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Objective:To investigate the effect of a degradable high-purity magnesium screw in fixing the greater trochanter bone flap of a lateral circumflex femoral artery transverse branch in the treatment of ischemic necrosis of femoral head in young and middle-aged adults.Methods:From February 2017 to February 2019, 12 cases (15 hips) of young and middle-aged patients with avascular necrosis of femoral head were treated in the Department of Orthopaedic of Affiliated Zhongshan Hospital of Dalian University. The age of patients was 30-53 years old. According to Association Research Circulation Osseous (ARCO), 2 hips were graded in stage II b, 4 in ARCO II c, 1 in ARCO III a, 5 in ARCO III b, 2 in ARCO III c and 1 in ARCO IV. The greater trochanter bone flap with a lateral circumferential vascular branch was used to fill the necrotic area, and fixed by a biodegradable high purity magnesium screw in the bone flap transfer. At 3, 6 and 12 months postoperation, the patient came to the hospital outpatient clinic for follow-up, and then were reviewed once a year. Imaging efficacy was evaluated by comparing preoperative and postoperative imaging. The Harris score and Visual Anoalogue Scale (VAS) score were tested at 12 and 24 months after surgery. The Harris score and VAS score before and after surgery were compared by Friedman test, and P<0.05 was considered statistically significant. Results:All 12 patients (15 hips) were entered in the 24-36 months of follow-up. At 12 and 24 months after surgery, Harris score was found at 87 (86, 92) and 90 (87, 92) respertively, which were both higher than that before surgery [59 (52, 74)] with a significant statistical difference ( Z=-3.743, Z=-4.473, P<0.05). However, there was no significant difference in Harris scores between 12 and 24 months after the surgery ( Z=-0.730, P>0.05). At the 12 and 24 months after surgery, VAS score was found at 3 (2, 3) and 2 (1, 3) respertively, which were both lower than that before surgery [6 (5, 6) ] with a significant statistical difference ( Z=-3.560, Z=-4.656, P<0.05). There was no statistical difference in VAS scores between 12 and 24 months after surgery ( Z=-1.095, P>0.05). X-ray and CT scan showed that the bone flaps healed well and the areas of osteonecrosis were repaired. Thirteen femoral heads were in good shape, and 2 femoral heads had further collapse of hips. No patients underwent joint replacement surgery at the time of last follow-up. Conclusion:Fixation of the greater trochanter flap of lateral circumflex femoral artery transverse branch with a degradable high-purity magnesium screw can ensure the healing of the flap at the implantation site and avoid the displacement and shedding of the flap. It is a new therapeutic option to treat the avascular necrosis of femoral head of young and middle-aged people.
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This study aimed to observe the intervention effect of Jianpi Huogu Formula(JPHGF) on the functional damage of vascular endothelial cells caused by glucocorticoid, and explore its action mechanism from the PI3 K/Akt and mitogen activated protein kinase(MAPK) signaling pathways. The extracted thoracic aorta ring of normal SD rats were intervened first with vascularendothelial growth factor(VEGF, 20 μg·L-1) and/or sodium succinate(MPS, 0. 04 g·L-1) in vitro and then with JPHGF(8, 16, and 32 μg·L-1) for five mcontinuous ethylpdays, rednisolofollowed nebythe statistics of the number, length, and area of microvessels budding fromvascular rings. In addition, the human umbilical vein endothelial cells(HUVECs) induced by VEGF(20 μg·L-1) were added with MPS(0. 04 g·L-1) and then with JPHGF(8, 16, and 32 μg·L-1) for observing the migration, invasion, and luminal formation abilities of HUVECs in the migration, invasion and luminal formation experiments. The protein expression levels of PI3 K, p-Akt, p-JN K, and p-ERK in HUVECs were assayed by Western blot. The results showed that JPHGF dose-dependently improved the num-ber,length, and area of microvessels in MPS-induced rat thoracic aortic ring, reversed the migration, invasion and lumen formation abiliti es of HUVECs reduced by MPS, and up-regulated the protein expression levels of PI3 K, p-Akt, and p-JNK in HUVECs. All thesehave suggested that JPHGF exerts the protective effect against hormone-induced damage to the angiogenesis of vascular endothelial cells by activating the PI3 K/Akt and MAPK signaling pathways, which has provided reference for exploring the mechanism of JPHGF in treating s teroid-induced avascular necrosis of femoral head(SANFH) and also the experimental evidence for enriching the scientific connotationof spleen-invigorating and blood-activating therapy.
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Animals , Humans , Rats , Glucocorticoids/pharmacology , Human Umbilical Vein Endothelial Cells , Neovascularization, Pathologic/metabolism , Rats, Sprague-Dawley , Vascular Endothelial Growth Factor A/metabolismABSTRACT
Objective:To observe the efficacy of modified Chushi Huqianwan combined with core decompression on Ⅰ， Ⅱ stage osteonecrosis of femoral head due to hot and humid syndrome， and the effect on bone metabolism index ［osteocalcin （BGP）， bone morphogenetic protein-2 （BMP-2）， bone isoenzyme alkaline phosphatase （BALP）］， blood lipid ［apolipoprotein A （ApoA）， apolipoprotein B （ApoB）， apolipoprotein C3 （ApoC3）］， protein expression ［matrix metalloproteinase-2 （MMP-2）， matrix metalloproteinase-9 （MMP-9）， tissue inhibitor of matrix metalloproteinase-2 （TIMP-2）］. Method:A total of 90 cases were divided into control group and observation group， with 45 cases in each group. The control group was given core decompression + Xianling Gubao， while the observation group was given core decompression + modified Chushi Huqianwan for 6 months. The hip harris score （HHS）， lateral head index （LHI） and traditional Chinese medicine （TCM） syndrome were observed between two groups. The serum bone metabolic indices （BGP， BMP-2， BALP）， blood lipid （ApoA， ApoB， ApoC3）， protein expressions （MMP-2， MMP-9， TIMP-2） were detected between two groups. The clinical efficacy， adverse reaction and recurrence in 36-month follow-up were compared between two groups. Result:The total effective rate was 97.73% （43/44） in observation group， which was higher than 80.95% （34/42） in control group （χ2=5.915， P<0.05）. The recurrence rate was 4.65% （2/43） in observation group， which was lower than 35.29% （12/34） in control group （χ2=5.317， P<0.05） during the 36-month follow-up. HHS and LHI in observation group were significantly higher than those in control group （P<0.05）， and TCM syndrome score was significantly lower than that in control group （P<0.05）. Compared with control group after treatment， BGP， BMP-2， BALP， MMP-2 and MMP-9 in observation group were significantly increased （P<0.05）， whereas ApoA， ApoB， ApoC3， TIMP-2 were significantly decreased （P<0.05）. No obvious adverse reactions were observed during the treatment. Conclusion:Modified Chushi Huqianwan combined with core decompression can significantly improve clinical symptoms， bone metabolism indexes， blood lipid and protein expressions of patients with Ⅰ， Ⅱ stage osteonecrosis of femoral head due to hot and humid syndrome.
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BACKGROUND: Avascular necrosis of the femoral head is mainly caused by insufficient blood supply of the femoral head. Core decompression is a common clinical treatment, enriched autologous bone marrow stem cell transplantation can improve hip function, and combined application can promote early recovery of patients. OBJECTIVE: To investigate the therapeutic effects of enriched autologous bone marrow stem cell transplantation combined with core decompression on serum levels of fibroblast growth factor-2, hypoxia-inducible factor-1α and vascular endothelial growth factor in patients with early avascular necrosis of femoral head. METHODS: Sixty-two cases of early avascular necrosis of femoral head treated from January 2016 to January 2018 were selected, and were divided into study group (n=31) and control group (n=31) according to the random number table method. The control group was treated with fine-needle porous-channel core pulp decompression, while the study group was treated with enriched autologous bone marrow stem cell transplantation on the basis of the control group. Harris score, Visual Analogue Scale score, serum fibroblast growth factor-2, hypoxia-inducible factor-1α and vascular endothelial growth factor levels and adverse reactions were observed before and after treatment. RESULTS AND CONCLUSION: (1) The Harris scores at 3, 6 and 12 months after treatment in the two groups were higher than those before treatment (P 0.05). (5) These results suggest that enriched autologous bone marrow stem cell transplantation combined with core decompression in the treatment of early avascular necrosis of femoral head can effectively improve hip joint function, promote the repair of femoral head necrosis area, alleviate pain, increase the level of fibroblast growth factor-2, and reduce the levels of hypoxia-inducible factor-1α and vascular endothelial growth factor.
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To introduce the surgical procedure of orthopaedic robot-assisted vascularised fibular grafting for the treatment of ANFH and report the short-term result. Methods From September, 2016 to November, 2018, 17 patients (21 hips) with ANFH had undergone robot-assisted free fibular grafting. There were 14 males and 3 females, of which, 8 cases were associated with the right side, 5 cases the left side, and 4 cases with both sides. The average age was 35 (ranged from 17 to 55) years. There were 7 patients suffered from idiopathic ischemic necrosis of femoral head, 4 patients who had cannulated screws fixed after a femoral neck fracture, 4 patients who had a history of alcohol consumption, 1 patient who had taken corticosteroids for 6 months to treat nephritis, and 1 patient who had a history of alcohol consumption and had also taken corticosteroids. Seventeen hips were in Ficat stage II, and 4 hips were in Ficat stage III. The orthopaedic surgical robot workstation was used to plan the entry point and target of the guide pin during the operation, to place a cannula in the optimal position. Then a bone window was created and the fibula was placed into the bone tunnel.Using fluoroscopy to monitor each step of the procedure and verify the position of the fibula. Finally, the vessels were anastomosed. The patient remain in bed completely for a week with the use of vasodilator. The follow-up was accomplished with phone call and outpatient clinic, and Harris score was evaluated. Results All 21 surgical procedures were successful. The guide pins and fibula were accurately placed according to the robot’s plan, and the tips of the fibula were placed at the centre of the load-bearing region of the femoral heads, 4 to 6 mm from the articular surface. Conventional anticoagulant, anti-infective therapy was performed after the pro-cedure. Ten patients were followed-up postoperatively more than 1 year, with an average of 15 (from 12 to 24) months. The function of the hip joint recovered smoothly for 9 patients.Frontal and lateral X-ray and CT scans showed that the tips of the fibula were placed at the centre of the load-bearing region, 4 to 6 mm from the articular surface.One patient suffered from bilateral femoral head necrosis and the right side recovered smoothly after operation.However, joint move-ment was restricted for the left hip and the pain was significant.An arthroscopic examination was performed 1 month after the operation and did not identify any problems such as intraarticular incular infection or articular surface of the femoral head was protruded by the tip of the fibula.The symptoms were alleviated after removing the osteophytes at the rim of the acetabulum.The Harris score was 62.4±13.6 before operation, and 84.5±4.5 at the last time of followed-up after opera-tion.The difference in Harris scores was statisticly significant (P＜0.05). Conclusion With the assistance of an or-thopaedic robot system, the guide pin can be accurately positioned, thereby allowing the tip of the fibula to be inserted in-to the optimal anatomical position and maximising its mechanical efficacy.In theory, it is the best choice for performing fibular bone transplantation in ANFH.And the early effect of treatment is good.
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Objective:To observe the effect of Wenyangbushen formula on mRNA expression of osteoprotegerin (OPG), receptor activator of nuclear factor- kappa B (RANK) and receptor activator of nuclear factor- kappa B ligand (RANKL) in rabbits with steroid-induced avascular necrosis of femoral head (SANFH). Methods:A total of 46 healthy conventional New Zealand white rabbits were randomly divided into normal group (n = 10) and model building group (n = 36). The modified method of horse serum plus methylprednisolone was used to establish the SANFH model. Two rabbits from the normal group and four from the model building group were used for HE staining. Then the other models were randomly divided into model group, and low-dose, medium-dose and high-dose treatment groups, with eight rabbits in each group. The normal group was given normal saline 10 ml/d, and the treatment groups were given Wenyangbushen formula 6.44 g/(kg·d), 9.66 g/(kg·d) and 12.88 g/(kg·d), respectively, for eight weeks. The mRNA expression of OPG, RANK and RANKL was detected by reverse transcription- polymerase chain reaction. Results:The empty lacuna rate was significantly higher in the model group than in the normal group (t = 17.085, P < 0.001). Compared with the model group, the mRNA expression of OPG increased (P < 0.01), and the mRNA expression of RANK and RANKL decreased (P < 0.01), in the treatment groups. Compared with the low-dose treatment group, the mRNA expression of OPG increased (P < 0.01), and the mRNA expression of RANK and RANKL decreased (P < 0.01), in the medium-dose and high-dose treatment groups. There was no significant difference in the mRNA expression of OPG, RANK and RANKL between the low-dose treatment group and the high-dose treatment group (P > 0.05). Conclusion:Wenyangbushen formula could increase the mRNA expression of OPG and inhibit the mRNA expression of RANK and RANKL in the femoral head tissue of the rabbits with SANFH.
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Objective: To analyze the clinical features of the patient with myelodysplastic syndrome who developed bilateral ischemia necrosis of femoral head after allogeneic hematopoietic stem cell transplantation, and to discuss the perioperative management, efficacy and prognosis of bilateral hip arthroplasty for such patients. Methods: The clinical material of one patient with myelodysplastic syndrome who developed bilateral ischemia necrosis of femoral head after allogeneic hematopoietic stem cell transplantation including age, gender, clinical symptoms, previous medical history and outcomes, auxiliary examinations, treatment regimen and prognosis were collected, and the relevant literatures were reviewed. Results: After allogeneic hematopoietic stem cell transplantation, the patient was diagnosed with bilateral ischemia necrosis of femoral head (Ficat stage: left stage IV, right stage IE); the patient presented bilateral hip joint pain and severe limitation of movement. Admission to complete preoperative examination, through multiple consultations of Department of Hematology (blood routine, coagulation routine, erythrocyte sedimentation rate, cyclosporine concentration) and Department of Anesthesiology (blood routine, coagulation routine, liver and kidney function, cardiopulmonary function and lower extremity venous color Doppler), bilateral total hip arthroplasty was decided to perform. The operation went on smoothly, the patient recovered quickly after operation, and the symptoms of pain were improved significantly. The first day after operation, the patient went to the ground, and walked with two crutches. There was no complications during perioperative period and postoperation. One month after operation, the patient recovered well, blood routine examination, liver function, renal function, erythrocyte sedimentation rate, C-reactive protein and pelvic positivity were all normal. Conclusion: Total hip arthroplasty is effective in the patients with bilateral ischemia necrosis of femoral head after allogeneic hematopoietic stem cell transplantation. Strengthening perioperative management can effectively prevent the complications and improve the quality of life of the patients.
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Objective: To compare effectiveness between sequestrum clearance and impacting bone graft and rotational osteotomy on the base of femoral neck via surgical hip dislocation approach for avascular necrosis of femoral head (ANFH) at Association Research Circulation Osseous (ARCO ) stage Ⅲ. Methods: A clinical data of 24 patients (27 hips) with ANFH at ARCO stage Ⅲ, who met the inclusion criteria between June 2012 and November 2017, was retrospectively analysed. Of all patients, 12 patients (14 hips) were treated with sequestrum clearance and impacting bone graft via surgical hip dislocation approach (group A); and 12 patients (13 hips) were treated with rotational osteotomy on the base of femoral neck via surgical hip dislocation approach (group B). There was no significant difference in gender, age, disease duration, and affected side, type, and stage of the ANFH between 2 groups ( P>0.05). The operation time of each hip and hospitalization stays of each patient in 2 groups were recorded and compared. Imaging examination was performed to observe the blood supply around femoral head, healing of the osteotomy, and the femoral head collapsed. The function of the hip was evaluated by Harris score. Results: There was no significant difference in operation time and hospitalization stays ( t=-0.262, P=0.797; t=-0.918, P=0.411). All patients were followed up, the follow-up time of group A was 12-28 months (mean, 19.7 months), and the follow-up time of group B was 14-24 months (mean, 17.8 months). The Harris score in groups A and B increased significantly at 6 months and 12 months after operation when compared with preoperative ones ( P0.05). At 12 months after operation, according to the Harris scoring, there were 3 hips of excellent, 7 hips of good, and 4 hips of poor, with the excellent and good rate of 71.4% in group A; there were 5 hips of excellent, 7 hips of good, and 1 hip of poor, with the excellent and good rate of 92.3% in group B. Digital substraction angiography was performed at 1 week after operation and indicated that the blood supply around the femoral head was not destroyed during the operation. Imaging examination after operation showed that the osteotomy of the greater trochanter all healed in 2 groups and the osteotomy of the femoral neck healed in group B. Hip collapse occurred in 2 patients (2 hips) of group A at 12 months after operation. No hip collapse occurred in group B. Conclusion: The rotational osteotomy on the base of femoral neck via surgical hip dislocation approach is superior to sequestrum clearance and impacting bone graft in delaying the collapse and improving the hip function for patients with ANFH at ARCO stage Ⅲ.
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Background: Magnetic Resonance Imaging (MRI) is a well-established imaging technique, which are available at most larger hospitals today. Due to the combination of this high contrast and the fact that it is a non-ionizing radiation, MRI is often used for investigation of a large range of pathologies in almost all parts of the body. This study was performed to describe the MRI features in various types of lesions causing painful hip joint, as well as identify the common lesions seen in painful hip joint and to analyse the severity and extent of the underlying lesion in various conditions of hip joint pain, and early detection of pathological changes helpful to prognosticate and influence therapeutic decisions.Methods: This descriptive study was done on 50 patients with complaints of hip joint pain were included into the study. Appropriate MRI sequences and multi-planar imaging performed for every patient.Results: Out of the 50 patients included in the study, 74% of them were males who were predominantly affected with hip pain. The most common age group which was affected was 51-60 years (20%) and 21-30 years (20%). The most common pathology amongst the patients was Avascular necrosis of femoral head seen in 44% of the patients, osteoarthritis was seen in 54 patients, Tuberculosis in 5 patients, 2 had Perthe’s disease, joint effusion was observed in 6 patients.Conclusions: MRI of the hip joint is an informative, diagnostic, non-invasive, rapid and accurate imaging modality for the assessment of hip pain and sufficient imaging modality for delineation of different hip joint pathology.
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Objective: To investigate the possibility of mitochondria-dependent apoptosis as a mechanism of early steroid-induced avascular necrosis of femoral head (SANFH) in rats and vitamin E as a possible prevention strategy. Methods: Seventy-two male Sprague Dawley rats were randomly divided into control group, model group, and intervention group, with 24 rats in each group. The rats in control group were not treated as normal control. The rats in model group and intervention group were established early SANFH models by lipopolysaccharide combined with methylprednisolone injection. At the same time, the rats in intervention group were injected with vitamin E (40 mg/kg) every day for 7 days. At 2, 4, and 8 weeks after the final injection, the bilateral femoral heads were harvested and observed by HE staining, TUNEL assay, immunohistochemical staining, and Western blot. The rate of empty lacunae, apoptotic index, and the expressions of Caspase-9, Caspase-3, and cytochrome-c (Cyt-c) proteins were calculated. Results: According to histological staining, there were significant differences in the rate of empty lacunae between intervention group and control group at 8 weeks ( P<0.05) and between intervention group and model group at 4 and 8 weeks ( P<0.05). The apoptotic index of intervention group was significantly lower than that of model group at each time point ( P<0.05). And there was significant difference between the intervention group and the control group at 8 weeks ( P<0.05). According to immunohistochemistry staining and Western blot, the expressions of Cyt-c, Caspase-9, and Caspase-3 all significantly decreased in intervention group than those in model group at each time point ( P<0.05); and the differences were significant between intervention group and control group at 8 weeks ( P<0.05). Conclusion: Vitamin E can delay the progression of early SANFH by reducing mitochondrial dependent osteocyte apoptosis.
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In recent years, due to the irregular and abused use of glucocorticoid in clinical treatment, the incidence of steroid induced avascular necrosis of femoral head (SANFH) is gradually increasing. TCM for the prevention and treatment of SANFH has received much attention from many scholars. However, due to the lack of the scientific explanation of molecular biology level for its pharmacodynamics mechanism, it is difficult to achieve the purpose of standardized treatment. The discovery of OPG/RANK/RANKL signaling pathway has opened up new shortcuts for the prevention and treatment of bone metabolic diseases. OPG/RANK/RANKL signaling pathway is associated with the pathogenesis of spleen deficiency and phlegm - blood stasis caused by phlegm-blood stasis due to paralysis of SANFH. The treatment efficacy based on the phlegm theory can eventually axial control of the system through the micro-information to express. This article discussed the relevance between the phlegm in the treatment of SANFH and molecular biology mechanism of OPG/RANK/RANKL signal regulation mechanism, and combined the system of bone metabolism regulation mechanism to discuss TCM differentiation of SANFH, with a purpose to provide references for clinical and further study.
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<p><b>OBJECTIVE</b>To compare the efficacy difference between acupotomy and acupuncture in the treatment of avascular necrosis of femoral head at the early and middle stages.</p><p><b>METHODS</b>The randomized controlled prospective study method was adopted. Sixty cases of avascular necrosis of femoral head at Ficat-ArletⅠto Ⅱ stages were randomized into an acupotomy group (32 cases) and an acupuncture group (28 cases) by the third part. In the acupotomy group, the acupotomy was adopted for the loose solution at the treatment sites of hip joint, once every two weeks, totally for 3 times. In the acupuncture group,points around the hip joint were selected and stimulated with warm acupuncture therapy, once every day, for 6 weeks. Harris hip score was observed before and after treatment. The efficacy was evaluated in the two groups.</p><p><b>RESULTS</b>Harris hip score was improved significantly after treatment in the two groups (both<0.05). The result in acupotomy group was better than that in the acupuncture group (<0.05). The effective rate was 90.6% (29/32) in the acupotomy group, better than 75.0% (21/28) in the acupuncture group after treatment (<0.05).</p><p><b>CONCLUSIONS</b>Harris hip score and the effective rate in the acupotomy group are better than those in the treatment with routine acupuncture for avascular necrosis of femoral head at the early and middle stages.</p>
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Objective To analyze the occupational characteristics in patients with avascular necrosis of femoral head and related factors.Methods A random sample of 1062 patients with avascular necrosis of femoral head of inpatient medical record data from 2007 to 2008 was selected, all patients were confirmed by X-ray, CT, MRI or radionuclide bone scan.Patients were assigned to three groups of agriculture (320 cases), non-agricultural (424 cases), the other(318 cases) groups by different occupation.The patient's age, gender, ethnicity, single or bilateral, etiology, staging, time of onset and region were compared in each group.Results The proportions of gender (male/female) were 21.94％ (233/1062) and 8.19％ (87/1062) in agriculture group,32.77％ (348/1062) and 7.16％ (76/1062) , 21.66％ (230/1062) and 8.29％ (88/1062) in non-agricultural and the other groups respectively.The proportions of region (Northeast, North, East, South, Southwest, Northwest of China) were 3.30％ (35/1062), 8.00％ (85/1062), 8.10％ (86/1062), 4.80％ (51/1062), 3.11％(33/1062) ,2.82％ (30/1062) in agriculture group, 8.29％ (88/1062), 10.08％ (107/1062), 7.72％ (82/1062), 7.25％ (77/1062), 2.26％ (24/1062), 4.33％ (46/1062), and 4.05％ (43/1062), 8.38％ (89/1062) ,8.10％(86/1062) ,4.61％(49/1062) ,2.17％(23/1062) ,2.64％(28/1062) in the group of non-agricultural and the other.The proportions of etiology (alcohol, hormones, trauma, two or more, the other) were 5.46％ (58/1062), 6.97％ (74/1062), 4.43％ (47/1062), 0.94％ (10/1062), 12.34％ (131/1062) in agriculture group, 10.55％ (112/1062), 7.72％ (82/1062), 5.74％ (61/1062), 2.26％ (24/1062), 13.65％ (145/1062), and 4.90％ (52/1062), 5.93％ (63/1062), 4.90％ (52/1062), 0.66％ (7/1062), 13.56％ (144/1062) in the group of non-agricultural and the other.The proportions of gender, region, etiology in each group were analyzed by x2 test, the differences were statistically significant (x2 =12.77, 24.55, 26.36, P ＜0.05).The onset time and ARCO staging in each group, the correlations were analyzed by Spearman test, the differences were statistically significant(rs =0.282,0.232,0.208, P＜0.05).The onset of time and average age in different occupational group with different, due to factors such as gender, ethnicity, single or bilateral, region, and so on.Conclusion Patients with avascular necrosis of femoral head in different occupational group have different epidemiological characteristics.The occupational characteristics analysis can provide scientific data for diagnosis,treatment and prevention in patients with avascular necrosis of femoral head.
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CONCLUSIONS: In hypoxia environment, the proliferation and migration of ECs is enhanced, and the secretion of VEGF and MIF is increased. High concentration of dexamethasone will suppress the process above, which induces vascular repair disorders and aggravating SANFH.
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PURPOSE: To evaluate clinical results of extracorporeal shock wave therapy (ESWT) with radiographic staging on patients with avascular necrosis of femoral head (AVNFH). MATERIALS AND METHODS: We evaluated 24 patients diagnosed with AVNFH (32 hip joints) who were treated with ESWT from 1993 to 2012. Average follow-up period was 27 months, and the average age of patients was 47.8 years. The Association Research Circulation Osseous (ARCO) system was used to grade radiographic stage prior to treatment. For this study patients were divided into two groups based on their ARCO stage, group 1 (ARCO stages I and II) and group 2 (ARCO stage III). Comparative analyses were done between the two groups using the visual analogue scale (VAS) score and the Harris hip score (HHS) at pre-treatment and 3, 6, 12, and 24 months after treatment. Failure was defined when radiographic stage progressed or arthroplasty surgery was needed due to clinical exacerbation. RESULTS: Both groups showed clinical improvements with VAS scoring at final follow-up (group 1: median 7 to 1.5, P<0.001; group 2: mean 7 to 4, P=0.056). Using HHS, group 1 showed a significant improvement (from 65.5 to 95 [P<0.001]), while no significance was observed for group 2 (P=0.280). At final follow-up, 3 hips from group 1 and one hip from group 2 showed radiographic improvement; however, two patients underwent total hip arthroplasty due to persistent pain and dysfunction. CONCLUSION: ESWT can be considered as an interventional option before surgical treatment in patients with not only early stage AVNFH but also with mid stage.
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Humans , Arthroplasty , Arthroplasty, Replacement, Hip , Follow-Up Studies , Head , Hip , Necrosis , Osteonecrosis , ShockABSTRACT
Objective To observe the clinical effect of Xisui Huangu Formula combined with technetium [99Tc] methylenediphosphonate injection in the treatment of avascular necrosis of femoral head (ANFH). Methods A total of 73 patients were randomly divided into treatment group (37 cases) and control group (36 cases). The control group was given conventional western medicine treatment, while the treatment group was given Xisui Huangu Formula on the basis of conventional western medicine treatment. Clinical symptoms and joint function of the two groups were observed before and after treatment, and the clinical effects were compared. Results In the treatment group, 17 cases were cured, 17 cases improved, 3 cases were unrecovered, and the effective rate was 91.89%. In the control group, 4 cases were cured, 25 cases improved, 7 cases were unrecovered, and the effective rate was 80.56%. The difference was statistically significant between the two groups (P<0.05). Improvement of joint pain, lameness, dysfunction, and joint function in the treatment group were better than those in the control group (P<0.05). Conclusion Xisui Huangu Formula can significantly improve clinical symptoms of ANFH. Integrated traditional Chinese and Western medicine therapy is helpful to alleviate ANFH disease progression.
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Objective:To investigate the diagnosis value of the X-ray and CT imaging, in the ischemic necrosis of femoral head.Methods: Seventy cases of patients with ischemic necrosis of femoral head were given X ray examination and CT examination, comparing two test results of two methods of inspection.Results: The result of statistical analysis, the rate of X-ray examination was 55.7%, the rate of CT examination was 81.4%. By chisquare test, CT examination compared with X-ray had significant difference (x2=1.389,P<0.05).Conclusion: Compared with X-rays, the sensitivity of CT examination in early diagnosis of avascular necrosis is high; CT examination is an effective method in early diagnosis of ischemic necrosis of femoral head.
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Objective To evaluate the feasibility,technique and preliminary clinical results of the intraoperative three-dimensional (3-D) computer navigation system assisted free vascularized fibular grafting for the treatment of osteonecrosis of the femoral head.Methods From October 2010 to April 2013,14 patients (18 hips) with osteonecrosis of the femoral head were treated by free vascularized fibular graft transfer,assisted by intraoperative3-D computer navigation system.Of 18 hips,8 were classified as stage Ⅱ ;6 as stage Ⅲ,4 as stage Ⅳ according to Steinberg system.The entire procedures were visualized and guided by the 3-D navigation system,including location of optimal entry point,exploration of the field,excision of the necrotic bone tissues,and the fibular grafting transfer with vessel anastomosis.The follow-up records included the results of X-ray,the Harris score of the hip,and the complications.Results Operations of all 14 patients (18 hips) were smooth and successful with patent vessel and umcompromised grafts evidenced by ECT scan at day 7 postoperatively.Postoperative X-ray confirmed the complete eradication of necrotic focuses with surrounding calcified bone and the accurate positioning of fibular grafts.The mean follow-up period was 23.6 months (8-29 months).Harris scores significantly improved from 57.5 ± 14.5 before operations to 87.5 ±2.5 after,with 6 hips' scores classified as Excellent,and 11 as Good.X-ray obtained more than 1 year after operation suggested improvement was achieved in 15 hips.Conclusion Intraoperative 3-D computer navigation system has multiple merits in assisting free vascularized fibular grafting for the treatment of osteonecrosis of the femoral head,including clear anatomic structure,better accuracy,less damage,and reliable functional recovery,which imply it is a highly applicable approach.
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Objective To explore the relationship between disorders of lipid metabolism and avascular necrosis of femoral head after operation of femoral neck fracture .Methods 160 patients with a diagnosis of fresh femoral neck fractures treated with AO cannulated compressed screws in orthopedic department of our hospital from January 2007 to January 2012 were involved .All the patients were divided into two groups :ANFH or non ANFH group according to the features of femoral head .The levels of blood lipid were examined .Then ,Logistic regression was used to screening risk factors and evaluate the influence of blood lipid factors ac-cording to βrisk factor .Results The levels of TC ,TG ,LDL and Apo B in ANFH group were (5 .99 ± 1 .05)mmol/L ,(2 .63 ± 0 .85)mmol/L ,(4 .16 ± 1 .21)mmol/L ,(0 .99 ± 0 .28)g/L respectively ,which increased remarkably compared with the control group ;while HDL ,Apo A1 levels in the ANFH group were (0 .88 ± 0 .19)mmol/L ,(1 .20 ± 0 .17)g/L ,which was remarkably lower compared with the control group ,and there were statistically significant difference (P=0 .000) .Serum TC and LDL levels were risk factors impacted on postoperative ANFH .Conclusion Postoperative ANFH was related to disorders of lipid metabolism .Serum TC and LDL levels could be diagnostic values on postoperative ANFH .Early control of blood lipid levels may prevent the development of ANFH in patients treated with AO cannulated compressed screws .
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Objective To explore the effect of avascular necrosis cystic degeneration on distribution of bone density. Methods Based on the bone reconstruction model of Weinans and Huiskes, bone density distribution in normal femoral head and in femoral head with avascular necrosis cystic degeneration were calculated by finite element analysis. Results (1) The medial system of lamellae, lateral system of lamellae, intertrochanteric arch and Ward's triangle were generated on the normal proximal femur under simulation. (2) If a primary cystic degeneration occurred, a secondary cystic area would appear below the primary one and its bone density would decrease dramatically with the primary cystic area increased. Cystic degeneration would also change the femoral bearing truss system. Conclusions (1) Wolff’s law on bone remodeling is consistent with modern topology optimization theory. (2) If cystic degeneration appeared due to avascular necrosis of the femoral head, it should be treated timely to prevent the secondary cystic degeneration and collapse of the femoral head.