The “First National Academic Seminar for Femoral Head Necrosis and Joint Retention and Reconstruction” was held ceremoniously at Beijing News Plaza Hotel on 14-16 April 2006. The organizer is the Joint Surgery Group of Orthopaedics Sub-Association of Chinese Medical Association. The undertakers are the Editorial Board of Chinese Journal of Orthopaedics, and the Osteonecrosis and Joint Retention and Reconstruction Center of China-Japan Friendship Hospital. The seminar specially invited topnotch experts in this field from USA, France, South Korea, Singapore, Chinese Taiwan and Chinese Mainland. The attending scholars agreed unanimously that maximally retaining femoral head and postponing its replacement through various kinds of treatment methods can significantly improve patient’s life quality. Experts Xiao Zhengquan, Gao Qinan, Fu Wanlin and Zhang Zhizhong from Beiya Hospital attended this seminar and exchanged their results of basic and clinical research on femoral head necrosis.
I. Can femoral head necrosis be cured thoroughly
The thorough cure of femoral head necrosis refers to the restoration of bone tissue structure and external shape of femoral head. At present, no treatment method that can thoroughly cure femoral head necrosis is available. In other words, femoral head necrosis can’t be thoroughly cured. For adults with femoral head necrosis, no treatment can restore the original bone tissue structure of the femoral head or its original shape. However, they can be restored for adults who are in the stage of femoral head ischemia and before the stage of necrosis of bone cells (the period when no dead bone cell is discovered during MRI examination, i.e. Period 0 under the International Staging System) and can be completely restored for children before bone and epiphysis are destroyed.
II. Standard for clinical cure of femoral head necrosis
For patients with femoral head necrosis, the standard for clinical cure is: pain disappears at rest, pain disappears or incompletely disappears during walk, there is no pain when carrying load or minor load, the function of hip joint resumes to normal or turns for the better, and X-ray photo indicates necrotic bone disappears, bone trabecula is formed, bone density is even, bone tissue of femoral head is partially restored, bone metabolism is stable and the shape of femoral head no longer continues to cave in or be destroyed.
III. Standard for clinical cure of early-stage femoral head necrosis
For patients with early-stage femoral head necrosis, the standard for clinical cure is: pain disappears at rest, there is no pain during a long and nonstop walk, there is no pain when carrying load, the function of hip joint resumes to normal, and X-ray photo indicates necrotic bone disappears, bone trabecula is formed, and bone density is even.
IV. Standard for clinical cure of mid-stage femoral head necrosis
For patients with mid-stage femoral head necrosis, the standard for clinical cure is: pain disappears at rest, there is no pain during 5-10 walks (each time 500m or 1000m), there is no pain when carrying minor load, the function of hip joint obviously turns for the better, and X-ray photo indicates necrotic bone disappears, bone trabecula is formed, and bone density is even.
V. Standard for clinical cure of late-stage femoral head necrosis
For patients with late-stage femoral head necrosis, the standard for clinical cure is: pain disappears at rest, there is no pain during 5-6 walks (each time 200m or 1000m), there is no pain when carrying minor load, the function of hip joint turns for the better, and X-ray photo indicates necrotic bone disappears, bone trabecula is formed, and bone density is even.
VI. EBM – an advanced medical concept in the world
EBM (Evidence Based Medicine) is a kind of clinical medicine based on scientific evidence. It advocates integrating clinical doctor’s personal clinical practice and experience with objective evidence from scientific research and providing the most correct diagnosis, the safest and most effective treatment and the most accurate prognosis for every individual patient.
EBM is different from traditional medicine. Traditional medicine focuses on experience, i.e. diagnoses and treats diseases based on non-experimental clinical experience, clinical data and understanding on disease’s fundamental knowledge. EBM has no intention to replace clinical skills, clinical experience, clinical data and medical knowledge. Only it wants to stress that any medical decision shall be established on the basis of the best evidence from scientific research.
VII. Concept for integration of traditional medicine and EBM
Traditional medicine focuses on experience. The key reason for the lasting flourish of traditional medicine is its stress on clinical experience. Experience is a forward-looking judgment which firstly passes a judgment on a thing and then verifies the judgment with the result. EBM is a kind of clinical medicine based on scientific evidence and giving priority to evidence. The further research on evidence of medical science covers unlimited unknown fields. The research subjects of medical research are unknown individuals. Each unknown individual is not totally comparative. Beiya Hospital integrates the forward-looking diagnosis of traditional experience-based medicine with the evidence verification of EBM, use all-round known scientific data to verify the correctness of the diagnosis made according to traditional experience-based medicine, and then use the scientific data of EBM to verify curative effect. In this way, we have obtained a scientific diagnosis and treatment solution with an eye to the quickest effect, the shortest treatment time and the least destruction on organism.
VIII. Use EBM to verify curative effect
Evidence – that can tell all truth from the false.
At Beiya Hospital, we all use EBM to verify the diagnostic and curative effect of femoral head necrosis and other difficult and complicated diseases. Before treatment, patients must undergo overall examination. Only by these complete examination data, can we later verify the effect of various treatment methods. Taking example for patients with femoral head necrosis, frontal and top view photos of the femoral head must be taken and the bone density of femoral head must be scanned before treatment. Through comparing the images and digitally evaluated bone density, and referring clinical symptoms and changes of hip joint function, we can clearly verify whether the treatment on femoral head necrosis is effective.
IX. Patient’s superlative right – right to know the truth and make choice
With regard to femoral head necrosis, firstly the patients shall be told that Beiya Hospital currently adopts “3 Tonifies and 1 Promote” 8-combination conservative treatment method which integrates TCM and Western Medicine, this method is non-destructive, the period of treatment is 3 months, as well as how long hospitalization the effect can be seen, how long clinical treatment the effect can be seen, how long it takes from treatment to clinical cure, and what the standards for clinical cure of different stages are. Secondly, the patients shall be told that what other treatment methods can be taken according to patient’s condition. We should let patients know of the hospital’s information they want to know, give advice to them and let them choose between conservative treatment and operation treatment.
Great physicians come from public praise. Let’s build good faith with evidence, and morality with honesty.
　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　-----Xiao Zhengquan