| Objective:Retrospectively analyze the clinical efficacy of the treatment of core decompression in combination with the nano—hydroxyapatite/collagen composite rod in patients with osteonecrosis of femoral head at Steinberg stage I、II、III,put these patients in a dynamic contrast system to evaluate the effects of this treatment and the degrees of the symptoms improved after surgery,and to evaluate the surgical timing.Methods:72 patients(93 hips) treated in the Union Orthopaedic Hospital affiliated to Huazhong University of Science and Technology from January 2013 to January 2015 with early stage of femoral head osteonecrosis were involved in our study.Among them there are 41 male patients(52 hips)and 31 female patients(41 hips);the age distribution of these patients is 22~59years old,the average is 36.6 years old.All patients had undergone the surgery of core decompression combined with artificial bone rod insertion.Postoperative standard treatment identically includes the prophylactic intravenous antibiotic and the anticoagulation therapy.Postoperative patients were instructed to be non-weight-bearing for 3 weeks,to partially weight-bear for at least 2~3 months,and to completely weight-bear thereafter.All patients were followed up for clinical and radio-graphical evaluation, including the Harris Hip Score which is to assess the clinical efficacy、the Visual Analogue Scale which is to evaluate the hip symptomatic improvement and the imaging evaluation which utilizes the pelvic X-ray film of the preoperative period、1months、3 months after the operation and the last follow-up to give us the full range observation of the shape of the femoral head、the repairment of it and the progression of the necrosis.Results:The follow-up time was 10 to 36 months,the average was20.8 months.Clinical evaluation results are as follows:In the collection of cases in this study,there are male 18 hips,female14 hips at Steinberg stage I,the average age of them is(32.5± 8.5)years old;there are male 27 hips,female 18 hips at Steinberg stage II,the average age of them is(36.7±10.4)years old;there are male 7 hips,female 9 hips at Steinberg stage III,the average age of them is(38.1±12.1)years old.There was no significant difference in the proportion of male and female patients in these three groups by chi square test(P >0.05),neither there was no significant difference in the average age of these groups through t test(P>0.05).The average preoperative HHS score of patients at Steinberg stage I was(76.7±10.5)points,and it improves to(92.6±8.1)points after the treatment,the average value of the improved score is(15.9 ± 9.2)points(P < 0.05);The average preoperative HHS score of patients at Steinberg stage II was(64.5 ±11.3)points,and it improves to(86.4±11.7)points after the treatment,the average value of the improved score is(21.9±11.5)points(P<0.05);The average preoperative HHS score of patients at Steinberg stage III was(59.7±10.1)points,and it improves to(78.8±11.5)points after the treatment,the average value of the improved score is(19.1 ± 10.8)points(P <0.05).There were significant differences between the post-treatment score of these three groups(P<0.05),and the improved score of patients at Steinberg stage II is higher than patients at stage I(P<0.05).Referring to the HHS system,among the whole 93 hips in our study:there are 45 hips excellent、32 hips good、12 hips fair and 4 hips poor,excellent and good rate reaches to 82.8%.X-ray results show that there are 4 hips showing radio-graphical progression.Conclusion:The therapeutic effects of the surgery of core decompression combined with the nano-hydroxyapatite/collagen composite rod(Artificial bone rod)in treating patients at early stage of the femoral head osteonecrosis are good.For patients at Steinberg stage I,the postoperative effects are better than patients at subsequent stages;for Steinberg stage II patients,they tend to have greater symptomatic improvements. |
