Clinical Study On The Treatment Of Early And Mid-term Femoral Head Necrosis With Core Decompression And Fibula Support Combined With Extracorporeal Shock Wave

Objective: Through the observation of core decompression with fibula support combined with extracorporeal shock wave in the treatment of early and mid-term femoral head necrosis,to explore the short-term clinical effect of this method in the treatment of early and middle stage osteonecrosis of the femoral head.Methods: From November 2015 to March 2017,50 cases of osteonecrosis of the femoral head,which were hospitalized in the Department of joint Department of Henan Traditional Chinese Medicine Hospital,were in accordance with the inclusion criteria.Sign the informed consent.The treatment group and the control group were randomly divided into the treatment group and the control group,with 25 cases in each group.The treatment group was treated with core decompression and fibula column support combined with extracorporeal shock wave therapy,while the control group was treated with multiple core decompression and extracorporeal shock wave therapy.Medullary capsule has the effect of promoting blood circulation and removing swelling,reinforcing bone and reinforcing tendon,and is mainly used for Fracture of each phase and early treatment of osteonecrosis of the femoral head.All patients were followed up for 1,3,6,and 12 months after operation.During the 1,3,6,and 12 months follow-up of all patients,the X-ray films of the pelvis frog were taken and the Harris and VAS scores of the hip joint were recorded.The Harris scores,VAS scores and the imaging evaluatio n at the last follow-up were compared between the two groups of patients before and 1,3,6 and 12 months after operation.To analyze the recent clinical effect of core decompression and fibula support combined with extracorporeal shock wave in the treatment of early and mid-term femoral head necrosis.Results: In this study,50 cases(87 hips)were collected,All cases were from the hospitalized patients in the Department of joint Department of Henan Traditional Chinese Medicine Hospital.The patients who were diagnosed with bilateral femoral head necrosis but only one side need to be intervened by the hip operation were treated with a single hip.Finally,50 cases(50 hips)were collected,25 cases(25 hips)in each group.During the follow-up period,3 cases were eliminated: treatment group have one case,because of the collapse of the femoral head during the follow-up period,artificial hip replacement was performed.The control group have two case,both of the collapse of the femoral head during the follow-up period,artificial hip replacement was performed.The final treatment group completed 24 cases(24 hips),including 18 male patients,6 female patients,14 alcoholic type,10 hormone type,the age from 26 years old to 44 years old.The control group completed 23 cases(23 hips),including 16 male patients,7 female patients,12 alcoholic type,11 hormone type,the age from 27 years old to 45 years old.All of the two groups of alcohol type avascular necrosis of the femoral head were all male.All the 47 subjects completed the clinical study according to the requirements.There was no significant difference between the two groups before the operation in the comparison of the factors of pathogenic factors,sex and ARCO staging.The difference in P>0.05 was not statistically significant.The two groups were compared in age,course of disease,body mass index(BMI),and there was no significant difference in P>0.05.There was no significant difference in P>0.05 difference between the two groups before the operation of the hip joint Harris score and the VAS score.The Harris and VAS scores of the hip joint were compared between the two groups before and after operation of 1,3,6,12 months,and repeated measurements of variance were used.From the time effect,the P values were all less than 0.05,indicating that the Harris scores and VAS scores of all subjects significantly changed with time points.According to the time group effect(interaction effect),the P values were less than 0.05,indicating that the trend of the Harris score and VAS score in the two groups was different with the time point.The Harris scores of hip joint between the two groups were compared with 1,3,6,and December after using the independent sample t test.The P values were all less than 0.05,and the differences were statistically significant.The results showed that the treatment group was significantly better than the control group.The VAS scores between the two groups were compared before and 1,3,6,and Decemb er respectively.The independent sample t test was used,and the P values were all greater than 0.05,the differences were not statistically significant.The results showed that the pain relief in the treatment group was not significantly different from that in the control group.The Harris score of all the patients was greater than 85 points at the last follow-up,and the excellent and good rate of hip joint Harris score between the two groups was compared,and the difference between P<0.05 was statistically significant.In the last follow-up,the evaluation of imaging efficacy between the two groups was compared.There was no statistical significance in the difference between the two groups.However,The total effective rate in the treatment group was 92%,and the total effective rate in the control group was 88%.Conclusion: Through the comparative study of two groups of patients with different treatments,it is verified that the core decompression and fibula pillar support combined with extracorporeal shock wave therapy is effective in the treatment of early and middle stage osteonecrosis of the femoral head.It can significantly improve the function of the hip joint and improve the success rate of the head necrosis of the femoral head.And effectively postpone or prevent the collapse of the femoral head,thus postponing the time of artificial hip replacement.It is worthy of clinical promotion.