The Clinical Study On Chinese Medicine Treatment Of Non-traumatic Femoral Head Necrosis Under The Guidance Of "Peri-collapse Period"

ObjectiveThrough the retrospective analysis of clinical data and imaging data in patients of peri-collapse stage femoral head necrosis with the non-operative treatment,with imaging changes(the femoral head collapse or collapsed?4mm)as the femoral head survival end point analysis,follow-up time of 24months or more,in order to verify the hip pain,the grading of bone marrow edema,JIC type,and necrosis range for avascular necrosis of the femoral head of non-surgical treatment prognosis effect,so as to further establish the suitable range and clinical value of non-surgical therapy in the treatment of collapse of femoral head necrosis.MethodA total of 97 patients(145 hips)who were in peri-collapse stage received non-operative treatment and comprehensive hip preserving in the clinic of the First Affiliated Hospital of Guangzhou University of Chinese Medicine.Above the patients,a total of 94 hips were in the non-collapsed group(ARCO phase?and?);a total of 51 hips were in the collapsed group(ARCO stage,collapsed<4mm).all the patients were classified according to hip pain classification and grading of bone marrow edema,JIC treatment of the type and scope of necrosis,follow-up time of 24 months or more.Kaplan-Meier survival analysis were made with the collapse of the femoral head and the femoral head collapse further development(collapsed over 4mm)for clinical observation of end point.Survival differences and clinical relevance were compared with different hip pain,bone marrow edema grading,JIC type,volume percentage of necrosis occurred in the collapse and the further development of the femoral head.ResultIn the non-collapsed group,a total of 94 hips with complete and continuous data,follow-up time of 3~36 months,the average follow-up of 20.23 months.Finally,46 hips had collapsed,survival time was 3~36 months.The relationship between the collapse of the femoral head and the related factors and the survival analysis are as follows:(1)There are significant differences in different hip pain classification and collapse of the overall survival time in comparison(log rank,?~2=30.33,P<0.0001).(2)There are significant differences between different grading of bone marrow edema and collapse of the overall survival time(log rank,?~2=35.9,P<0.0001).(3)There are significant differences between different types of JIC and collapse of the overall survival time(log rank,?~2=27.78,P<0.0001).(4)There are not significant differences between different scope of necrosis and collapse of the overall survival time(log rank,?~2=1.501,P=0.4722).In the collapsed group,a total of 51 hips with complete and continuous data,follow-up time of 3~36 months,the average follow-up of 19.12 months.Finally,27 hips had collapsed?4mm,survival time was 3~36 months.The relationship between the further development of the collapse of the femoral head and the related factors and the survival analysis are as follows:(1)There are significant differences in different hip pain classification and the further development of the collapse of the overall survival time in comparison(log rank,?~2=14.27,P=0.0026).(2)There are significant differences between different grading of bone marrow edema and the further development of collapse of the overall survival time(log rank,?~2=9.054,p=0.0286).(3)There are significant differences between different types of JIC and the further development of collapse of the overall survival time(log rank,?~2=16.33,P=0.0010).(4)There are not significant differences between different scope of necrosis and the further development of collapse of the overall survival time(log rank,?~2=2.085,P=0.3525).ConclusionHip pain grading,grading of bone marrow edema and JIC typing are all important prognostic indicators for assessing the collapse of the femoral head necrosis and further development after the collapse.The higher the grading of the hip pain,the more serious the bone marrow edema,the higher the JIC typing,the greater the possibility of the poor prognosis of the femoral head necrosis.There was no absolute relationship between the extent of necrosis and the prognosis of necrosis of the femoral head.The relative necrosis range of the necrotic position has a greater prognostic value.In order to achieve good effect of traditional Chinese medicine non-operative hip preserving treatment for femoral head necrosis,we must make early diagnosis and early treatment,accurately grasp the scope of adaptation of traditional Chinese medicine and close cooperation between doctors and patients.