| Objective: There are many surgical methods for Osteonecrosis of the femoral head(ONFH)hip preservation,and the classical Core decompression(CD)combined with bone graft is more effective,but the prognosis level varies greatly among individuals.The purpose of this study was to observe the therapeutic effect of CD combined with calcium sulfate and calcium phosphate artificial bone in the treatment of early and middle ONFH,and to provide relevant basis for the further development of this operation in the future.Methods: A total of 28 patients(40 hips)with femoral head necrosis admitted to the Second Xiangya Hospital of Central South University from December 2019 to December 2021 were selected.Clinical data were collected according to the inclusion and exclusion criteria agreed by our research group,and the therapeutic effects of CD combined with calcium sulphate-calcium phosphate artificial bone implantation on early and mid-stage femoral head necrosis were retrospectively analyzed.All patients were given strict bed rest to avoid weight-bearing for 3 months after surgery,and the hip joint weight-bearing was determined according to the review results.Visual Analog Scale Score(VAS)and Harris Hip Score(HHS)and The 36-Item Short Form Health Survey(SF-36)were statistically analyzed.Regular postoperative follow-up was maintained,with Total Hip Replacement Arthroplasty(THA)as the end point.Different necrotic index grading,Association Research Circulation Osseous(ARCO)staging,China-Japan Friendship Hospital classification(CJFH)were observed.on the curative effect.Results: Clinical data of 28 patients(40 hips)were collected,including 24 males and 16 females.The age ranged from 20 to 59 years,with an average age of 43.32±10.66 years.Unilateral 16 cases,bilateral24 cases;Alcohol type 14 cases,hormone type 8 cases,other 19 cases;ARCO Ⅱ stage 25 hips,ARCO ⅢA stage 11 hips,ARCO ⅢB stage 4hips;The average time of each hip joint was 56.90±14.90 min.The average follow-up time was 17.39m(6-26 m).Up to the last follow-up,4patients(7 hips)received THA for femoral head collapse,and the success rate of hip preservation was 24/28,85.71%(33/40,82.50%).There were significant differences in VAS score,HHS score and SF-36 score after operation compared with that before operation(P < 0.05).The mean VAS score at 6 months after surgery was 4.08±1.77 points.The VAS score at 1month after surgery(95%CI:0.0553-2.405)and 3 months after surgery(95%CI:0.3028-3.777)was lower than that of stage Ⅲ B,but there was no significant difference between stage Ⅲ A and stage Ⅲ B(P > 0.05).VAS scores of CJFH type C patients 3 months after surgery(95%CI:0.3984-4.002)and 6 months after surgery(95%CI: 0.31166-4.755)were lower than those of L3 type.VAS scores of grade A were lower than grade C at 3 months after surgery(t=2.958,P=0.009)and 6 months after surgery(t=3.214,P=0.005).The mean HHS score 6 months after operation was 71.53±13.67.The HHS scores of stage ARCO Ⅱ patients were higher than that of stage ARCO Ⅲ B(95%CI: 4.663-23.52),6(95%CI: 6.102-38.30)and 12(95%CI: 12.02-43.28)at 3 months after surgery,but there was no significant difference between stage Ⅲ A and stage ⅲ B(P > 0.05).HHS scores of PATIENTS with CJFH TYPE C were higher than those of L3 type 3 months after surgery(95%CI:2.243-22.82),6 months after surgery(95%CI: 7.004-40.06),and 12 months after surgery(95%CI: 6.107-41.89).Sf-36 scale was conducted before and 6 months after surgery,and scores of all dimensions were significantly higher than those before surgery(P < 0.0001).Conclusion: CD combined with calcium sulfate and calcium phosphate can effectively improve the pain symptoms of patients with early ONFH and improve the quality of life of patients.This operation has considerable curative effect,simple and easy to operate,and is suitable for popularization in primary hospitals. |
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