非创伤性股骨头坏死塌陷晚期保髋治疗的初步临床研究
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摘要
研究背景
非创伤性股骨头坏死是一种进展性疾病,没有干预或干预失败,多数患者的股骨头必然发生塌陷,塌陷后会在2-4年进展到骨关节炎期,导致关节的残废。由于塌陷后病情进展很快,多数患者就诊时病情已发展到坏死晚期,保髋治疗非常困难。
目前治疗晚期股骨头坏死的主要方法是人工关节置换术,可以短时间内缓解疼痛,改善患者功能。但股骨头坏死患者多发于中青年,国内外学者的研究显示中青年轻患者进行关节置换的中远期疗效并不理想,假体松动会的机会很大,并可能导致多次关节翻修。而且,昂贵的关节置换和翻修费用造成患者沉重的经济负担。因此,对于中青年患者如果能够保髋成功,将具有很重要的临床价值和社会经济价值。
很多因素影响保髋的疗效,如坏死的面积、部位、塌陷的程度、致病因素等,关节软骨的状态是一个重要的影响因素。我们临床发现,尽管股骨头塌陷后病情进展很快,但中青年患者的关节软骨在塌陷后约半年的时间仍可以保持相对较好的状态,保髋的成功率较高。随着时间的延长,塌陷程度加重,关节软骨开始退变,保髋的疗效降低。一旦塌陷程度加重(大于4mm)、塌陷时间超过半年,病情进展到坏死晚期,保髋治疗非常困难,但由于多数中青年患者就诊时病情已处于这一阶段,所以仍有保髋研究的价值。为了深入研究这一阶段的保髋治疗,我们提出“塌陷晚期”的概念,并将其作为一个理论观点,探讨其疾病特点和治疗方法,以提高非创伤性股骨头坏死晚期保髋的疗效。
1非创伤性股骨头坏死塌陷晚期的理论研究
1.1塌陷晚期的概念：所谓“塌陷晚期”是指股骨头坏死后塌陷时间大于6个月、塌陷程度大于4mm,而没有出现关节间隙明显变窄的病理阶段,它是一个相对概念。。
1.2主要表现为股骨头内和股骨头外的不稳定,头内不稳定是指股骨头软骨不稳定和头内骨性不稳定,关节软骨不稳定是指软骨的破裂、退变；头内骨性不稳定是指软骨、软骨下骨、死骨、正常骨的结构和力学不稳定。股骨头外不稳定是指关节不稳定,如髋关节半脱位。
1.3塌陷晚期的治疗原则和方法：选择适合保髋的患者；改善血运、纠正塌陷,重建股骨头内、外的生物力学稳定；修补关节软骨,促进关节软骨的修复。带蒂骨瓣移植是可供选择的适宜方法,其中旋股外血管横支大转子骨瓣移植是比较理想的方法。
1.4塌陷晚期的疗效评价：应包括临床评价和影像学评价,临床评价的主要内容为疼痛、关节活动度、关节功能。X线评价的当包括头内修复情况、头臼同心圆关系、关节稳定性、关节间隙。
1.5中医中药治疗可提高塌陷晚期保髋的疗效。
2中药结合带蒂大转子骨瓣移植治疗塌陷晚期股骨头坏死的临床疗效分析
2.1研究方法
按照塌陷晚期的诊断标准,收集2003年1月至2007年12月在我院住院治疗的股骨头坏死患者34例38髋,采用中药结合带旋股外动脉横支的大转子骨瓣移植术,平均随访45.5个月。对所有的病例记录一般情况、致病原因、疼痛出现时间,中医证型分布以及术前和末次随访时疼痛评分、关节活动度、Harris评分、坏死范围、正蛙位分型、正蛙位塌陷程度、股骨头内修复、头臼同心圆关系、关节稳定性、关节间隙等情况,并以Harris评分为疗效标准,计算Harris评分优良率,观察临床改善和影像学进展情况,分析影响末次随访临床疗效的术前相关因素。采用Exce12000进行数据录入,SPSS13.0统计学软件进行相关统计分析。
2.2研究结果
2.2.1本组病例末次随访Harris评分优良率为63.16%,其中优占15.79%,良占47.37%,可占21.05%,差占15.79%。
2.2.2末次随访时临床指标改善和影像学指标进展情况
末次随访时髋关节Harris评分、疼痛评分、关节活动度明显高于术前,正位塌陷、蛙位塌陷、股骨头头臼关系、关节稳定性等指标都得到改善。并且头内修复较好17髋占44.7%,修复欠佳19髋占50%,修复较差2髋占5.3%；关节间隙无明显变窄17髋占44.7%,轻度变窄15髋占39.5%,明显变窄6髋占15.8%。2.2.3术前各因素与末次随访Harris评分单因素相关性分析
术前Harris评分、疼痛评分、关节活动度、坏死范围、蛙位分型,塌陷时间与末次随访Harris评分有相关性。术前Harris评分越高,末次随访Harris评分就越高；术前疼痛评分越低,末次随访Harris评分就越高；术前关节活动度越好,末次随访Harris评分就越高；术前坏死范围越小,末次随访Harris评分就越高；蛙位分型为C2型的末次随访Harris评分优于蛙位分型为C1型；塌陷时间越短,末次随访Harris评分就越高。而不能认为年龄、致病原因、正位分型、蛙位塌陷程度、中医证型与末次随访Harris评分相关。
2.3研究结论
2.3.1“塌陷晚期”的概念是我们根据塌陷后软骨退变的规律对保髋疗效影响而做出的经验总结。深入研究这一阶段疾病的特点,是提高非创伤性股骨头坏死晚期保髋疗效的需要。将其作为一个概念进行阐述有助于深化晚期保髋治疗的认识。
2.3.2塌陷晚期的病理特点是股骨头内、外不稳定。治疗的关键是修补关节软骨,促进软骨修复；重建血运、纠正塌陷、重建股骨头内、外的生物力学稳定。
2.3.3带旋股外血管的大转子骨瓣移植术结合中药治疗是治疗塌陷晚期股骨头坏死的有效方法,临床观察研究显示,它可以改善疼痛、提高关节活动度和Harris评分,可以纠正塌陷程度、改善头臼关系和关节稳定性、改善血运并促进坏死修复,从而取得较好的保髋疗效。
2.3.4塌陷晚期的治疗要遵循个体化治疗的原则,许多临床因素都会影响保髋疗效。临床研究显示术前Harris评分、疼痛评分、关节活动度、坏死范围、蛙位分型、塌陷时间与疗效有相关性。
2.3.5对塌陷晚期保髋疗效的评价要将临床和影像的结合,完全纠正晚期塌陷是不现实的,头臼和谐、关节稳定、股骨头内修复和关节间隙才是疗效评价的重点。
Background
Femoral head necrosis is one kind of progressive disease, which does not have the intervention or the intervention defeat, most patients femoral heads would collapse inevitably. After the collapse, the condition will progress in 2-4 years to the osteoarthritis stage and lead to joint disability, As the disease progresse very quickly after collapse, the majority of patients to the doctor had developed to later period of the necrosis and hip-preserving treatment is very difficult.
At present, the main treatment of the later period femoral head necrosis is artificial joint replacement. It can quickly relieve pain and improve function in patients. However, multiple patients with femoral head necrosis in young and middle aged, studies have shown that the long-term efficacy is not satisfactory in young patients with joint replacement. The main problem is prosthesis loosening and may result in multiple arthroplasty. Moreover, the high cost of joint replacement and arthroplasty caused to patients heavy economic burden. Thus, for younger patients if they can preserve hip,it would have important clinical value and economic value.
Many factors affect the efficacy of hip preserving, such as necrosis of the area, location, degree of collapse, pathogenic factors,the status of articular cartilage is an important factor. Our clinical found that the articular cartilage of young patients can still remain relatively good condition after the collapse of about half a year, despite the collapse of the femoral head after the disease progressed very quickly, but ensure a higher success rate of hip. With the time, the subsidence of the increase, the beginning of articular cartilage degeneration, reduced the efficacy of hip preserving. Once the subsidence of the increase (greater than 4mm), collapsed more than six months,the disease progress to the late stage of necrosis of the hip, and the treatment is very difficult. But most young patients are at this stage of disease when they see the doctors, so there is still clinic value of preservating the hip. In order to study this phase, we put forward the concept of later stage collapse, and as a theoretical point of view, we investigate the char-acteristics and treatment approach of this stage to improve the efficacy of hip preserving.
1 Research of Later stage collapse of non-traumatic femoral head necrosis
1.1 Concept of later stage collapse:it means the time of collapse of femoral head necrosis is longer than 6 months and the degree of collapse is greater than 4mm, without significant joint space narrowing of the pathological stage.
1.2 Nature pathological features of later stage collapse:the inside and outside instability of the femoral head. The former refers to the instability after collapse within articular cartilage, subchondral bone, sequestrum, and normal bone.The latter refers to cartilaginous instabi-lity, such as subluxation.
1.3 The therapeutic principles and treatment:select the patients for hip preserving, improve blood circulation, correct the collapse, reconstruct the internal and external instability of the femoral head, and repair articular cartilage, promoting cartilage repai. Transplantation of vas-cularized bone-flap graft(TVBG)is a suitable alternative method, and vascularized great trochanter bone flap transposition is an ideal method.
1.4 Evaluation of the effect of later stage collapse after treatment. It is should be included by clinical evaluation and imaging evaluation. Clinical evaluation of the main content includes pain, range of motion and joint function. X ray evaluation should include the station of repair of femoral head, the concentric relationship between the femoral head and acetabulum, the stability of the hip joint and the joint space.
1.5 Chinese medicine and mothod can improve the hip-preserving efficacy of later stage collapse
2 Clinical analysis of effect on Chinese medicine combined with vascularized great trochanter bone flap transposition in later stage collapse of femoral head necrosis
2.1 Methods
According to the diagnostic criteria on later stage collapse, from January 2003 to December 2007,34 patients were collected from our hospital who were diagnosed as femoral head necrosis in 38 hips and treated with Chinese medicine combined with a transverse femoral artery branch of the greater trochanter transplantation. The average follow-up was 45.5 months. Make record of the general situation, causes, time of the pain appear, Chinese Medicine sydrone and records the result of preoperative and final follow up, such as pain score, range of motion, Harris score, necrotic area, the type of Anteroposterior and Frog-bit of X-ray, degree of collapse of Anteroposterior and Frog-bit, the repair of femoral head, the concentric relationship between the femoral head and acetabulum, the stability of the hip joint and the joint space. Harris score is the craterin to curative effect. Calculate Harris score high rate of clinical improvement and radiographic observation of progress in the last follow-up analysis on the preoperative clinical factors. Collecting date by Excel 2000 and analyse correlative date according to the software SPSS 13.0.
2.2 Results
2.2.1 Of the 34 case's final followed up for the Harris score:63.16% of the patients had satisfactory results, which accounted for 15.79% as excellent, as good in accounting for 47.37%, and can be accounted for 21.05% as moderate and poor accounting for 15.79%.
2.2.2 Clinical improvement and radiological indicators of progress indicators when last follow-up.
Compared to pre-operative, it improved at the last follow-up, such as Harris score, pain score, range of motion, Degree of collapse of Anter-oposterior and Frog-bit, the repair of femoral head, the concentric relationship between the femoral head and acetabulum, the stability of the hip joint. there are 19 hips(44.7%) comparatively good way of repairing and unsatisfactory by 19 hip(50%) and poor repair of 2 hips(5.3%). There is no obvious joint space narrowing of 17 hips (44.7%),15 hips with mild narrowing(39.5%) and significantly narrower of 6 hips(15.8%).
2.2.3 The corelation analysis between factors on preoperative and Harris score with the last follow-up single factor.
The Harris score of Preoperative, pain score, range of motion, necrotic area, type of Frog-bit, time of Collapse, which affects the Harris score of the final follow up. The more preoperative Harris score is, the higher the Harris score of the final follow up. The lower preoperative pain score is the higher the Harris score of the final follow up. The better the range of motion in preoperative is, the higher the Harris score of the final follow up. The smaller necrotic area is, the higer the Harris score of the final follow up. Type C2 of Frog-bit is better than C1 in Harris score of the final follow up. The shorter time of collapse,the higher the Harris score of the final follow up. there is no statistion significance in age,cause, type of Anteroposterior, degree of collapse of the Frog-bit and type of TCM with the Harris score of the final follow up.
2.3 Conclusions
2.3.1 The concept of later stage collapse is a summary of clinical experience, bases on hip cartilage degeneration on the curative effect of hip preserving,As a concept put forward and described, its contents will help to deep understanding of the later stage hip preserving treatment.
2.3.2 Pathological features of the later stage collapse is the breakdown of articular cartilage degeneration and internal and external instabi- lity of the femoral head, the key is to treat articular cartilage repair and promoting cartilage repair, reconstruction of blood circulation, co-rrect the collapse, reconstructing the biological mechanical the inter-nal and external stability of femoral head.
2.3.3 Chinese Medicine combined with external femoral artery of the greater trochanter transplantation is the treatment of advanced osteonecrosis of femoral head collapse and effective method of clinical observation, it can reduce pain, improve joint range of motion and the Harris score. It help to correct the degree of collapse, improve head acetabular relations and improve joint stability and promote necrosis of repair and obtain better insurance hip preserving efficacy.
2.3.4 Treatment on later stage collapse should follow the principle of individual. Many clinical factors will affect the efficacy of hip preserving. Clinical studies have shown that preoperative Harris score, pain score, range of motion, necrotic area, frog-bit type, collapsing time and effect are related.
2.3.5 It is important that combing of clinical and imaging to evaluate the efficacy of hip preserving, and it's unrealistic to entirely correct the collapse. The most important point in evaluate the efficacy is mortar harmony, joint stability, restoration of femoral head and joint space.
非创伤性股骨头坏死是一种进展性疾病,没有干预或干预失败,多数患者的股骨头必然发生塌陷,塌陷后会在2-4年进展到骨关节炎期,导致关节的残废。由于塌陷后病情进展很快,多数患者就诊时病情已发展到坏死晚期,保髋治疗非常困难。
目前治疗晚期股骨头坏死的主要方法是人工关节置换术,可以短时间内缓解疼痛,改善患者功能。但股骨头坏死患者多发于中青年,国内外学者的研究显示中青年轻患者进行关节置换的中远期疗效并不理想,假体松动会的机会很大,并可能导致多次关节翻修。而且,昂贵的关节置换和翻修费用造成患者沉重的经济负担。因此,对于中青年患者如果能够保髋成功,将具有很重要的临床价值和社会经济价值。
很多因素影响保髋的疗效,如坏死的面积、部位、塌陷的程度、致病因素等,关节软骨的状态是一个重要的影响因素。我们临床发现,尽管股骨头塌陷后病情进展很快,但中青年患者的关节软骨在塌陷后约半年的时间仍可以保持相对较好的状态,保髋的成功率较高。随着时间的延长,塌陷程度加重,关节软骨开始退变,保髋的疗效降低。一旦塌陷程度加重(大于4mm)、塌陷时间超过半年,病情进展到坏死晚期,保髋治疗非常困难,但由于多数中青年患者就诊时病情已处于这一阶段,所以仍有保髋研究的价值。为了深入研究这一阶段的保髋治疗,我们提出“塌陷晚期”的概念,并将其作为一个理论观点,探讨其疾病特点和治疗方法,以提高非创伤性股骨头坏死晚期保髋的疗效。
1非创伤性股骨头坏死塌陷晚期的理论研究
1.1塌陷晚期的概念：所谓“塌陷晚期”是指股骨头坏死后塌陷时间大于6个月、塌陷程度大于4mm,而没有出现关节间隙明显变窄的病理阶段,它是一个相对概念。。
1.2主要表现为股骨头内和股骨头外的不稳定,头内不稳定是指股骨头软骨不稳定和头内骨性不稳定,关节软骨不稳定是指软骨的破裂、退变；头内骨性不稳定是指软骨、软骨下骨、死骨、正常骨的结构和力学不稳定。股骨头外不稳定是指关节不稳定,如髋关节半脱位。
1.3塌陷晚期的治疗原则和方法：选择适合保髋的患者；改善血运、纠正塌陷,重建股骨头内、外的生物力学稳定；修补关节软骨,促进关节软骨的修复。带蒂骨瓣移植是可供选择的适宜方法,其中旋股外血管横支大转子骨瓣移植是比较理想的方法。
1.4塌陷晚期的疗效评价：应包括临床评价和影像学评价,临床评价的主要内容为疼痛、关节活动度、关节功能。X线评价的当包括头内修复情况、头臼同心圆关系、关节稳定性、关节间隙。
1.5中医中药治疗可提高塌陷晚期保髋的疗效。
2中药结合带蒂大转子骨瓣移植治疗塌陷晚期股骨头坏死的临床疗效分析
2.1研究方法
按照塌陷晚期的诊断标准,收集2003年1月至2007年12月在我院住院治疗的股骨头坏死患者34例38髋,采用中药结合带旋股外动脉横支的大转子骨瓣移植术,平均随访45.5个月。对所有的病例记录一般情况、致病原因、疼痛出现时间,中医证型分布以及术前和末次随访时疼痛评分、关节活动度、Harris评分、坏死范围、正蛙位分型、正蛙位塌陷程度、股骨头内修复、头臼同心圆关系、关节稳定性、关节间隙等情况,并以Harris评分为疗效标准,计算Harris评分优良率,观察临床改善和影像学进展情况,分析影响末次随访临床疗效的术前相关因素。采用Exce12000进行数据录入,SPSS13.0统计学软件进行相关统计分析。
2.2研究结果
2.2.1本组病例末次随访Harris评分优良率为63.16%,其中优占15.79%,良占47.37%,可占21.05%,差占15.79%。
2.2.2末次随访时临床指标改善和影像学指标进展情况
末次随访时髋关节Harris评分、疼痛评分、关节活动度明显高于术前,正位塌陷、蛙位塌陷、股骨头头臼关系、关节稳定性等指标都得到改善。并且头内修复较好17髋占44.7%,修复欠佳19髋占50%,修复较差2髋占5.3%；关节间隙无明显变窄17髋占44.7%,轻度变窄15髋占39.5%,明显变窄6髋占15.8%。2.2.3术前各因素与末次随访Harris评分单因素相关性分析
术前Harris评分、疼痛评分、关节活动度、坏死范围、蛙位分型,塌陷时间与末次随访Harris评分有相关性。术前Harris评分越高,末次随访Harris评分就越高；术前疼痛评分越低,末次随访Harris评分就越高；术前关节活动度越好,末次随访Harris评分就越高；术前坏死范围越小,末次随访Harris评分就越高；蛙位分型为C2型的末次随访Harris评分优于蛙位分型为C1型；塌陷时间越短,末次随访Harris评分就越高。而不能认为年龄、致病原因、正位分型、蛙位塌陷程度、中医证型与末次随访Harris评分相关。
2.3研究结论
2.3.1“塌陷晚期”的概念是我们根据塌陷后软骨退变的规律对保髋疗效影响而做出的经验总结。深入研究这一阶段疾病的特点,是提高非创伤性股骨头坏死晚期保髋疗效的需要。将其作为一个概念进行阐述有助于深化晚期保髋治疗的认识。
2.3.2塌陷晚期的病理特点是股骨头内、外不稳定。治疗的关键是修补关节软骨,促进软骨修复；重建血运、纠正塌陷、重建股骨头内、外的生物力学稳定。
2.3.3带旋股外血管的大转子骨瓣移植术结合中药治疗是治疗塌陷晚期股骨头坏死的有效方法,临床观察研究显示,它可以改善疼痛、提高关节活动度和Harris评分,可以纠正塌陷程度、改善头臼关系和关节稳定性、改善血运并促进坏死修复,从而取得较好的保髋疗效。
2.3.4塌陷晚期的治疗要遵循个体化治疗的原则,许多临床因素都会影响保髋疗效。临床研究显示术前Harris评分、疼痛评分、关节活动度、坏死范围、蛙位分型、塌陷时间与疗效有相关性。
2.3.5对塌陷晚期保髋疗效的评价要将临床和影像的结合,完全纠正晚期塌陷是不现实的,头臼和谐、关节稳定、股骨头内修复和关节间隙才是疗效评价的重点。
Background
Femoral head necrosis is one kind of progressive disease, which does not have the intervention or the intervention defeat, most patients femoral heads would collapse inevitably. After the collapse, the condition will progress in 2-4 years to the osteoarthritis stage and lead to joint disability, As the disease progresse very quickly after collapse, the majority of patients to the doctor had developed to later period of the necrosis and hip-preserving treatment is very difficult.
At present, the main treatment of the later period femoral head necrosis is artificial joint replacement. It can quickly relieve pain and improve function in patients. However, multiple patients with femoral head necrosis in young and middle aged, studies have shown that the long-term efficacy is not satisfactory in young patients with joint replacement. The main problem is prosthesis loosening and may result in multiple arthroplasty. Moreover, the high cost of joint replacement and arthroplasty caused to patients heavy economic burden. Thus, for younger patients if they can preserve hip,it would have important clinical value and economic value.
Many factors affect the efficacy of hip preserving, such as necrosis of the area, location, degree of collapse, pathogenic factors,the status of articular cartilage is an important factor. Our clinical found that the articular cartilage of young patients can still remain relatively good condition after the collapse of about half a year, despite the collapse of the femoral head after the disease progressed very quickly, but ensure a higher success rate of hip. With the time, the subsidence of the increase, the beginning of articular cartilage degeneration, reduced the efficacy of hip preserving. Once the subsidence of the increase (greater than 4mm), collapsed more than six months,the disease progress to the late stage of necrosis of the hip, and the treatment is very difficult. But most young patients are at this stage of disease when they see the doctors, so there is still clinic value of preservating the hip. In order to study this phase, we put forward the concept of later stage collapse, and as a theoretical point of view, we investigate the char-acteristics and treatment approach of this stage to improve the efficacy of hip preserving.
1 Research of Later stage collapse of non-traumatic femoral head necrosis
1.1 Concept of later stage collapse:it means the time of collapse of femoral head necrosis is longer than 6 months and the degree of collapse is greater than 4mm, without significant joint space narrowing of the pathological stage.
1.2 Nature pathological features of later stage collapse:the inside and outside instability of the femoral head. The former refers to the instability after collapse within articular cartilage, subchondral bone, sequestrum, and normal bone.The latter refers to cartilaginous instabi-lity, such as subluxation.
1.3 The therapeutic principles and treatment:select the patients for hip preserving, improve blood circulation, correct the collapse, reconstruct the internal and external instability of the femoral head, and repair articular cartilage, promoting cartilage repai. Transplantation of vas-cularized bone-flap graft(TVBG)is a suitable alternative method, and vascularized great trochanter bone flap transposition is an ideal method.
1.4 Evaluation of the effect of later stage collapse after treatment. It is should be included by clinical evaluation and imaging evaluation. Clinical evaluation of the main content includes pain, range of motion and joint function. X ray evaluation should include the station of repair of femoral head, the concentric relationship between the femoral head and acetabulum, the stability of the hip joint and the joint space.
1.5 Chinese medicine and mothod can improve the hip-preserving efficacy of later stage collapse
2 Clinical analysis of effect on Chinese medicine combined with vascularized great trochanter bone flap transposition in later stage collapse of femoral head necrosis
2.1 Methods
According to the diagnostic criteria on later stage collapse, from January 2003 to December 2007,34 patients were collected from our hospital who were diagnosed as femoral head necrosis in 38 hips and treated with Chinese medicine combined with a transverse femoral artery branch of the greater trochanter transplantation. The average follow-up was 45.5 months. Make record of the general situation, causes, time of the pain appear, Chinese Medicine sydrone and records the result of preoperative and final follow up, such as pain score, range of motion, Harris score, necrotic area, the type of Anteroposterior and Frog-bit of X-ray, degree of collapse of Anteroposterior and Frog-bit, the repair of femoral head, the concentric relationship between the femoral head and acetabulum, the stability of the hip joint and the joint space. Harris score is the craterin to curative effect. Calculate Harris score high rate of clinical improvement and radiographic observation of progress in the last follow-up analysis on the preoperative clinical factors. Collecting date by Excel 2000 and analyse correlative date according to the software SPSS 13.0.
2.2 Results
2.2.1 Of the 34 case's final followed up for the Harris score:63.16% of the patients had satisfactory results, which accounted for 15.79% as excellent, as good in accounting for 47.37%, and can be accounted for 21.05% as moderate and poor accounting for 15.79%.
2.2.2 Clinical improvement and radiological indicators of progress indicators when last follow-up.
Compared to pre-operative, it improved at the last follow-up, such as Harris score, pain score, range of motion, Degree of collapse of Anter-oposterior and Frog-bit, the repair of femoral head, the concentric relationship between the femoral head and acetabulum, the stability of the hip joint. there are 19 hips(44.7%) comparatively good way of repairing and unsatisfactory by 19 hip(50%) and poor repair of 2 hips(5.3%). There is no obvious joint space narrowing of 17 hips (44.7%),15 hips with mild narrowing(39.5%) and significantly narrower of 6 hips(15.8%).
2.2.3 The corelation analysis between factors on preoperative and Harris score with the last follow-up single factor.
The Harris score of Preoperative, pain score, range of motion, necrotic area, type of Frog-bit, time of Collapse, which affects the Harris score of the final follow up. The more preoperative Harris score is, the higher the Harris score of the final follow up. The lower preoperative pain score is the higher the Harris score of the final follow up. The better the range of motion in preoperative is, the higher the Harris score of the final follow up. The smaller necrotic area is, the higer the Harris score of the final follow up. Type C2 of Frog-bit is better than C1 in Harris score of the final follow up. The shorter time of collapse,the higher the Harris score of the final follow up. there is no statistion significance in age,cause, type of Anteroposterior, degree of collapse of the Frog-bit and type of TCM with the Harris score of the final follow up.
2.3 Conclusions
2.3.1 The concept of later stage collapse is a summary of clinical experience, bases on hip cartilage degeneration on the curative effect of hip preserving,As a concept put forward and described, its contents will help to deep understanding of the later stage hip preserving treatment.
2.3.2 Pathological features of the later stage collapse is the breakdown of articular cartilage degeneration and internal and external instabi- lity of the femoral head, the key is to treat articular cartilage repair and promoting cartilage repair, reconstruction of blood circulation, co-rrect the collapse, reconstructing the biological mechanical the inter-nal and external stability of femoral head.
2.3.3 Chinese Medicine combined with external femoral artery of the greater trochanter transplantation is the treatment of advanced osteonecrosis of femoral head collapse and effective method of clinical observation, it can reduce pain, improve joint range of motion and the Harris score. It help to correct the degree of collapse, improve head acetabular relations and improve joint stability and promote necrosis of repair and obtain better insurance hip preserving efficacy.
2.3.4 Treatment on later stage collapse should follow the principle of individual. Many clinical factors will affect the efficacy of hip preserving. Clinical studies have shown that preoperative Harris score, pain score, range of motion, necrotic area, frog-bit type, collapsing time and effect are related.
2.3.5 It is important that combing of clinical and imaging to evaluate the efficacy of hip preserving, and it's unrealistic to entirely correct the collapse. The most important point in evaluate the efficacy is mortar harmony, joint stability, restoration of femoral head and joint space.
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