| Objective:1.To develop a new kind of effective treatment for the nontraumatic avascular necrosis of the femoral head. 2. To evaluate the preliminary clinical effect of the advanced core decompression combined with traditional Chinese medicine in treatment of osteonecrosis of the femoral head.Methods: 65 in-patients(98 hips) in pericollapse stage of nontraumatic ostenecrosis of the femoral head, were selected in the department of hip joint disease of the first affiliated hospital of Guangzhou university of TCM . 53 male (79 hip)and 12 female (19 hip). Steroid- induced group(40 hip),15 male , 11 female, alcohol- induced group(51 hip), 35, all female. Idiopathic 4(7 hip) 3 male ,1 female. They were given to the treatment of the advanced core decompression (including core decompression .nonevascularized fibular graft and tubular screw fixation)combined with traditional Chinese medicine. The follow-up ranged from 12 to 27 months(average, 17.5 months).Patient were evaluated preoperatively according to the Association Research Circulation Osseous (ARCO) international classification system while image evaluation and clinical effect evaluation was done respectively. Referred to the Harris Hip Score, the clinical evaluation was done preoperatively and postoperatively .The image effect evaluation was done according to the radiological image preoperatively and followup arter.The statistic results were test by Epitable soft.Results: 1. There are significant difference on x - rays , pain , walk distance , joint movement, total mark between before operation and at the time of follow - up (P < 0. 01) . in Harris Hip Score we referred;2.ClinicaI evaluation: The overall results : the excellent rate is 32.7% (32 hips);good 41.8 % (41 hips);poor 25.5%(25 hips);3.X-ray evaluation: (1) Stage II the excellent rate is 41.1% (14 hips);good 47.1 % (16 hips);poor 11.8%(10 hips);Stage III the excellent rate is 28.1% (18 hips);good 39.1%(25 hips);poor 32.8%(21 hips);The good-to-excellent rate of stage II compared to stage III result in P=0.02<0.05;(2) Steroid- induced group, the excellent rate is 20% (8 hips), good 37.5%(5hips),poor 42.5%(17 hips);Alcohol- induced group, the excellent rate is 41.2%(21 hips), good 47.0% (24 hips);The good-to-excellent rate of steroid- induced group compared to alcohol- induced group result in P=0.02<0.05;(3) The good-to-excellent rate of steroid-induced group stage II is 70%(7 hips) .alcohol- induced group stage II is 94.7%(18 hips);(2) The good-to-excellent rate of steroid- induced group stage HI is 53.3%(19 hips) , alcohol- induced group stage HI is 84.4%(27 hips);The good-to-excellent rate of steroid-induced group stage HI compared to alcohol- induced group stage HI result in P=0.001<0.05;Conclusion: The treatment for the nontraumatic avascular of the femoral head in pericollapse stage with the advanced core decompression combined with traditional Chinese medicine had a good clinical result, It can effectively protect from the depression of the femoral head ,and also reshape femoral head after depression . It can relieve pains quickly and improve the function of the hip,which lead to a higher level of life. Early diagnosed is the key treatment. It is differential between the steroid- induced group and the alcohol- induced group in the statistic results, The alcohol- induced group is better than steroid- induced group. |
