Clinical Study Of The Nontraumatic Osteonecrosis Of The Femoral Head

PART 1 Study of the Correlation between BME with Pain and StageObjective: To evaluate BME on MRI image in nontraumatic osteonecrosis of the femoral head(NONFH) and the relationship between BME with hip pain and the stage of NONFH, discuss the mechanism and significance of occurrence and development of bone marrow edema(BME) in NONFH, in order to strengthen further understandings about clinical significance of BME in NONFH and to provide objective imaging proof for Chinese traditional medicine treatment based on stasis theory.Methods: With all 166 hips in 97 patients with NONFH, BME was identified from MRI:40 with grade O(no BME), 84 with grade 1 (small BME), 42 with grade 2(large BME).Based on rating scale of pain, NONFH were divided into three groups:38 hips in the no pain group, 94 hips in the mild pain group, 34 hips in the moderate or severe pain group. According to ARCO staging system, NONFH were divided into four stages:14 hips in stageⅠ,74 bids in stageⅡ, 68 hips in stageⅢand 10 hips in stageⅣ. Contingency table analyses and rank sum tests were used to compare the difference of pain gradings and stages among these groups.Results: BME of the femur was best demonstrated on T2WI and STIR coronal images. Grade 1-2 BME were seen in 75.9% diseased femoral heads. BME of the femur was increasing with porgressing of the disease. BME was not commonly seen and localized in stageⅠof NONFH, but it was more commonly seen and extensive in stageⅡ,Ⅲof NONFH. In the stageⅠ-Ⅲ, the prevalence of each score BME was of great significant difference (X~2=27.680, P<0.001).The results of rank sum tests for several independent samples showed, significant differerce of BME (P<0.001) among three groups. With the advance of disease, the rank of BME increased gradually. ln the three pain groups, the prevalence of each score BME was of great significant difference (X~2=26.981, P<0.001). The results of rank sum tests for several independent samples showed, significant differerce of BME (P<0.001) among three groups. With the advance of pain scale, the rank of BME increased gradually.Conclusion: BME is a sign that is accompanied with NONFH. The porbability and extent of BME correlated well with the stage of NONFH. The condition of BME can be used as a index for the appraisal of advancement of disease and the judgement of treatment result. The finding on MRI of BME was associated with the presence or absence of hip pain. The more severe the pain was, the more large the BME would be. BME on MRI can provide objective imaging proof for Chinese traditional medicine treatment based on stasis theory. PART 2 Analysis of Correlative Factors Influencing the Operative Results of MIS Treatment of NONFH with Impacting Bone Graft and Strut GraftObjective: To explore correlative factors influencing the operative resultsin the treatment of nontraumatic osteonecrosis of the femoral head, and patients who had undergone operation of impacting bone graft and strut graft in limited invasive way.Methods: 67 patients (99 hips) were treated with impacting bone graft and strut graft in limited invasive way in profesional joint department from Feb, 2004 to Dec, 2004 were reviewed, with the mean age of 37.6 years(range, 19-62 years).The hips were grouped according to some influential factors such as the recovery of the contour of the head, size of the lesion, location of the lesion, stage of disease, the presence or absence of BME and weight bearing date postoperative that related to the operative results. All data were analyzed.Results: The average follow-up of all cases was 19.01 months (range, 2-25 months). Excellent and good rates for operative results (reference to Harris score system) and radiographic results (reference to ARCO system) were 80.81% and 76.77% respectively; Excellent and good rates for operative results in anatomical and nonanatomical reduction group were 86.21% and 55.56% respectively. As the size of lesion, excellent and good rates was 88.71% and 73.53% in the group＜30% of head involved and≥30% of head involved respectively. As the location of lesion, the excellent and good rates were 86.57% and 75.86% in the medial group and the lateral group respectively. In the stageⅡand stageⅢgroup which was classified by ARCO system, the excellent and good rates were 94.44% and 76.67% respectively. As the BME, the excellent and good rates were 93.94% and 77.78% in the presence of BME group and the absence of BME group respectively. As the weight bearing date postoperative, the excellent and good rates was 90.67% in the group of≥3 months, and 57.14% in the group of <3 months. The differences between each factor group and operative results were significant (P<0.05).Conclusion: The quality of collapse correction, size of lesion, location of lesion, stage of disease, the presence or absence of BME and weight bearing date postoperative are the factors influencing the operative results of osteonecrosis of the femoral head. Understanding and avoiding the unfavorable influences of the factors will predict and improve the operative results.