Clinical outcome of surgical hip dislocation combined with impacting bone graft and nonvascularized iliac flap implanting in the treatment of ARCO Ⅲ osteonecrosis of the femoral head

doi:10.3877/cma.j.issn.1673-9450.2020.02.003

Abstract

Abstract:

Objective

To investigate the mid-term effect of the treatment of the Association Research Circulation Osseous (ARCO) Ⅲ osteonecrosis of the femoral head (ONFH) by impacting bone graft and nonvascularized iliac flap via hip surgical dislocation approach.

Methods

A total of 30 cases(32 hips) from October, 2014 to December, 2016 were treated with impacting bone graft and nonvascularized iliac flap via surgical hip dislocation approach in First Affiliated Hospital of Guangzhou University of Chinese Medicine.Among them, there were 17 cases of ARCO ⅢA stage, 7 cases of ARCO ⅢB stage, 8 cases of ARCOⅢC stage, 23 cases of males and 7 cases of females, the average age of the patients was (27.6±3.4). All the patients were treated by surgical dislocation approach to remove the necrosis of the femoral head, pressure bone grafting and autogenous iliac bone flap implantation. All patients were assessed by Harris score for preoperative and postoperative hip function. The excellent rate of femoral head was used as the evaluation index. Data were processed with t test and chi-square test.

Results

All the patients had good postoperative healing, with good trochanteric healing, and no vascular and nerve injury, infection, bone nonunion and other complications occurred. The mean follow-up time was (41.0±5.7) months. The Harris score at the last follow-up were assessed the efficacy, among which 17 hips were excellent, 14 hips were good, and 1 hip was poor. The Harris score at the last follow-up was (82.1±4.6)points, which was better than that before surgery[(53.5±8.3) points], the difference was statistically significant (t=17.409, P<0.05). One patient underwent total hip replacement 19 months after surgery. At the last follow-up, the excellent rate was 96.88%, compared with preoperative (15.60%), the difference was statistically significant (χ²=45.406, P<0.05).

Conclusions

The clinical symptoms and joint function can be significantly improved in mid-term follow-up of ARCO Ⅲ ONFH patients with the treatment for the surgical hip dislocation combined with impacting bone graft and nonvascularized iliac flap implanting, and the long-term effect needs to be further observed.

Key words: Hip joint, Femur head necrosis, Metaphase, Surgical hip dislocation, Clinical efficacy

Qiushi Wei, Fengxiang Pang, Xiaojun Chen, Peng Yang, Mincong He, Bin Fang, Qingwen Zhang, Yuesheng Zheng, Yongwei Dong, Wei He, Zhenqiu Chen, Wei He. Clinical outcome of surgical hip dislocation combined with impacting bone graft and nonvascularized iliac flap implanting in the treatment of ARCO Ⅲ osteonecrosis of the femoral head[J]. Chinese Journal of Injury Repair and Wound Healing(Electronic Edition), 2020, 15(02): 90-95.

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URL: https://zhssyxfzz.cma-cmc.com.cn/EN/10.3877/cma.j.issn.1673-9450.2020.02.003

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References 23

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时间	Harris评分(分，±s)				髋关节股骨头功能
时间	ARCO ⅢA期	ARCO ⅢB期	ARCO ⅢC期	合计	优(髋数)	良(髋数)	差(髋数)	优良率(%)
术前	59.3±6.7	54.2±5.6	48.2±5.1	53.5±8.3	0	5	27	15.60
末次随访	88.7±3.9	84.5±3.7	79.3±4.1	82.1±4.6	17	14	1	96.88
t/χ²值	15.636	12.769	12.574	17.049	?	?	?	45.406
P值	0.003	<0.05	0.014	<0.05	?	?	?	<0.05

时间	Harris评分(分，±s)				髋关节股骨头功能
时间	ARCO ⅢA期	ARCO ⅢB期	ARCO ⅢC期	合计	优(髋数)	良(髋数)	差(髋数)	优良率(%)
术前	59.3±6.7	54.2±5.6	48.2±5.1	53.5±8.3	0	5	27	15.60
末次随访	88.7±3.9	84.5±3.7	79.3±4.1	82.1±4.6	17	14	1	96.88
t/χ²值	15.636	12.769	12.574	17.049	?	?	?	45.406
P值	0.003	<0.05	0.014	<0.05	?	?	?	<0.05

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