Nonvascularized Fibular Supporting Grafts Combined With Traditional Chinese Medicine For Pericollapse Stage Osteonecrosis Of The Femoral Head

Objective: We will retrospectively evaluate the effect of nonvascularized fibular supporting grafts combined with traditional Chinese medicine for pericollapse stage osteonecrosis of the femoral head, so, we could get some useful information and provide objective basis for the treatment of osteonecrosis of the femoral head. Methods: Sixty-seven patients (ninety-nine hips) with osteonecrosis of the femoral head underwent nonvascularized fibular supporting grafting combined with traditional Chinese medicine at the hip center of the first hospital of Guangzhou TCM from February 2004 to December 2004. The follow-up time ranged from 5 to 25 months (average, 19.01 months). Clinical evaluation refer Harris hip score system.We compared the clinical effect in different stage, the size and position of the lesion, autograft and allograft of the fibula. Radiographic effect was examined by the pre-operativea and post-operative X-ray and MRI, and we examined the collapse degree of the femural head. Comparing the clinical and radiographic effect by dialectic, we evaluated treatment effect of every pattern of dialectic and want to provide objective basis for treatment of TCM.Results: Of all the hips, the screws penetrate the article surface into the joint cavity in two hips and turned to arthroplasty, the femeral head secondary collaps happened in one hip combined with serieous pain and turned to total hip arthroplasty. Of the remaining 96 hips, clinical successful rate was 83.3%, and the clinical effective rate was 94.8%. Successful results were achieved in 94.4% of the patients with ARCO â…¡ hips, 76.7% with Stage â…¢ osteonecrosis hips. Good results were obtained in 94% of the patients younger than 45 years. According to the size of the lesion, A type, 8hips (8.1%), B 54 hips (57.6%), 54(88.7%) hips had good to excellent clinical results. C type, 34 hips, 25 hips got good to excellent clinical results. Comparing lateral osteonecrosis lesion, medial and central lesion have better clinical result. Between autograft and allograft of the fibula, there was no marked difference. By radiologic evaluation, good to excellent result was 79.1%.33 hips didn't collapse before the operation. After the surgery 12 hips did not collapse, 17 hips collaps <2mm , the ratio is87.9%;38 hips collapsed <2mm before the operation, and the collaps degree did not change in 23 (60.5%) hips, 14 (36.8%) progressed to 2~4mm;in 25 hips, the collaps degree was 2~4mm before the operation, 11 (44%) improved to <2mm, 10 (40%) no change;there were 6 hips progressed to >4mm degree after the operation. There was no significant difference between qi- stagnancy and blood stasis and deficiency of kidney-YANG But between deficiency of kidney-YANG and endo-retention of damp heat, there was obvious difference. Of all the hips underwent the operation, screws penetrating into the joint cavity happened in 11 hips, and there was no wound infection. There was no obvious rejection to the allograft of the fibula. Conclusion: The treatment for the pericollapse stage osteonecrosis of the femoral head with the nonvascularized fibular supporting grafts combined with traditional Chinese medicine had a confirmable clinical result. The stage of the hip, the size and the poison of the lesion could affect the clinical result. When the lesion size ratio is greater than 30%, and lateral poison, the result was not fine often. Our method could prevent or improve the collapse degree of the femoral head, contain the shape of the femoral head and the normal constitution of the hip. Of the dialecticals, the endoretention of damp heat and qi-stagnancy and blood stasis had the worst clinical result.