,1 hip progressed from stage Ⅱa to Ⅲa,2 hips progressed from stage Ⅱa to Ⅱb;in the observation group,1 hip progressed from stage Ⅱa to Ⅱc,and 1 hip progressed from stage Ⅱb to Ⅱc.Except for the above patients,there was no obvious progress in necrosis of the femoral head from the imaging manifestations,bone grafting morphology and position were good,the femoral head was intact,and the lesions were re-ossified;the bioceramic rod was in place,no abnormal appearance,and no obvious signs of loosening.However,the bone growth process of the control group was slow,and with the gradual resorption of the implanted bone,the decompression bone tract still exists,indicating that its long-term support effect is not ideal;The radiation between the observation group’s bioceramics and normal bone tissue rapidly shrank,prompting its ability to induce osteogenesis is good.ConclusionCD and bioceramic rod and particle implantation and CD and Bone Grafting both can be used to treat early femoral head necrosis to achieve good results.However,the former iseasy to operate and has less trauma.It has better effect on symptom relief and function improvement after surgery,and it can be popularized and applied. |
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