Abstract:

BACKGROUND: Some studies have found a certain relationship between the distribution of traditional Chinese medicine syndrome types and the morphological differences in femoral head necrosis.

OBJECTIVE: To observe the morphological differences of hip joints of different types of traditional Chinese medicine syndromes with femoral head necrosis through 3D graphics, and to evaluate the efficacy of standardized and comprehensive non-surgical hip preservation for femoral head necrosis.

METHODS: From December 2016 to February 2017, 73 femoral head necrosis patients (108 hips) treated with non-surgical hip preservation in the First Affiliated Hospital of Guangzhou University of Chinese Medicine were enrolled in this study. According to the syndrome type of traditional Chinese medicine, the patients were divided into the kidney deficiency and blood stasis group (47 hips), the accretion group (30 hips) and the Qi stagnation and blood stasis group (31 hips). X-ray films and CT spiral scans of both hips were taken to measure the central hip angle, Sharp angle, upper and lower acetabular diameter, anteroposterior diameter, and acetabularity depth, acetabular abduction angle, and acetabular anteversion angle. Totally 88 cases (131 hips) of femoral head necrosis treated with standardized comprehensive hip preservation from December 2016 to February 2017 in the First Affiliated Hospital of Guangzhou University of Chinese Medicine underwent traditional Chinese medicine, physical therapy, and functional exercise. The clinical function of hips was diagnosed by visual analogue scale and Harris scores, and the necrosis in the treatment area was evaluated by X-ray films. This study was approved by the Ethics Committee of the First Affiliated Hospital of Guangzhou University of Chinese Medicine, approval No. Y[2019]118.

RESULTS AND CONCLUSION: (1) X-ray films showed significant differences in Sharp angle and central edge angle among the three groups (P < 0.01). Among them, the sharp angle was largest; the central edge angle was smallest in the kidney deficiency and blood stasis group. The Sharp angle was smallest and the central edge angle was largest in the Qi stagnation and blood stasis group. (2) CT spiral scan showed that there was a difference in abduction angle between the three groups (P < 0.001), of which the kidney deficiency and blood stasis group was largest. Acetabularity depth was smaller in the kidney deficiency and blood stasis group than in the Qi stagnation and blood stasis group (P < 0.05). There was no significant difference in the upper and lower acetabular diameters, anteroposterior diameters, and acetabular anteversion angles of the three groups. (3) After 2 years of comprehensive hip-sparing treatment, 88 patients had significantly improved pain and hip function. Imaging results showed an improvement of 89 hips and 21 unchanged hips, with an improvement rate of 67.9%. (4) The results showed that there was a difference in hip joint morphology between different syndrome types. The development of the acetabulum of kidney deficiency and blood stasis type was poorer than that of Qi stagnation and blood stasis type and accretion type. Standardized and comprehensive non-surgical hip-sparing treatment of femoral head necrosis in the early and middle stages can significantly improve the symptoms of patients in the short term.

Key words: femoral head necrosis, visualization, morphology, syndrome types, conservative treatment, traditional Chinese medicine, differences, feasibility