A retrospective comparison of hyperbaric oxygen and core decompression for mild to moderate avascular necrosis of the femoral head

Sun, Ming1,#; Liang, Hairui2,#; Chen, Yong2; Duan, Siyu1; Xu, Rongda1; Cai, Zhencun1,3,*

Author Information

1Department of Orthopedics Surgery, The Second Affiliated Hospital of Shenyang Medical College, Shenyang, Liaoning Province, China

2Department of Orthopedic Surgery, Central Hospital Affiliated to Shenyang Medical College, Shenyang, Liaoning Province, China

3Liaoning Province Key Laboratory for Phenomics of Human Ethnic Specificity and Critical Illness, and Shenyang Key Laboratory for Phenomics, Shenyang, Liaoning Province, China

*Correspondence to: Zhencun Cai, sychczc@163.com.

#Both authors contributed equally to this work.Funding:This study was supported by the Natural Science Foundation of Liaoning Province (No. 2024-MS-222), the Liaoning Provincial Department of Education Fund Project (No. JYTMS20231396) and the Science and Technology Plan Project of Shenyang City (No. 22-321-32-13).

Abstract

Avascular necrosis of the femoral head is a condition resulting from disrupted blood supply, leading to ischemia and bone tissue necrosis. Core decompression (CD) restores the blood supply through pressure relief, whereas hyperbaric oxygen (HBO) enhances tissue oxygenation and promotes bone repair. Their combined use may complement each other in improving blood supply, promoting bone healing, and inhibiting disease progression, thus achieving a better therapeutic effect. To assess and compare the efficacy of HBO and/or CD for treating mild to moderate femoral head avascular necrosis, a retrospective study was conducted on patients diagnosed with Ficat stage II non-traumatic osteonecrosis between January 2017 and January 2022 at the Affiliated Central Hospital of Shenyang Medical University, China. A total of 72 patients were divided into HBO, CD, and combination groups, with 24 patients in each group. After 1 year of follow-up, 90% of patients in the HBO group, 85% in the CD group, and 95% in the combination group showed satisfactory improvements in hip joint function. The SF-36 quality of life questionnaire scale scores also significantly improved in all three groups, with the combination group showing the most significant improvement. These findings suggest that HBO offers promising potential for treating non-traumatic femoral head necrosis, with efficacy similar to that of CD. The combination group showed the most significant improvement in both hip joint function and quality of life.

摘要

股骨头缺血性坏死是由于血供中断导致局部缺血和骨组织坏死的疾病。髓芯减压术（CD）通过减轻压力恢复血供，而高压氧（HBO）则能增强组织氧合作用并促进骨修复。两者联合应用可协同改善血供、促进骨愈合、抑制疾病进展，从而获得更优疗效。为评估比较HBO和/或CD治疗轻中度股骨头缺血性坏死的疗效，本研究对2017年1月至2022年1月期间在中国沈阳医学院附属中心医院诊断为Ficat II期非创伤性骨坏死的患者开展回顾性分析。72例患者被分为HBO组、CD组和联合治疗组，每组24例。经过1年随访，HBO组90%患者、CD组85%患者、联合治疗组95%患者的髋关节功能获得满意改善。三组患者的SF-36生活质量量表评分均有显著提升，其中联合治疗组改善最为显著。研究结果表明，HBO在治疗非创伤性股骨头坏死方面具有良好应用前景，疗效与CD相当，而联合治疗组在髋关节功能和生活质量改善方面效果最为突出。