Femoral Head Extensive Decompression, Bone Impacting And Free Fibula Supporting Grafting Combined With Chinese Medicine And Syndrome Differentiation And Treatment For Pericollapse Stage Osteonecrosis Of The Femoral Head:a Clinical Observation

Objective:we retrospectively evaluate the clinical efficacy of femoral head extensive decompression, bone impacting and free fibula supporting grafting combined with Chinese medicine and syndrome differentiation and treatment for pericollapse stage osteonecrosis of the femoral head. We also summarize factors affecting clinical result. We want to provide the clinical basis for the conservative of early stage of osteonecrosis of the femoral head.Method:24patients (29hips) with pericollapse stage osteonecrosis of the femoral head treated with femoral head extensive decompression, bone impacting and free fibula supporting grafting combined with Chinese medicine at the First Joint Orthopedic Group of Orthopedic Department in Jiangsu Provincial Traditional Chinese Medicine Hospital attached to Nanjing University of Traditional Chinese Medicine from November2009to May2011. They are39.3years on average. We use the Harris hip score system before surgery and at last follow-up for contrast before and after surgery At last follow-up, we get a imaging score based on X-Ray and integrate it with Harris hip score to get a new score called comprehensive score of clinical efficacy. We use this score to evaluate clinical efficacy of the treatment. We observe the difference among affecting factors such as stage, necrotic area, collapse, incentive, type of syndrome and age. All results are statistically analyzed and processed.Result:There are24patients (29hip) in the study. The mean time of follow-up is18.6months.3hips are failure and turn to total hip arthroplasty, accounting10.34%. The patients who reserve femoral head are accounting89.66%. In the remaining26hip,76.92%is excellent or good, and92.31%is effective. The mean Harris score is70.9before operation, while84.6at last follow-up. The difference of the two is statistically significant. There are15ARCO Ⅱstage (non-collapse before operation) hips. At last follow,10hips do not collapse,4hips collapse but less than2mm. The two account93.33%.1hip collapses about2-4mm, accounting6.67%. No one hip collapse more than4mm. There are6ARCO III A stage (collapse but less than2mm) hips. At last follow-up,3hips (50.00%) do not collapse more,2hips (33.33%) progress to2-4mm, and1hip (16.67%) progresses to more than4mm. There are5ARCO ⅢB stage (collapse about2-4mm) hip. At last follow-up,3hips (60.00%) improve or do not collapse more,2hips (40.00%) progress to more than4mm. The difference among non-collapse group, less2mm group and2-4mm group is statistically significant (P=0.016). Comparing with each two, the differences between group1and group2, group1and group3have statistical significance (P=0.010, P=0.002), the difference between group2and group3is not statistically significant. The mean comprehensive score of ARCO II group (15hips) is90.93at last follow-up.15hips have excellent or good results, accounting100.00%. The mean comprehensive score of ARCO III group (11hips) is75.07at last follow-up.4hips obtain excellent or good results, accounting45.45%. The difference between two groups is significant in statistic (P<0.001). There are9type A and B hips (typing with JIC system or Pang’s system). The mean comprehensive score at last follow-up is91.89. All of them receive excellent or good results. The number of type C hips is17. The mean comprehensive score at last follow-up is80.16. Among the17hips,12hips have excellent or good results, accounting70.59%. The difference is significant statistically (P=0.007). There are3traumatic hips, and the mean comprehensive score at last follow-up is95.60. All of them are good or excellent. There are11alcoholic hips, and the mean comprehensive score at last follow-up is80.78, and7hips (63.64%) result well or excellently among them. There are9Steroid-induced hips, and the mean comprehensive score at last follow-up is84.76. Among them,7hips (77.80%) result well or excellently. There is no statistically significant difference among the three groups. There are3Qi Zhi Xue Yu syndrome hips, and the mean comprehensive score at last follow-up is95.60.100.00%of them are good or excellent. There are13Shi Re Qin Yin syndrome hips, and the mean comprehensive score at last follow-up is80.78.69.23%of them are good or excellent. There are10Tan Shi Zu Zhi syndrome hips, and the mean comprehensive score at last follow-up is85.28.80.00%of them are good or excellent. Difference among the three groups is not significant statistically. There are9patients who are less than30years old, and their mean comprehensive score at last follow-up is85.86. There are7patients who are31-40years old, and their mean comprehensive score at last follow-up is81.23. There are5patients who are41-50years old, and their mean comprehensive score at last follow-up is84.80. There are5patients who are more than50years old, and their mean comprehensive score at last follow-up is85.08. Difference among the four groups is not significant statistically. None of the patients has infection or wound healing after surgery.3patients arc left over incision soreness in rainy days. One patient’s grafting fibula pierces articular surface which leads to the occurrence of osteoarthritis. But we do not open the hip joint.Conclusion:The treatment of femoral head extensive decompression, bone impacting and free fibula supporting grafting combined with Chinese medicine and syndrome differentiation and treatment can effectively prevent repair or slow the progression of femoral head collapse. Stage, type, size range of lesion, degree of collapse can affect the efficacy of the treatment significantly. The earlier stage, smaller size range of lesion, and less collapse, the better result we will obtain. Incentives, age, type of syndrome do not affect the result significantly.