Multi-channel Drilling Decompression Again After Decompression And Bone Graft For The Treatment Of The Early And Midlle Stage Osteonecrosis Of The Femoral Head

Background Core decompression has been the most of thebasic and common surgeries of joint salvaging for the treatment of osteonecrosis of the femoral head(ONFH) among various statergies. But it may lead to aggravating, even hip pain again resulting from unthorough decompression of the necrosis. It needs total hip arthroplasty(THA) during the later stage if not treatment ahead of time.Objective The outcome of multi-channel drilling decompression after core decompression and bone graft for the treatment of early and middle stage osteonecrosis of the femoral were retrospectively analysisedMethods 22 patients(36hips) from July, 2008, through April, 2013 received core decompression, sequestrum erasion, impaction of artificial bone filling particles were regarded as the single decompression group. 16 patients(26 hips) from January, 2010, through May, 2013 obtained multi-channel drilling decompression again after single decompression were looked as secondary decompression group. The average age was 38.4 years old(range 18~67) with 32 men and 6 women. There are 14 patients with single hip and 24 with bilateral hips. The necrosis stage was divided into the Association Research Circulation Osseous(ARCO)Ⅰstage andⅡstage. Hip Harris Score(HHS) was used to evaluate the postoperative improvement of the hip function and the Visual Analogue Scale(VAS) to assess the intensity of pain.Results Demographics and baseline characteristics were similar between the two groups(P >0.05). 38 patients(62 hips) were all followed up,and the follow up rangedfrom 27 to 84 months. At the postoperative followup of 27 months, HHS were significantly increasedwhen compared before surgery in the two groups, and there was a signifficant difference of HHS between the two groups(90.6 ± 4.3 vs. 82.7 ± 6.5, P=0.000). VAS were significantly reducedwhen compared before surgery in the two groups, and there was a signifficant difference of VAS between the two groups(2.8 ± 0.8vs.3.5±0.9, P=0.001). In the single group, the excellent function was obtained in 3 hips, good function in 23 hips, and fair function in 4 hips, the good rate was 72.2%, the survival rate of the femoral head was 83.3%. In the secondary group, the excellent function was obtained in 18 hips, good function in 6 hips, and fair function in 2 hips, the good rate was 92.3%, the survival rate of the femoral head was 100%. There was a signifficant difference of HHS(92.3% vs. 72.2%, P=0.048), and there was no statistical significance of the survival rate of the femoral head(100% vs. 83.3%, P=0.079). 2 hips treated by THA in the single group, and another group not.Conclusions Patients who did core decompression and bone graft half a year ago, and whose symptoms improved unobviously or recovered slowly carring on multi-channel drilling decompression in the weight-bearing area can induce process of injury repair in the femoral head, promotingthe function of hip joint, and play a very good prevention and treatment role for hip pain.