| PurposeThe 3D pattern of the hip joint was reconstructed by CT data and the morphological differences of the femoral head necrosis of the femoral head in different TCM syndromes were observed.Based on the large sample size,the 3D morphological database of the hip joint was constructed to realize the quantitative analysis of the three-dimensional shape of the femoral head necrosis of the femoral head.At the same time,the evaluation of traditional Chinese medicine,physical therapy,functional exercise and other standardized comprehensive non-surgical hip-salvage for the treatment of femoral head necrosis was studied.Method1.Quantitative study of stereotypes of hip joints in different types of TCM syndromes:a retrospective analysis of the first affiliated to guangzhou university of traditional Chinese medicine from December 2016 to February 2017 using non-surgical hip protection for patients with femoral head necrosis was studied.The patient diagnosed with femoral head and the syndrome type belonged to patients with qi stagnation and blood stasis type,kidney deficiency and blood stasis type,and stasis-phlegm type femoral head necrosis.The imaging data showed that the femoral head was not collapsed.The center edge angle and Sharp Angle of the hip was measured by x-ray plate.The suprainferior diameter,anteroposterior diameter,acetabular depth,abduction angle,anteversion angle was measured by CT three-dimensional image.Statistical analysis of the relationship between hip morphology and femoral head necrosis TCM syndromes were observed.2.Efficacy evaluation of standardized non-surgical hip-salvage treatment for femoral head necrosis:retrospective analysis of the first affiliated hospital of Guangzhou University of Traditional Chinese Medicine from December 2016 to February 2017 using non-surgical hip-salvage treatment for patients with femoral head necrosis was studied,All patients received traditional Chinese medicine,physical therapy,functional exercise and other standardized comprehensive non-surgical hip-salvage treatment.The VAS pain score and Harris score at the time of admission was assessed at two years after treatment to assess the clinical function of the patient’ s hip,Furthermore,x-ray plate were used to compare the imaging before and after treatment.The adverse reactions of patients were recorded during the course of treatment to evaluate the safety of the treatment.The results were processed using SPSS20.0 software.When P<0.05,the difference was statistically significant.Result1.Quantitative study of stereotypes of hip joints in different types of TCM syndromes:according to the inclusion criteria and exclusion criteria,73 patients(108 hips)were enrolled in this section,including 42 males and 31 females with an average age of 25.2±0.97 years.The TCM syndromes type 31 hips were qi stagnation and blood stasis,47 hips were kidney deficiency and blood stasis,and 30 hips were stasis-phlegm type.The ARCO stage was I la,Ⅱb,and Ⅱc with 1,55,and 52 hips,respectively.Statistical analysis showed that the Sharp angles of patients with different TCM syndromes of femoral head necrosis were statistically significant(P<0.01).The Sharp angle of patients with kidney deficiency and blood stasis type femoral head necrosis was the largest,and the Sharp angle of patients with qi stagnation and blood stasis type femoral head necrosis was the smallest.There was a statistically significant difference in the abduction angle of patients with TCM syndromes.The abduction angle of patients with kidney deficiency and blood stasis type femoral head necrosis was larger than that of sputum accumulation type and qi stagnation and blood stasis type(P<0.01).There was no significant difference in abduction angle between the two groups in the stasis-phlegm type and qi stagnation and blood stasis type.There was a statistically significant difference in the center edge angle of the patients with different TCM syndromes of femoral head necrosis(P<0.01).The center edge angle of patients with kidney deficiency and blood stasis type ONFH was the smallest.The center edge angle of patients with qi stagnation and blood stasis type ONFH was the highest.The acetabular depth of patients with kidney deficiency and blood stasis type femoral head necrosis was shallower than that of qi stagnation and blood stasis type femoral head necrosis patients(P<0.01).There was no statistically significant difference in the suprainferior diameter,acetabular anteroposterior diameter and anteversion angle in patients with femoral head necrosis(P>0.05),indicating that there was mild dysplasia of the acetabulum in patients with kidney deficiency and blood stasis type femoral head necrosis.2.Efficacy evaluation of standardized non-surgical hip-salvage treatment for femoral head necrosis:according to the inclusion criteria and exclusion criteria,88 patients(131 hips)were included in this section,including 58 males and 30 females,with an average age of 25.4±0.79 years.The average follow-up time was 24.0±11.1 months,There were 14 cases of femoral head necrosis caused by trauma,54 cases by hormone,and 20 cases by intemperance.The ARCO stage was 56,52,17,and 6 hips in stages Ⅱb,Ⅱc,Ⅲa,and Ⅲb respectively.JIC classification is A type 2 hip,B type 74 hip,C1 type 40 hip,C2 type 15 hip.The VAS score at admission was 2.84±0.90,and gradually decreased after treatment.After two years,the VAS score decreased to 0.77±0.86,The Harris score at admission was 68.6±3.72.It gradually increased with treatment.After two years,the Harris score increased to 84.8±5.93.The difference was statistically significant,indicating that the symptoms were significantly relieved after non-surgical hip-salvage treatment and the function was significantly improved.The imaging evaluation showed that 89 hips improved,21 hips don’ t change,15 hips deteriorated,and 6 hip failures.The improvement rate was 67.9%,indicating that the patient showed signs of improvement in necrotic areas on the X-ray after non-surgical hip-salvage treatment.The band and the low-density light-transmissive area are gradually reduced,and the density of the femur skull is gradually uniform.During the treatment,some patients had muscle soreness after muscle exercise around the hip joint.All patients had no obvious adverse reactions such as subcutaneous blood stasis and limb swelling.Conclusion1.Under the observation of 3D visualization technology,there is a difference in hip joint morphology between different TCM syndromes types.The acetabular development of patients with kidney-deficiency and blood stasis type femoral head necrosis is worse than that of qi stagnation and blood stasis type and stasis-phlegm type.There is a certain relationship between developmental dysplasia of the hip and the occurrence and development of femoral head necrosis.Therefore,attention should be paid to the development of acetabulum while treating femoral head necrosis.2.Patients with qi stagnation and blood stasis type of femoral head necrosis have large center edge angle,which may be affected by the reduction quality of femoral neck fractures.The femoral head fractures cause internal movement of the femoral head.Therefore,in the treatment of qi stagnation and blood stasis type femoral head necrosis patients should also pay attention to the presence of acetabular impact.3.The standardized comprehensive non-surgical hip-salvage treatment,combined with traditional Chinese medicine,physical therapy and functional exercise,for early and mid-term femoral head necrosis can significantly improve the patient’ s symptoms and quality of life in the short term.And its effect on relieving pain on the Ⅱ and Ⅲ stocks patients with bone necrosis are more obvious.The side effects produced during the treatment are small and worthy of clinical promotion. |
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