Treatment of nontraumatic osteonecrosis of the femoral head using bone impaction grafting through a femoral neck window
Treatment of nontraumatic osteonecrosis of the femoral head using bone impaction grafting through a femoral neck window
复制标题
DOI：
10.1007/s00264-009-0822-1
复制
发表时间：
2010-06-01
影响因子：
2.7
通讯作者：
Li, Zi-Rong
中科院分区：
文献类型：
--
作者：
Wang, Bai-Liang;Sun, Wei;Li, Zi-Rong
非创伤性股骨头坏死（非 ONFH）是一种可能导致股骨头塌陷并需要进行全髋关节置换术的疾病。各种头部保留手术已被用于治疗这种疾病，以避免进行全髋关节置换术。这些包括各种血管化和非血管化骨移植手术。我们检查了通过股骨头颈交界处的窗口（称为“灯泡”方法）进行骨移植，结合脱矿骨基质（DBM）和自体髂骨治疗股骨头坏死的效果。该研究纳入了 110 名患者（138 髋；41 名女性，69 名男性；平均年龄 32.36 岁，范围 17-54 岁），根据 ARCO（骨循环研究协会）系统，患有 IIA-IIIA 期非创伤性股骨头缺血性坏死。骨移植手术被称为“灯泡”手术，其中病变骨被骨移植替代物（DBM 和自体髂骨的组合）取代。结果由 Harris 髋关节评分的变化、放射线照相阶段的进展以及髋关节置换的需要决定。平均随访时间为 25.37 个月（范围 7-42 个月）。所有数据均通过统计分析进行处理，包括 Cox 风险模型分析和 Kaplan-Meier 生存分析。术前和术后评估显示，Harris 髋关节平均评分从 62 分上升至 79 分。临床上，138 个髋关节中有 94 个（68%）在最近一次随访中获得成功，IIA 期患者的放射学改善为 100%，IIB 期患者为 76.67%，IIC 和 IIIA 期患者为 50.96%。根据Harris评分，IIA期100%、IIB期93.33%、IIIA、IIC期59.62%获得优良结果，IIA、IIB期生存率为85%，IIIA、IIC期生存率为60%。 Cox风险模型分析显示，临床成功率与术前分期和股骨头坏死面积均相关。并发症包括异位骨化、股外侧皮神经病变和关节感染。该手术可有效避免或预防早期至中期股骨头坏死的年轻患者需要进行全髋关节置换术。因此，特别是对于中小面积（< 30%，或塌陷深度< 2 mm）的塌陷前期非外伤性股骨头坏死，可作为首选治疗方法。
Nontraumatic osteonecrosis of the femoral head (non-ONFH) is a disorder that can lead to femoral head collapse and the need for total hip replacement. Various head-preserving procedures have been used for this disease to avert the need for total hip replacement. These include various vascularised and nonvascularised bone grafting procedures. We examined the effect of bone-grafting through a window at the femoral head-neck junction known as the "light bulb" approach for the treatment of osteonecrosis of the femoral head with a combination of demineralised bone matrix (DBM) and auto-iliac bone. The study included 110 patients (138 hips; 41 females, 69 males; mean age 32.36 years, range 17-54 years) with stage IIA-IIIA nontraumatic avascular necrosis of the femoral head according to the system of the ARCO (Association Research Circulation Osseous). The bone grafting procedure is called "light bulb" procedure in which the diseased bone was replaced by a bone graft substitute (combination of DBM and auto-iliac bone).The outcome was determined by the changes in the Harris hip score, by progression in radiographic stages, and by the need for hip replacement. The mean follow-up was 25.37 months (range 7-42 months). All data were processed by a statistics analysis including Cox risk model analysis and Kaplan-Meier survival analysis. Pre- and postoperative evaluations showed that the mean Harris hip score increased from 62 to 79. Clinically, 94 of 138 hips (68%) were successful at the latest follow-up, and radiological improvement was noted in 100% of patients in stage IIA, 76.67% of patients in stage IIB and 50.96% of patients in stage IIC and IIIA cases. Excellent and good results according to the Harris score were obtained in 100% of cases in stage IIA, 93.33% in stage IIB and 59.62% in stages IIIA and IIC stage, with a survivorship of 85% in stages IIA and IIB and 60% in stage IIIA and IIC cases. Cox risk model analysis showed that the clinical success rate correlated with both pre-operation stage and the necrotic area of the femoral head. The complications included ectopic ossification, lateral femoral cutaneous nerve lesion and joint infection. This procedure may be effective at avoiding or forestalling the need for total hip replacement in young patients with early to intermediate stages of osteonecrosis of the femoral head. Therefore, it may be the treatment of choice particularly in nontraumatic osteonecrosis of the femoral head of pre-collapse stage with small and middle area (< 30%, or the depth of collapse < 2 mm).