| ObjectiveThere is a obvious characteristics,"crescent sign",in the patients with Osteonecrosis of the Femeral Head(ONFH) at ARCO stage III. Patients often come to see a doctor because of intense hip pain,the pain is the most important one of the clinical symptoms. So far, about the crescent sign relations with hip pain reported in the literature are rare. The range and the location of the crescent sign if there is any correlation with pain, that is not clear yet. There is a "crescent sign" on some clinical imaging of the ONFH patients with hip pain, but their level of pain are not consistent, and some patients have very severe pain, but their imaging crescent sign on its range, location are always different. What if there is some correlation between crescent sign symptoms and hip pain? In addition, will different TCM syndrome types make crescent sign and pain with different performance, it seems unclear now.This study of non-traumatic osteonecrosis of the the Femeral Head with ARCO Ⅲ special imaging-^crescent sign", hip pain, and TCM syndrome type, for statistical analysis, in accordance with the relevant data. Analysis discussed correlation among the three preliminary summary, will help close contact ONFH clinical symptoms, medical imaging and hip pain. To figure out the relationship that among TCM syndrome types, the nature of the crescent sign and hip pain, will contribute to provide new ideas for the diagnosis and treatment of non-traumatic necrosis of the femoral head. MethodsAccording to the inclusion criteria, exclusion criteria of non-traumatic osteonecrosis ARCO stage Ⅲ, collect patients basic information, imaging data, symptoms and signs associated with pain. On the basis of TCM "bone erosion" concept, put the patients divided into two TCM syndrome types;In the meantime, measure the range and the location of crescent sign in the hip anteroposterior and breaststroke X-ray on each patient, and asked each patient to fill up the Oxford hip score (OHS) form, and make a data record. For the patients suffering from total hip arthroplasty, to get their femoral head specimens postoperatively. According to the two TCM syndrome types, Grouped the original data and collected the medical records of patients, the range and location of crescent sign, and the OHS score, the data will be entered into the database and the data analyzed with the results using the SPSS17.0Medicine statistical software. In the light of the analyzed result, Discuss the correlation between hip pain, crescent sign and TCM syndrome type, the measurement data between the two groups were compared using t test, count data using2X2chi-square test, correlation analyzed using Spearman correlation analysis, P≤0.05was considered statistically significant.ResultsThe research collected necrosis of the femoral head in patients with ARCO Ⅲ71cases, a total of97hips. Here was the outcome:1. On the hip anteroposterior and breaststroke X-ray, the vast majority of the crescent sign was JIC type Cl and C2in the main part of the distribution, even more than the outer edge of the acetabulum;2. There is a certain correlation among the anteroposterior range, breaststroke range and the total range of the crescent sign;3. Location and range:(1)Among the B, C1and C2type of the anteroposterior X-ray, there is a statistically significant differences of the range (P<0.05);(2) There is a statistically significant differences of the range between the breaststroke A-Cl, A-C2, B-C2, C1-C2;(3) Between the Cl of the two kinds of X-ray, there is a statistically significant differences of the corresponding range, and also the C2type of the two kinds of X-ray;(4) Between the C1of the two kinds of X-ray, there is a statistically significant differences of the total range.4. Location and TCM syndrome types:There are no statistically significant differences between the different JIC type of the anteroposterior and the breaststroke X-ray, and the same JIC type of the two kinds of X-ray in different TCM syndrome types.5. Location and pain:(1) In the same type of X-ray, the pain of the crescent sign located in the weight-bearing surface were worse than the location far away from the weight-bearing surface one.(2)Between the anteroposterior and the breaststroke X-ray, there is no statistically significant differences of the OHS score in the same JIC type, and there is no significant correlation of different JIC type with different X-ray;6. Range and TCM syndrome types:between the two kinds of TCM syndrome types of ONFH, there was no significant difference of anteroposterior range, breaststroke range, the total range with the three respective comparative (P>0.05);7. Range and pain:(1)There was a significant difference between "<15%" group and ">30%" group in pain;(2) It shows weak correlation between breaststroke range and the pain, but there were no significant correlation between anteroposterior range, total range and the pain.8. TCM syndrome types and pain:there was no significant difference of different TCM syndrome types of ONFH with pain(P>0.05). Conclusion(1)There are two kinds of crescent sign had found in this study, one is called the "cartilage stripping", the femoral head cartilage and the bone under the cartilage were separated;Another is called "bone separation", the interface between the necrosis bone and the survival bone were separated inside the femoral head;The appearance of Crescent sign means that femoral head collapse can be observed in radiological point.(2) To observe crescent sign, the crescent sign location type can be observed by breaststroke X-ray were almost C1and C2types mainly, and its range is larger than that observed by anteroposterior X-ray. There is a strong positive correlation between breaststroke range and total range of crescent sign, the greater breaststroke range, the greater the total range often. Breaststroke crescent sign range can be used as a judgment indicators to judge the total range of crescent sign within femoral head in the early collapse;And it also has a weak correlation with of hip pain, it can assist to patients diagnosis, but still need to be in combination with the practical situation of patients, not only by breaststroke X-ray to judge patients severity.(2) From the inside to outside, the closer crescent sign location to the acetabulum outer edge, even more than acetabulum outer edge, the bigger its range is. (3) In the same type of X-ray, the pain of the crescent sign located in the weight-bearing surface were worse than the location far away from the weight-bearing surface one.(4) Between different TCM syndrome types, the range, location distribution, pain score of the crescent sign had no significant difference. |
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