Mont Michael A, Etienne Gracia, Ragland Phillip S
Rubin Institute for Advanced Orthopaedics, Center for Joint Preservation and Reconstruction, Sinai Hospital of Baltimore, 2401 West Belvedere Avenue, Baltimore, MD 21215, USA.
Clin Orthop Relat Res. 2003 Dec(417):84-92. doi: 10.1097/01.blo.0000096826.67494.38.
Osteonecrosis is a disease with a wide-ranging etiology and poorly understood pathogenesis seen commonly in young patients. Various head-preserving procedures have been used for this disease to avert the need for total hip replacement. These include various vascularized and nonvascularized bone grafting procedures. We will describe the use of bone-grafting through a window at the femoral head-neck junction for the treatment of osteonecrosis of the femoral head. Bone morphogenetic protein (BMP)-enriched allograft was used to avoid donor site morbidity. Nineteen patients (21 hips) were followed up for a mean of 48 months (range, 36-55 months) after a bone grafting procedure in which the diseased bone was replaced by a bone graft substitute (combination of demineralized bone matrix, processed allograft bone chips, and a thermoplastic carrier). Eighteen of 21 hips (86%) were clinically successful at latest followup. Two of these patients have minimal radiographic progression (< 2 mm head collapse). This procedure is straightforward technically, led to low morbidity, and did not necessitate procurement of donor site bone graft. This procedure may be effective at avoiding or forestalling the need for total hip arthroplasty in young patients with early to intermediate stages of osteonecrosis of the femoral head.
股骨头坏死是一种病因广泛且发病机制尚不清楚的疾病，常见于年轻患者。针对这种疾病，已采用了各种保头手术以避免全髋关节置换的需要。这些手术包括各种带血管和不带血管的骨移植手术。我们将描述通过股骨头-颈交界处的窗口进行骨移植治疗股骨头坏死的方法。使用富含骨形态发生蛋白（BMP）的同种异体骨以避免供区发病。19例患者（21髋）在进行骨移植手术后平均随访48个月（范围36 - 55个月），在该手术中，病变骨被骨移植替代物（脱矿骨基质、处理过的同种异体骨碎片和热塑性载体的组合）所替代。21髋中的18髋（86%）在最近一次随访时临床效果良好。其中2例患者的影像学进展极小（股骨头塌陷< 2 mm）。该手术技术操作简单，发病率低，且无需获取供区骨移植。该手术可能有效地避免或延缓年轻的早期至中期股骨头坏死患者进行全髋关节置换的需要。
