Two Prospective Studies About The Conservative Treatment Of The Non Traumatic Femoral Head Necrosis Based On The MRI Classification

Abstract:Objective:To find a best conservative treatment of the different stages of femoral head necrosis according to observe and compare the curative effect and the clinical symptoms change of patients who suffer from a non traumatic femoral head necrosis but not need surgical intervention,and treated with the traditional Chinese medicine alone or combining with Alendronate Sodium,based on the traditional Chinese medicine syndrome differentiation and treatment and the MRI which is used as evaluation standard for the diagnosis,classification and treatment effect of femoral head necrosis.Methods:The patients were filtered from the Traditional Chinese Medicine Hospital Affiliated to Southwest Medical University according to the inclusion and exclusion criteria from Sep.2014 to Mar.2016.A total of 60 patients(68 hips)were included,and signed the informed consent.The included patients were randomly divided into Chinese medicine group(n=30)and combination group(n=30).Each patient was checked with MRI.The Chinese medicine group was treated with the traditional Chinese medicine,while the combination group was treated with the traditional Chinese medicine combining with Alendronate Sodium for half a year.After 9 month of follow-up,the result of Harris hip score and MRI imaging were recorded.The SPSS19.0 software was used for statistical analysis.Results:All the patients were followed up for 9-18 months,with a median follow-up time of 10.6 months.There were 68 hips totally including Chinese medicine group and combination group,of which 2hips accepted the hip arthroplasty because of the illness aggravation during the follow up and 1 hip lost to follow up.The result can be concluded as follows:1.Overall effect:Harris hip score showed that 40hips(61.54%)were excellent,16 hips(24.62%)were good,6 hips(9.23%)were moderate,3 hips(4.62%)were poor,and the excellent and good rate was 86.15%.Radiographic evaluation:There were 52 hips stable and 13hips aggravation among the 65 hips,the stability rate was 80.00% and the aggravation rate was 20.00%.2.Comparison between groups by clinical stages:(1)In ARCO?stage:After 9 months of treatment,there were no significant difference between two groups(?~2=0.400,P>0.05;?~2=2.256,P>0.05)both in the Harris hip score and imaging stability rate;(2)In ARCO?stage:The Harris hip score and imaging stability rate of combination group were higher than Chinese medicine group with significant difference(?~2=3.821,P<0.05;?~2=3.824,P<0.05);(3)In ARCO?a stage:No statistical differences were founded between two groups(?~2=0.01,P>0.05),while the imaging stability rate of combination group are more stable than Chinese medicine group(?~2=5.529,P<0.05).Conclusion:In the early stage of non traumatic femoral head necrosis,two methods of treatment can effectively improve the clinical symptoms,signs and stable the imaging findings.There were no differences between the Chinese medicine group and combination group treatment effect In ARCO?stage,while the effect of the combination group treatment was better than the traditional Chinese medicine group in ARCO?stage and ARCO?a stage.Therefore,the traditional Chinese medicine can be used for the early stage of non traumatic femoral head necrosis alone,while combining with Alendronate Sodium for the middle-late stage of non traumatic femoral head necrosis.Furthermore,MRI is important for the ARCO stage of ONFH patients,and the evaluation of treatment effect.The precise ARCO stage can guide the treatment,save the cost,evaluate the treatment effect and guide the forward treatment options.