Clinical Observation On The Treatment Of Early Non-traumatic Femoral Head Necrosis With Fine Needle Multi-orifice Decompression Combined With Bushen Huoxue Decoction

[Objective]Through clinical retrospective studies,we reviewed the clinical efficacy of the combination of fine needle multi-orifice core decompression and Bushen Huoxue Decoction in the treatment of early non-traumatic femoral head necrosis,analyzed the advantages of combining them and related factors that affect the prognosis.To improve the success rate of hip preservation,provide a certain reference for the treatment of early femoral head necrosis with a clear cause.[Methods]1.Theoretical researchRead the relevant literature of the motherland medicine to comprehend the understanding of the motherland medicine on necrosis of the femoral head(including other bone necrosis).Finally,according to the characteristics of femoral head necrosis related syndromes,the treatment principles,methods and composition of traditional Chinese medicine are discussed to provide reference for clinical treatment.2.Clinical researchWe selected 55 patients(61 hips)with femoral head necrosis in the early stage of etiology(ARCO staging IA-IIA period)from September 2009 to September 2014.The patients were divided into control group and treatment group.25 patients(28 hips)were treated with fine needle multi-orifice core decompression;30 patients(33 hips)in the treatment group were treated with fine needle multi-orifice core decompression combined with Bushen Huoxue decoction.Statistics of Harris scores and imaging evaluations of patients and after treatment at 3 months,1 year,2 years,3 years,and last follow-up.The results obtained were analyzed and discussed to evaluate their clinical efficacy and related factors that influenced the efficacy.[Result]The average follow-up time of this study was 53.32± 7.99 months(36-60 months).No neurovascular injury,thrombosis and other serious postoperative complications occurred during the follow-up period.A total of 5 patients(6 hips)underwent other surgical treatment,including 2 patients with ARCO IC stage(JIC type C2)undergoing total hip arthroplasty.On the fifth postoperative day,the VAS scores of the two groups were significantly improved compared with preoperative(control group:6.07±1.14,3.78±0.86,P<0.05;treatment group:5.95±1.09,3.46±0.91,P<0.05);At the last follow-up,the Harris scores which between control group and treatment group were significantly higher than before surgery(control group:85.81 ±4.59,63.93±3.95,P<0.05;treatment group:88.37±5.19,64.18±3.35,P<0.05),Harris score did not differ significantly between groups(85.81 ±4.59,88.37±5.19,P>0.05);however,the viability score in the treatment group was significantly higher than that in the control group(51.65 ±5.02;40.16± 4.97,P<0.05).The excellent rate of Harris score and imaging stability were higher than 80%in the two groups(control group:82.1%,90.9%;treatment group:85.7%,93.9%);Comparison of two groups of different ARCO staging and JIC classification imaging stability:ARCO IA patients with the best efficacy;followed by the IB phase;the IC phase was slightly less effective,the treatment group of IC imaging stability rate of 90%,In the control group,the imaging stability rate was 77.8%in the IC phase;the JIC genotype A-B imaging had the best stability,and the C2 type had the worst prognosis.The stability rate of C2 type in the control group was 72.7%,and the stability rate in the treatment group was 90%.The results showed that the combination of fine needle acupuncture combined with hip core decompression and Bushen Huoxue decoction can effectively treat early non-traumatic femoral head necrosis,reviewing the related factors,and finding the efficacy were closely related with etiology,age,preoperative Harris score,the BMI,preoperative onset time,postoperative follow-up time.It has nothing to do with the number of drill holes and hospital stay.[Conclusion]Fine needle acupuncture multi-channel decompression combined with Bushen Huoxue Decoction can effectively treat early non-traumatic femoral head necrosis.It is suitable for ARCO stage I to IIA patients with well-defined etiology.Etiology,age,stage of necrosis of femoral head,preoperative Harris score,BMI,and preoperative onset time can all affect the therapeutic effect.Clinical criteria should be strictly chosen to achieve satisfactory results.