Clinical Research On Using Crutches Combined With Traditional Chinese Medicine Treatment Of Early Osteonecrosis Of The Femoral Head

ObjectiveThe aim of the study is to evaluate the curative effect ofearly Osteonecrosis of the Femoral Head (ONFH) using crutchescombined with Traditional Chinese Medicine (TCM).At the sametime， observe the corresponding index, analyse theeffectiveness of using crutches and the characteristics of TCM，in order to provide guidance to hip-preservation treatment forONFH in the clinical setting.Method52ONFH patients（86hips）, from2010June to2011December,were selected from Wuhan Municipal Hospital of TraditionalChinese Medicine Orthopedic out-patients for the study.28cases（46hips）were instructed with double crutches strictlyplus TCM treatment;24cases（40hips）didn`t use crutches orfailed to strictly on crutches for a variety of reasons,theywere given TCM treatment only; and all patients were instructedwith moderate exercises during the treatment process.Beforethe treatment and the last follow-up (after the treatment), thepatients were evaluated using the JOA and pain visual analogscale (VAS) by the same physician;and were taken X-ray Examination to evaluate whether stable or increasing collapseof femoral head.ResultThrough out-patient review and telephone follow-up，all thepatients were followed up.The average follow-up for usingcrutches+TCM group was18.2months and TCM group was16.7months.1.JOA score： The JOA scores were recorded before thetreatment and the last follow-up. Using two independent samplest test, the comparison between the2groups before the treatmenthas no significant difference (P>0.05), however, there wassignificant difference (P <0.01) between the2groups afterthe treatment.JOA scores and the improvement indices showedthat using crutches+TCM is more effective than TCM only.2.Curative effect of JOA：Using two independent samples ttest, there was significant difference (P <0.01) between the2groups after the treatment，show that combined using crutchesis more effective than TCM only.3.VAS score：The VAS scores were recorded before thetreatment and the last follow-up. The data showed that TCMcombined with using crutches or not treatment for ONFHobviously can both help to relieve the symptom of hip pain (P<0.05). The comparison between the2groups before thetreatment has no significant difference (P>0.05), however,comparison between the2groups after treatment,there weresignificant differences (P <0.05)，indicating that combinedcrutches treatment is more outstanding than TCM in curativeeffect of improving the pain. 4.Imaging evaluation：The radiological imaging data fromthe last follow-up were compared between the2groups. Thestability and exacerbation rates were evaluated and comparedbetween the2groups.There was a significant difference (P <0.01) between the2groups, indicating that the use of crutches+TCM therapy is more effective than TCM without crutches todelay the progress of the femoral head necrosis，promote itsrepair and reduce the collapse of the femoral head.As a general analysis，the above results showed thatcombined using crutches treatment group is more effective thanTCM treatment group.ConclusionThe use of crutches with TCM treatment could significantlyimprove patients pain level，ameliorate the function of hipjoints, promote regional repair osteonecrosis of the femoralhead and reduce the collapse of the femoral head,curativeeffect is obviously better than TCM not cooperate with crutchestreatment. Using crutches combined with traditional Chinesemedicine treatment of early stage osteonecrosis of the femoralhead is effective, non-invasive, economical and safe,it issuitable for promotion.On the other hand, the concern is howto take effective measures to promote the patients refusedusing crutches to accept this kind of treatment at the same timewith TCM in the clinical, further studies are still needed tomultidisciplinary.