Treatmentthe Avascular Necrosis Of The Femoral Head With Scrape The Focus And Valgus Flexion Intertrochanteric Osteotomy

Background : Avascular necrosis of the femoral head ( ANFH) is a kind of disease that, the pathologic progress of cytoclasis ,which caused by the function of one alone or various factors combined to the bone cell, the marrow builds the blood cell and the lipocytes , lead the destroy of a joint cartilage , femoral head collapse and the joint function lose. At present it is a kind of familiar disease. Because its heavy illness of coxa joint for femoral head collapse ,this disease is very important to be diagnosis and treatment. So far, the treatment methods of ANFH include the nonoperative treatments and operative treatments . nonoperative treatments include rest,hige-pressure oxygen therapy , stimulation with electricity therapy and Chinese traditional medicine ,et. nonoperative treatments include pure core decompression with or without grafting, core decompression with blood substances , osteotomy , periosteum transplantation with the vessel pedicel , inervention therapy and resurfacing ,and so on . When the earlier period of pathological changes and the necrosis of the femoral head is not quite serious , these methods are applicable ,and the curative effect are certain relatively. Total hip arthroplasty is applicable to the patients who are in the terminal period , with femoral head collapse ,restricted movement , and acute pain. This method includes the pure femoral head replacement and total hip replacement. Objective : Further study the treatment avascular necrosis of the femoral head with scrape the focus and contraindication of this surgical method to guide the clinical treatment of ANFH. Method : This text summary 42 cases (51 hip joints)with ANFH from 1989 to 1994. There were 39 male and 3 female cases,aged from 14 to 62。There were 21 left hip joints and 30 right hip joints. There were 19 hip joints stage Ⅱ, 27 hip joints stage Ⅲ,4 hip joints stage Ⅳand 1 hip joint stage Ⅴ. Surgical treatment were managed after 2—5 days in our hospital .We were compared all the X–ray slides of preoperation's with the postoperation. We adopt scraping the focus and valgus flexion intertrochanteric osteotomy with internal fixation. We adopted general anesthesia or extradural and lumbar anesthesia , cut a triangle bone at trochanter major-orient as the hemline among the trochanters along the trochanter minor . The hemline is 1.5~2.0cm ,abducent angle is about 30 degrees,and fastened the bones with 6 holes armor plate . We compared the joint movable range of the preoperation's with the postoperation's. We discussed the curative effect of this method . Result : all cases were treated with skin traction in the trouble limb in the neutral or mild valgus position .After surgical it could be seen that the armor plates fasten well ,steadily ,the angle between collum ossis femoris and corpus ossis femoris is approximate 160 degrees,the necrotic focus is outside the load section. The hip joint movable range was changd from 193 degrees to 193 degrees after surgical .According to the assess criterion of hip joint function in 1982,the class increased from classⅢ~Ⅳto class Ⅳ~Ⅴafter the surgical . All patients relieved the pain after 3months of the surgical ,and the fracture cured basically ,line is unclear .The patients were took out the...