Treatment of avascular necrosis of the hip by a non-vascularised cortical graft
Treatment of avascular necrosis of the hip by a non-vascularised cortical graft
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DOI：
10.1302/0301-620x.88b4.16950
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发表时间：
2006-04-01
影响因子：
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通讯作者：
Nelissen, RGHH
中科院分区：
文献类型：
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作者：
Keizer, SB;Kock, NB;Nelissen, RGHH
这项回顾性研究描述了核心减压和放置无血管骨移植物在股骨头缺血性坏死治疗中的长期结果。我们治疗了 65 名患者的 80 个髋关节，其中 18 名患者采用自体胫骨皮质移植物，62 名患者采用同种异体腓骨移植物。患者的平均年龄为 36 岁 (SD 13.2)。共有 78 个髋关节可供评估，其中术前 6 个髋关节为 Ficat-Arlet 0 期、3 个 I 期、31 个 IIA 期、16 个 IIB 期、13 个 III 期和 9 个 IV 期。总共 34 个髋关节（44%）在平均四年内进行了翻修（SD 3.8）。使用临床终点的生存分析显示手术后五年的生存率为 59%。当使用临床和放射学终点时，我们发现两种移植物之间的存活率存在显着差异（p = 0.002），有利于自体胫骨移植物。我们认为这种差异是由于与腓骨同种异体移植物使用的转子区域相比，胫骨质量更好且体积更大。这是一种相对简单、关节外且可重复的手术。我们认为，核心减压、去除坏死组织以及将松质移植物填充到核心轨道中是手术的重要部分。
This retrospective study describes the long-term results of core decompression and placement of a non-vascularised bone graft in the management of avascular necrosis of the femoral head. We treated 80 hips in 65 patients, 18 by a cortical tibial autograft and 62 by a fibular allograft. The mean age of the patients was 36 years (SD 13.2). A total of 78 hips were available for evaluation of which pre-operatively six were Ficat-Arlet stage 0, three stage I, 31 stage IIA, 16 stage IIB, 13 stage III and nine stage IV.A total of 34 hips (44%) were revised at a mean of four years (SD 3.8). Survivorship analysis using a clinical end-point showed a survival rate of 59% five years after surgery. We found a significant difference (p = 0.002) in survivorship, when using a clinical and radiological end-point, between the two grafts, in favour of the tibial autograft. We considered this difference to be the result of the better quality and increased volume of tibial bone compared with that from the trochanteric region used with the fibular allograft.This is a relatively simple, extra-articular and reproducible procedure. In our view core decompression, removal of the necrotic tissue and packing of the cancellous grafts into the core track are vital parts of the procedure.