To Compare The Clinical Effect Of Microinvasive Allo-fibula Implantation With Core Decompression And Bone Grafting Through Fenestration Over Femoral Head And Neck In The Treatment Of Early Femoral Head Necrosis

ObjectiveThrough clinical retrospective study, compare the clinical effect of microinvasive allo-fibula implantation with core decompression and bone grafting through fenestration over femoral head and neck in the treatment of early femoral head necrosis. To analyze the advantages and disadvantages of two different surgical methods, So as to provide clinical basis for the treatment of femoral head necrosis, improve the curative effect of hip surgery. Combined with the motherland medicine literature study of femoral head necrosis, select kidney promoting blood circulation to remove blood stasis after taking Chinese medicine, the curative effect of the surgery.Methods1. Theoretical researchBy looking at the motherland medicine all previous dynasties literature, understand the motherland medicine understanding of femoral head necrosis, according to the character of the necrosis of the femoral head type characteristics. Type character related to the study of treatment method, and the main use of traditional Chinese medicine (TCM), and to guide clinical treatment.2. Clinical researchFrom November 2009 to November 2013,30 patients (40 hips) with early osteonecrosis of femoral head (Stage Ⅱ～ⅢA according to the classification system of ARCO) were selected in this study. Those patients were randomly assigned to group A and B, treated by microinvasive allo-fibula implantation with core decompression(20 hips) or bone grafting through fenestration over femoral head and neck(20hips) respectively. The clinical effect of two groups were compared, and the VAS score in lweek postoperation, Harris hip score (HHS) and radiologically score were also evaluated.ResultsThe VAS score in 1 week postoperation:group A score (2.40±1.20) and group B score (4.30±1.50), group A were lower than group B, The difference was significant (t=-3.81, P< 0.05). All the 30 patients (40 hips) were followed up for 8-40 months, average 24 months. At the last follow up, the Harris hip aggregate score, pain score and range of motion score of patients in group A were all higher than that in group B, the difference was significant(P<0.05). The HHS of group A with stage ARCO ⅡB was higher than that in group B, the difference was significant(P<0.05); because of the small samples size, stage ARCOⅡC and ARCOⅢA have no statistical difference between group A and B(P>0.05).Group A follow-up function Harris hip score was (86.9 ±86.9) points, including pain score (36.70 ±9.11) points, joint activity score (3.85±1.09); Excellent 6 hip, good 10 hips, but 4 hips,1 hip, was 75.0%; Group B function Harris hip score (77.40±15.47) points, including pain score (31.00±8.52) points, joint activity score (3.10±0.85); 5 hip,8 hips, but 2 hips, five hip, was 65.0%. Two groups of postoperative cases of poor effects of C2 type femoral head necrosis, group A (5%) and group B (20%). Postoperative function Harris hip score 2 group were compared with the preoperative, difference was statistically significant (group A:t=6.43, P< 0.05; group B:t=0.05, P< 0.05). This group A during the follow-up period was 1 joint replacement, the replacement rate of 5%, B group of 4 routine joint replacement, the replacement rate of 20%,1 case of joint replacement surgery may be in 2 years in domestic demand.ConclusionMicroinvasive allo-fibula implantation with core decompression is an effective method for treatment of early femoral head necrosis, and it also can improve the prognosis of femoral head necrosis.