Abstract:

Objective To compare the short ⁃term effect of advanced core decompression（ACD）plus synthetic bone substitutes（SBS）grafting alone with ACD+SBS combined with extracorporeal shock wave therapy （ESWT）for early ⁃stage osteonecrosis of the femoral head（ONFH）. Methods Patients who met the inclusion criteria from January 2018 to January 2020 were randomly divided into two groups. The research group was the case of ACD+SBS+ESWT，and the control group was the case of ACD+SBS alone. Finally，66 patients entered the result analysis. There were 30 cases（30 hips）in the research group. The preoperative VAS score was（6.7 ± 0.8），the Harris score was（68.3 ± 5.0），and the Kerboul angle was（197.7 ± 61.2）°. There were 36 cases（36 hips）in the control group. The preoperative VAS score was（6.7 ± 0.9），the Harris score was（68.3 ± 5.0），and the Kerboul angle was（201.9 ± 61.4）°. The follow⁃up time was 24 months. The changes in VAS score and Harris score of the affected hip at 3 months，6 months，12 months，and 24 months after operation were recorded. An MRI was performed at the last follow⁃up，and the Kerboul angle was measured to reassess the size of the necrotic area. Results The two groups were followed up for 24 months. There were 4 cases of collapse in the research group and 6 cases in the control group. No patients underwent a total hip replacement. At the end of the 24⁃month follow⁃up study，Significant improvement of VAS and Harris in both groups was seen before surgery. The VAS and Harris scores of the studygroup were better than those of the control group at three months，six months，and 12 months after operation （P < 0.05）. However，there was no difference between the two groups at 24 months of follow⁃up. The Kerboul angle of the research group was（175.0 ± 80.4）°，and that of the control group was（193.1 ± 73.6）°. Both groups were improved compared to preoperative，but there was no difference between the two groups. The Δkerboul angle of the study group was（-22.7 ± 20.3）°，and that of the control group was（-8.9 ± 26.3）°. The improvement of the kerboul angle in the study group was significant（P = 0.042）. Conclusion ACD + SBS + ESWT and ACD + SBS alone had satisfactory effects in treating early ⁃ stage ONFH. The former better relieved pain and improve function than the latter in the early follow⁃up period，and the improvement of kerboul angle was also more obvious.

Key words:

femur head necrosis, core decompression, hip?preserving surgery, ESWT, bone graft substitutes