The Clinical Efficacy Of Drilling Decompression,Autogenous Iliac Bone Graft And Allogeneic Fibula Supporting Graft Combined With YI Shenxiaotong Pill In The Treatment Of Early Necrosis Of Femoral Head

Objective : we retrospectively evaluate the clinical efficacy of drilling decompression,autogenous iliac bone graft and allogeneic fibula supporting graft combined with YI Shenxiaotong pill in the treatment of early necrosis of femoral head.we also summarize the method of clinical curative effect and provide the clinical basis for the conservative of early necrosis of femoral head.Methods:From January 2014-January 2016,40 patients who met the inclusion criteria of The second affiliated hospital of henan university of TCM Joint Orthopedic ward were randomly divided into observation group and control group according to hospitalization time sequence,each group has 20 people.Control group patients give drilling decompression,autogenous iliac bone graft and allogeneic fibula supporting graft treatment,observation group based on the control group with our homemade proprietary Chinese medicine YI Shenxiaotong pill,followed up for 12~24 months postoperatively,and with reference to Harris hip score standard,giving the Harris hip score of preoperative and postoperative 1、3、6、12 months.According the last score we will put them into four grades including excellent、better、good、bad to Assess the hip joint function.12 months after surgery,according to the X-ray imaging assessment(refer to ARCO stage)give imaging evaluation(refer to ARCO stage),observe the repair of the femoral head and the progress of necrosis and classify by Zhangchangqing imaging assessment standard.All results are statistically analyzed and processed.Results1 The general informationAll of the patients had been followed up 12~24 months,with an average of 19.55 months.In the observation group,14 males(16 hips)and 6 females(7 hips)were enrolled in this study.The control group(n=6)has a total of 11 males(14 hips)and 9 females(11 hips).There was no significant difference between the two groups in the sex composition(P>0.05);The average age of the observation group was 39.30±8.45 years old,and the control group was38.55±8.69 years old,P>0.05.There was no significant difference between the two groups in the age composition(P>0.05);Observation group had 17 cases of single hip,double hip in 3 cases,the control group had 15 cases of single hip,double hip in 5 cases.There was no significant difference between the two groups in single and double hip(P>0.05).According to the Harris score before treatment,the observation group had IB stage 4 hips,IIA stage 5 hips,IIB stage 14 hips,the control group has IB stage 5 hips,IIA stage 10 hip,IIB stage 10 hips.There was no significant difference in staging before treatment between the two groups before treatment(P>0.05);Before treatment,according to the cause of the disease,the observation group had 8 cases of hormone type,10 cases of alcohol type,2 cases of other types,the control group had 9 cases of hormone type,9 cases of alcohol type,4 cases of other types.There was no significant difference between the two groups in etiological classification before treatment(P>0.05).2 Clinical efficacy1)According to the Harris score prior-treatment and post-treatment 1、3、6、12 months were scored:The score of the observation group before treatment was 61.22±11.41 points,1months after treatment for was 75.65±8.48 points,3 months was 79.17±7.58 points,6 months was 83.09±8.90 points,12 months was 86.65±12.55 points;The score of the control group before treatment was60.64±13.95 points,1 months after treatment for was 70.04±9.78 points,3 months was 72.56±9.59 points,6 months was 75.8±12.32 points,12 months was 78.08±15.06 points.On the time factor,the difference of the hip function score between the two groups was statistically significant(P=0.000).The results showed that the curative effect of the hip joint in the two groups increased significantly with time(P<0.05).Before treatment,compared with the control group,P=0.551,P>0.05,two groups before treatment had no significant difference in hip joint function.After treatment,the comparison betweengroups,P1=0.037(treatment for 1 months),P3=0.011(treatment for 3 months),P6=0.024(treatment for 6 months),P12=0.024(treatment for 12 months),showed that hip function of the observation group after the treatment of 1、3、6、12 months was significantly higher than that of the control group(P<0.05).2)12 months after the treatment according to the Harris score of hip joint function curative effect comparison,the observation group had 10 hips excellent and 7 hips better,3 hips good,3 hips bad,good rate of 73.9%;the control group had 4 hips excellent and 8 hips better,6 hips good,7 hips bad,good rate of 48%;by the rank sum test,Z=-2.605,P=0.009,P<0.05,and the difference was statistically significant.3)Imaging evaluation 12 months after treatment,the observation group improved 17 cases,unchanged in 3 hips,deterioration 1 hips and failure 2 hips,efficiency of 86.96%;the control group improved 11 cases,unchanged in 7 hips,deterioration 3 hips and failure 4 hips,efficiency of 72%,using rank sum test,Z=-1.973,P=0.048,P<0.05.The difference was statistically significant.Conclusion:Drilling decompression,autogenous iliac bone graft and allogeneic fibula supporting graft combined with YI Shenxiaotong pill in the treatment of early necrosis of femoral head can effectively prevent,repair or delay the collapse of the femoral head,Clinical and imaging results has obvious effect.