| Clinical studies on treatment of avascular necrosis of the femoral head with different bone graft materials and TCM.1ObjectiveThrough the graft material of the core decompression and bone grafting combined with traditional Chinese treatment of femoral head necrosis, the clinical efficacy study on different bone graft materials and the correlation of the clinical efficacy.2Research methodsAccording to the inclusion criteria and exclusion criteria,, patients was selected for the period June2009to December2011from Chinese Academy of Wangjing Hospital of bone and joint, which had femoral head necrosis and treatment of core decompression with bone graft combined with traditional Chinese oral ins with; Collect general information for clinical observation and collection of patients before and after surgery and in3months,6months,12months imaging data and Harris hip score table, then make the establishment of the database, select SPSS11.5statistical test kits t-test and rank sum test on the data for statistical analysis.3results3.1General information and baseline:3.1.1General information:A total of53cases in which follow-up of44cases for12months and four cases in follow-up of6months, five cases at follow up of3months; There are44cases of male,9cases female; Maximum age for57years and the minimum age is18years old, average age is36.16±9.85years old; ARCO stage is from II to IIIb stage; There are atotal of four categories of graft material:calcium phosphate bone graft material, calcium sulfate bone graft materials, autologous bone graft materials and allogeneic bone graft material, which the application of calcium phosphate bone graft material is atotal of16cases,15cases of calcium sulfate,14cases of autologous bone, eight cases of allogeneic bone.3.1.2The baseline situation:group of calcium phosphate, calcium sulfate group, the auto graft group and allograft bone of four groups in age, gender, body mass index, and Harris hip score had no significant statistical difference, P>0.05.3.2The Radiographic results:3.2.1Radiographic stability rate of follow-up for12months:when ended to12months, the radiographic stable rate is83.33%; stable rate of allogeneic bone graft group is100%;For autologous bone graft group,12cases in13cases Is stable which make the stable rate92.3%; For the calcium sulfate bone graft group,10cases in11cases are stable,the stable rate is90.9%; For calcium phosphate bone graft group, eight cases are stable among12cases, which make stable rate66.7%. In accordance with the staging evaluation of ARCO stage II,23cases in29cases are stable, the stable rate is79.3%;14hips in15cases of ARCO III stage are stable the stability rate is93.33%.3.2.2The group of experts assess the radiographic imaging of the bone graft of bone graft region changes around surgery and in follow-up2,which was summarized as the outcome of absorption、no significant absorption, and absorbs further divided into absorbed bone growth, and no significant bone growth after absorbed.3.2.2.1absorption means the grafting area density was significantly lower than the previous follow-up.The absorption rate of the graft material in the follow-up period was shown in Table1(the absorption rate refers to the percentage of cases absorbed for total number of cases on the cultivation of bone material):3.2.2.2, No significant absorption, in the follow-up, there is no significant changes in the radiographic density of the bone graft region,compared with the previous period of the graft material. The ratio without apparent absorption and the ratio of absorption was a direct negative correlation.3.2.2.3Absorption of bone re-growth:In three months or six months when the density of grafting area was significantly lower compared with postoperative radiographic results in follow-up (6months or12months), but the corresponding density in next follow-up in imaging on the bone graft area increased. The bone growth rate of each graft material group in different periods is shown in Table2;: 3.2.2.4No obvious growth of bone after absorption:absorption, a direct negative correlation with bone re-growth.3.3Harris average score results:calculation of the different graft material groups after surgery, patients were followed up for3months,6months and12months. Specific ratings are shown in Table3.3.3.1The follow-up of12months, Harris evaluation:3.3.1.1Harris, the overall effect:core decompression combined with traditional Chinese medicine treatment of53cases after12months follow-up Harris hip score than before surgery significantly increased, to improve the score was40.3±9.9, a significant difference by paired t-test statistics significance, P<0.01.3.3.1.2bone graft group efficacy:calcium group was12month follow-up Harris hip score was significantly lower than other groups, a significant difference P<0.05by rank sum test results; calcium sulfate group, the autograft group, and the same kind of Harris hip score between the allograft by the rank sum test showed no significant difference P>0.05.3.3.2each bone graft group were followed up for3months,6months Harris Assessment: calcium phosphate bone graft group3months after the Harris hip score was significantly higher than other groups, a year Harris hip score was significantly lower than the rest, by rank sum test results statistically significant, P<0.05. Bone group were followed up for three months, the Harris hip score was significantly lower than other groups, with significant difference P<0.05by rank sum test results.4Conclusion4.1Harris hip score for a calcium phosphate group which followed up for three months is better than the rest of the bone graft group, but the postoperative follow-up imaging steady rate and the Harris hip score at12months were significantly lower than the rest of the bone graft group.4.2The calcium sulfate bone graft material in the three months absorption rate was significantly higher than the rest of the bone graft group, but the imaging steady rate and Harris score12and the auto graft group and allograft bone had no significant difference.4.3The Harris hip score of autogenous bone after3months of follow-up was significantly lower than the rest of the bone graft group, but patients were followed up for12months imaging steady rate and the Harris hip score and the calcium sulfate group and allogeneic bone group no significant difference.4.4Allogeneic bone imaging at1year postoperatively stable rate than the rest of the bone graft group, but a year Harris hip score was no significant difference with the autograft group and the calcium sulfate group; bone re-absorption rate and absorption of bone material The growth rate was lower than the rest of the bone graft group.4.5The core decompression and bone grafting combined with traditional Chinese medicine treatment of avascular necrosis of the good clinical efficacy; treatment ARCO stage II effective, ARCO stage Phase III treatment is necessary. |
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