A Retrospective Cohort Study Of The Clinical Efficacy Of Bushen Huoxue Decoction In The Treatment Of Different ARCO Stages Of Femoral Head Necrosis (kidney Deficiency And Blood Stasis)

BackgroundOsteonecrosis of the femoral head(ONFH)is a common and difficult disease in orthopedics.It is currently considered to be a type of disease that causes avascular necrosis of the femoral head due to compression of the intravascular bone network due to various causes.The disease develops rapidly,and there is no effective treatment for hip protection.Once advanced,advanced hip arthroplasty is needed.Objective1.A retrospective cohort study was used to compare the clinical efficacy of patinets with Bushen Huoxie Prescription in different cohorts and ARCO stages of ostenonecrosis of the femeral head(ONFH).2.To analyze the influencing factors of terminal event in patients with ONFH for accumulating evidence-based medical evidence of the extending survival rate with the treatment of Bushen Huoxie Prescription.Method This retrospective cohort study included 277 patients with ONFH was conducted in the Shanghai Guanghua Hospital between January,2014 and September,2018 and was divided into two groups :the exposed group(Bushen Huoxie Prescription and Physical Rehabilitation Therapy)and the non-exposed group(Simple Physical Rehabilitation).To analyze the factors of age,gender,height,weight,ARCO stages,obesity,TCM syndrome,Visual Analogue Scale/Score(VAS),Harris hip score(Harris),the area of ONFH and survival time of femoral head.Result1.The study included 277 cases,127 cases in the exposed group and 150 cases in the non-exposed group.There were no significant differences in age,gender,VAS,the area of ONFH between the two groups before treatment.2.The survival time of the exposed group was 336 days and that of the non-exposed group was 251 days.The difference was statistically significant between the two groups(P<0.001).3.The difference of the survival time was statistically significant between differentARCO stages in the exposed group(P<0.05)and the non-exposed group(P<0.05).The difference of the survival time in ARCO stage I was statistically significant between the exposed group and the non-exposed group(P<0.05).The difference of the survival time in ARCO stage II was statistically significant between the exposed group and the non-exposed group(P<0.05).The difference of the survival time in ARCO stage III was statistically significant between the exposed group and the non-exposed group(P<0.05).The difference of the survival time in ARCO stage IV was statistically significant between the exposed group and the non-exposed group(P<0.05).4.The area of ONFH in the exposed group was 17.85±5.28(%)before the treatment and that of was 13.22±7.92(%)after the treatment.There was significant difference before and after the treatment in the exposed group(P < 0.001)and that was no significant difference in the non-exposed group.The area of ONFH in ARCO stage I,II and III were significant differences before and after the treatment in the exposed group(P<0.001)and that was no significant differences in ARCO stage IV.There were no significant differences of the non-exposed group in every ARCO stages before and after the treatment.The difference of the area of ONFH in ARCO stage I,II and III were statistically significant between the exposed group and the non-exposed group(P<0.05)and that was no significant difference in ARCO stage IV.5.The rate of terminal event in the exposed group(8.67%)was lower than the non-exposed group(35.3%).The difference was statistically significant between the two groups(P<0.001).6.The rate of terminal event in the exposed group(8.67%)was lower than the non-exposed group(35.3%).The difference of the rate of terminal event was statistically significant between the exposed group and the non-exposed group in the ARCO stage I,II and IV(P<0.05)and that was no significant difference in ARCO stage III.7.The time of terminal event in the exposed group(156.92±62.459 days)was longer than the non-exposed group(59.080±43.688 days).The difference was statistically significant between the two groups(P<0.05).The time of terminal event in the exposed group of ARCO stage III(107.50±15.61 days)was longer than the non-exposed group of ARCO stage III(38.530±14.200 days).The difference was statistically significant between the two groups(P<0.001).The time of terminal event in the exposed group of ARCO stage IV(181.63±62.71 days)was longer than the non-exposed group of ARCO stage IV(32.610±24.876 days).The difference was statistically significant between the two groups(P<0.001).8.Cox proportional hazard regression model was used to explore the influence of terminal event such as different cohorts,disease stages,obesity,Harris,VAS and TCM syndrome.Different cohorts(RR=4.794,P<0.001)and disease stages(RR=1.492,P<0.05)were considered the influence of terminal event.Conclusion1.The area of ONFH in the ARCO stage I,II and III can be reduced with the treatment of Bushen Huoxie Prescription,which can delay the operation time and decrease the rate of surgery in patients with ONFH.The effect is more obviously especially for patients with stage I and stage II symptoms and tissue destruction.2.The treatment of Bushen Huoxie Prescription is a protective factor for terminal event.3.Bushen Huoxie Prescription is a safe and effective treatment,which can be widely used in clinical practice.