Relativity Study Between Retaining Angle Of Anteriorly And Laterally Of Femoral Head And Prognosis Of Necrosis Collapse Of Femoral Head

Objective:By using non-surgical hip-salvage treatment of femoral head necrosis patients were retrospectively analyzed,evaluation of the femoral head before,outside wall retention correlation with femoral head collapse progress and femoral head before,the influence of the outside wall retaining Angle of femoral head survival,discuss in front of the femoral head,outer wall keep Angle in femoral head necrosis application value of the theory of "peri-collapse period".Methods:Retrospective study included patients with peri-collapse period of osteonecrosis of the femoral head(including ARCO Ⅱ stage and ARCO Ⅲ A stage)who received non-operative hip preservation treatment in the first affiliated Hospital of Guangzhou University of traditional Chinese Medicine from August2012 to February 2019.A total of 121 hips of 87 patients were included,including 62 males(87 hips)and 25 females(34 hips).A total of 58 hips in the collapse group were included in the collapse group,including 42 males and 16 females,including 20 alcoholic hips,32 steroid hips and 6 idiopathic hips.The others without collapse progression were included in the non-collapse group,a total of 63 hips,including 45 hips in males and 18 hips in females,including 15 hips in alcoholic group,42 hips in steroid group and 6 hips in idiopathic group.The retention angles of the anterior and lateral walls of the femoral head were measured on the X-ray imaging system.The chi-square test,independent sample t-test,ROC curve and Kaplan-Meier survival analysis were used for statistical tests.SPSS 24.0 software was used for all statistical tests.Results:All patients received clinical follow-up.During follow-up,femoral head collapse progressed in 58 hips.Follow-up time ranged from 3 to 83 months,with a mean follow-up time of 39.60±20.43 months.All patients ranged in age from 15 to 68 years,with a mean age of 37.22±11.09 years.According to the results of ROC analysis,on the anteroposterior radiographs,the critical value of the lateral wall retention angle was 60.44 °,that is,when the lateral wall retention angle was less than 60.44 °,it was significantly correlated with collapse(sensitivity = 85.71%,specificity = 80.00%,logarithmic rank test: P < 0.0001).On frog lateral radiograph,the critical value of the anterior wall retention Angle was 63.89°,i.e.,the lateral wall retention Angle ≤63.89° was significantly associated with collapse(sensitivity = 89.29%,specificity = 90.77%,log-rank test: P <0.0001).The Kaplan-Meier survival curve showed that the survival rate of the femoral head was significantly higher than the critical value,when the retention Angle of the lateral wall was less than 60.44°,the survival rate of the femoral head was only 8.74% at 80 months.The survival rate of the femoral head reached78.75% at 80 months when the lateral wall was preserved at an Angle of > 60.44°.When the current lateral wall retention Angle was less than 63.89°,the survival rate of the femoral head was only 10.22% at 60 months.The survival rate of femoral head reached 84.7% at 80 months when the lateral wall was preserved at an Angle of > 63.89°.Conclusion:Lateral femoral head before and wall retaining Angle can be comprehensive and objective reflect the distribution of the column and the lateral column of the side femoral head necrosis,has a strong ability to judge the risk of collapse,quantitative indicators of the subsidence can be predicted,can more accurate prognostic judgment of collapse,provide a new basis for clinically preferred non-surgical hip-salvage treatment,has high clinical value.