The Clinical And Experimental Study On Early Treatment In Avascular Necrosis Of Femoral Head

The avascular necrosis of the femoral head (ANFH) is a kind of frequent and refractoriness disease of orthopedics. The pathogenesis of ANFH was not clear and lack of unified treatment in current time. There were many means of early treatment of ANFH, but exist various problems, or too much trauma or blow the mark of therapeutic effect, ultimate cause dysfunction or nonfunction in joint. The trend and orientation of surgical treatment on ANFH is Minimally Invasive method. The study showed that treatment methods, follow-up outcomes and surgery comprehension of progressed core decompression and hip arthroscope debridement treated cases with early ANFH. So we did animal experiments and biomechanics to testified those treatments.Objective1. To probe the therapeutic effect of hip arthroscope treated ANFH with small diameter, multiple porous, low drill velocity decompression.2. Observing short-term clinical therapeutic effect of debridement sequestrums, minimally invasive injectable graft (Miig X3).3. To understand histology appearance and appearance of MiigX3 in femoral head of dogs, and provide bases for clinical application.4. We designed and manufactured a newly instruments for scavenge sequestrums of femoral head, and evaluated clinical value.Material and methods1. From February 2001 to April 2006, 226 cases (383 hips) with earlied ANFH treated with Steinmann pin drilling decompression. There were 169 males (296 hips), 57 females (87 hips) aging froml4~64 years (mean, 36.5 years);bilateral ANFH 157 cases (314 hips), unilateral ANFH 69 cases (69 hips);theetiopathogenisis of ANFH were: alcohol 143 cases (63.27%), hormone 46 cases (20.35%), alcohol and hormone 12 cases (5.31%), idiopathic 21 cases (9.29%), trauma 4 cases (1.77%). with case history 4~10 years (mean, 6.7 years). 42 cases concomitanted one kind of morbus internus, Preoperative stage of association research circulation osseous (ARCO): I stage 55 hips, II a stage 95 hips, II b stage 123 hips, lie stage 83 hips, Ilia stage 9 hips, Illb stage 11 hips, IIIc stage 7 hips. Under the monitor of C-arm X-ray, 226 cases (383 hips) were decompressed with 3.5 mm Steinmann pin, small diameter, multiple porous, low drill velocity. 209 hips combined with hip arthrosynovitis or cartilage trauma treated with synovectomy and cartilage trimming through hip arthroscope at mean time.2. From March 2005 to March 2006, 26 cases (31 hips) with ANFH treated with MiigX3. There were 19 males, 7 females aging from 21~57 years (mean, 36.6 years);left side were 11 cases, right side 10 cases, both sides were 5 cases. Preoperative stage of ARCO: lib stage 10 hips, lie stage 13 hips, Illb stage 6 hips, IIIc stage 2 hips. Under the monitor of C-arm X-ray, guide pin penetrate to the core of ANFH, debridement sequestrums with hollow round bur and spatula, then injected MiigX3, observing therapeutic effect through follow-up.3. Drilling from juncture of femoral head and neck to the core of femoral head on 6 dogs, 5.0x10mm defect formed, soaked with 95% alcohol for 30 min;right side inject MiigX3, and left side as blank. Respectively taken X-ray films in 1, 4 and 6 weeks post operation;then sacrifice 2 dogs at above time point. Normal and necrosis femoral head cancellous bone and fibular cortical bone harvest from total hip replacement (THR) and amputation cases. Testified elastic modulus of femoral head cancellous bone, fibular cortical bone and MiigX3 with biomechanics machine.4. Debrided sequestrums on the femoral head sample with tailor-made instrument, then formed a tennis racquet cave. After protophase experiment and transited to clinic application, scavenged sequestrums followed by injection Miig X3, then evaluated on clinical application effects.Results1. 164 cases acquired 3-60 months (means, 35 months) follow-up. Harris scores improved from 68.6 ±4.3 pre-operatively to 76.8 ± 5.2 post-operatively, and showed that pain relieve, increased walk distance and progressed in gait. 143 cases progressed pain symptom at least 50% as compared with original pain intensity in day 2 post operation, 115 cases pain symptom nearly diminished 1 week post operation. In all cases, the therapeutic effect in 227 (59.27%) hips were fineness (Harris score >80);133 (34.73%) hips were well(70