| Research purpose:Objective to explore the surgical operation method of dislocation of the hip,look straight into the cleaning necrotic bone in the femoral head,carries on the impaction bone grafting,and cooperate with the oral Chinese medicine medicinal broth,treatment of ischemic necrosis of femoral head.Through a retrospective analysis,at the same time,compared with the core decompression fibular graft treatment methods,the advantages and disadvantages of the two different treatment methods were summarized to better improve the experience of retaineding hip joint.Research methods:(1)Through the historical literature,to understand China's traditional Chinese medicine and modem medicine understanding of ischemic necrosis of femoral head,the classification and use of Chinese medicine treatment of the disease experience,provide guidance for clinical treatment.(2)Selected cases from Chinese medicine hospital orthopedics joint ward of Jiangsu Province,from February 2012 to December 2016,30 cases(36 hips)femoral head necrosis middle-late inpatients(ARCO ?A??B).These patients were treated of surgical hip dislocation with impaction bone grafting and the core decompression fibular graft surgery.Among them,24 patients(28 hips)and 6 women(8 hips)were female,and the age range was 24?56 years old,with an average of 41.3 years,and they were divided into two groups according to the different treatment.Observation group 16 cases(18 hips):Surgical dislocation of the hip was applied and with impaction bone grafting;Control group of 14 cases(18 hips):the treatment of the bone marrow decompression fibular bone grafting;The effect of the patients was analyzed and the results of the functional changes,pain and imaging indicators were evaluated comprehensively.Results:The clinical follow-up of 2?3 years,analysis time at the end of the observation group of patients in function,joint pain,joint mobility and imaging score were higher than the control group,statistically significant(P<0.05).Observe group ?A period Harris score higher than the control group,the patient was statistically significant difference(P<0.05).And two groups of ? score statistics difference between patients with stage B of not obvious(P>0.05).During the last follow-up of the observation group,the hip joint Harris score(82.72 + 3.55),the joint activity score(3.67 + 0.59),and the pain score(38.67 plus or minus 5.04);5,good 8,4,1,good rate 72.2%;In the control group,the hip joint Harris score(77.83 plus or minus 3.97),the joint activity score(3.11 + 0.58),and the pain score(33.89 or minus 5.01);Good,good,good,good,good,good,good,good.In the CJFH subtype,the patients with better efficacy of the two groups were cetype patients,and the patients with poor efficacy were L2 and L3 patients(5.6%of the observation group and 16.7%of the control group).After treatment,the scores of both groups were higher than those before treatment,statistically significant difference.Observation group:t =-23.98,P<0.01;Control group:t =-20.00,P<0.01.In the follow-up observation group,one patient underwent hip replacement therapy with a replacement rate of 5.5%and control group 3 routine joint replacement,with a replacement rate of 16.7%.Research conclusions:This study found that dislocation and minimally invasive surgical pith decompression two hip surgery to middle-late femoral head necrosis were better in the near future curative effect,surgical dislocation method the pith decompression fibula support method have better imaging higher stability,to relieve pain,improve the collapse of the femoral head,to maintain the function of hip joint,delay hip replacement and so on curative effect is distinct,but this kind of treatment are not perfect,in the later,there are still some cases collapse secondary osteoarthritis,hip replacement.The location of necrosis is more important than the extent of necrosis,especially the completeness of the lateral part of the femoral head,which is the key to the success of the hip. |
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