The Clinical Study About Impacting Bone Graft Combined With TCM Treating Pericollapse Stage Alcohol-induced And Steriod-induced ONFH

Objective:This retrospective study composed four purpose:(1) The effect of the treatment about Impacting Bone Graft combined with traditional Chinese medicine treating Pericollapse Stage ONFH will be evaluated. Then, the concept of Pericollapse Stage was objectively evaluated on guiding treatment. (2) Difference between the alcohol-induced and steriod-induced ONFH will be compared according to clinical effect, radiology progression, and the distribution difference of the syndrome types by TCM theory. (3) The contribution of the factors composed in the ARCO classification system will be analasised in this clinical study. (4) the rerationship between the clinical result and the theory of diease differentiation and syndrome differentiation will be analasised.Methods:From January 2004 to December 2006, There were 83 (123 hips) ONFH cases were treated with Impacting Bone Graft combined with TCM at the hip center of the first hospital of Guangzhou TCM university. All these case were related with alcohol abuse or steriod adminstration, and should be consistently followed up at least for 2 years. there were 66 (79.5%) male and 17 (20.5%) female cases,35 (42.2%) steriod-induced and 48 (57.8%) alcohol-induced. According to ARCO classification, stageⅡ47 (38.2%) hips, stageⅢ76 (61.8%) hips. According to lesion size,66 (53.7%) hips were 15%～30%,57 (46.3%) hips were >30%. According to lesion region,19 (15.4%) hips B type,39 (31.7%) hips C1 type,65 (52.8%) hips C2 type. According to the colleps extent of the femur head,47 (38.2%) hips zero,26 (21.1%) hips<2mm, 26 (21.1%) hips 2～4mm,24 (19.5%) hips >4mm. The follow up time was 24～60 months, average 39.35 months. At the last follow up,the Harris score was collected, the difference of the treatment effect between the AONFH and the SONFH was analysised. The factors, such as lesion stage, size, region and extent of the collaps of the femur head, was analysed one by one with their influence on the Harris score and survival rate. The Independent-Samples T Test procedure Wes used to compare means for two groups of cases based on stage(stageⅡ, stage III), percent involvement (15% to 30%[moderate], or>30%[severe]), and reason(alcohol or steriod). The One-Way ANOVA procedure was used for a quantitative dependent variable based on lesion region(B,C1,C2), extent of the collaps (zero,<2mm,2～4mm,>4mm.). The log rank test was used to compare Kaplan-Meier survival curves for the time from surgery to the last follow up for separate groupings based on stage (stageⅠ, stageⅢ), percent involvement(15% to 30%[moderate], or >30% [severe]), reason(alcohol or steriod), and lesion region(B, Cl, C2), in this procedure, that Harris score less than 70 was seen as failure event. The Mann-Whitney procedure was used to compare progression of the femur head collaps between the AONFH and the SONFH. In the precollaps ONFH group, the log rank test was used to compare Kaplan-Meier survival curves for the time from surgery to the time the femur head collaps happened for separate groupings based on stage(stageⅡ, stage III), percent involvement(15% to 30%[moderate], or>30% [severe]), reason(alcohol or steriod),and lesion region(B, C1, C2), in this procedure, that collaps of the femur head was seen as failure event. Linear Regression was used to compare the factos with regard to their ability to predict the time to progression. Finaly, the clinical effect was evaluated with regard to diease differentiation and syndrome differentiation by TCM theory. According to Harris score, we compared the clinical result and the survival rate of the femur head based on different syndrome types of femoral head necrosis by TCM theory. All of the data was analyzed by the statistical packages SPSS 11.5 for windows.Results:According to Harris score at the last follow up, we got the clinical results:excellent 34 (27.6%) hips, good 26 (21.2%) hips, fair 37 (30.1%) hips, poor 25 (21.1%) hips, and the clinical excellent rate was 48.8%, and the clinical effective rate was 78.9%. Of all the hips, there were 7 hips converted to total hip arthroplasty in the end. Comparing AONFH and SONFH, there wasn't significant difference based on Harris score, collaps extent of the femur head, survival rate of the precollaps hips, and distribution of syndrome types of femoral head necrosis by TCM theory. With regard to factors in ARCO classification, there was significant difference based on stage(stage II, stageⅢ), percent involvement (15% to 30%[moderate], or>30%[severe]). Though there was statistical difference based on lesion region (B, C1, C2), yet,there was not significant difference between Cl and C2. The collaps extent of the femur head before operation could infuence the clinical result significantly, but the difference just existed between the group>4mm and the other group(zero,<2mm,2～4mm). According to Harris score, there was not significant difference based on distribution of syndrome types of femoral head necrosis by TCM theory.Conclusion:The Impacting Bone Graft combined with TCM is a effective therapeutic regimen for the pericollapse stage ONFH. As long as the collaps of the femur head is not more than 4mm, the hip can be treated with this regimen, considering the factors in the ARCO classification, the stage and lesion size play a important role on chosing therapeutic method and assess prognosis. But the lesion region is not indispensable, if lesion size would be measured,the factor of lesion region can be delected from the classification system, so as to simplify the classification system. Comparing to other similar studies, it looks like the excellent rate(48.8%) and effective rate(78.9%) is lower, but considering the more cases of ARCOⅢand percent involvement (>30% [severe]), maybe the result is better. Comparing to total hip replacement,the Evaluation Criterion for surgery conserving hips based on Harris score should be lower. Refering the results of this study, that the Harris score 70 should be seen as the criterion assigning the effective clinical result. Just based on this study, there is not significant difference between AONFH and SONFH on clinical result. Using the theory of diease differentiation and syndrome differentiation, the TCM was composed to the therapeutic regimen, the purpose for this is to accelerate reparing reaction of the necrosis bone. There is not significant relationship between the syndrome types of femoral head necrosis by TCM theorv and the clinical result.