Zhao Dewei, Zhang Yao, Wang Weiming, Liu Yupeng, Li Zhigang, Wang Benjie, Yu Xiaobing
Department of Orthopaedic Surgery, ZhongShan Hospital of Dalian University, Dalian, Liaoning Province, 116001, China.
Orthopedics. 2013 Jun;36(6):789-95. doi: 10.3928/01477447-20130523-26.
Osteonecrosis of the femoral head is a progressive disease. Without operative intervention, it most often results in collapse and deterioration of the joint. Many joint-preserving surgeries have been implemented, but no uniform treatment exists. The authors report a modified technique of tantalum rod implantation combined with vascularized iliac grafting for the treatment of osteonecrosis of the femoral head. Fifty-two patients (56 hips) with osteonecrosis of the femoral head (Association Research Circulation Osseous classification stage II-IV) treated with this technique were retrospectively reviewed. The major steps of this technique included vascularized iliac graft harvested, necrotic lesion excised, and combined interventions implantation. All patients were followed for a mean of 60 months. Seven hips had to be converted to a total hip arthroplasty. The 5-year joint-preserving success rate of entire group was 87.5%, with 95% for Association Research Circulation Osseous stage II hips, 92% for Association Research Circulation Osseous stage III hips, and 63.6% for Association Research Circulation Osseous stage IV hips. The success rate was lower for stage IV hips compared with stage II and III hips. Mean Harris Hip score of the 49 hips improved significantly from 50 to 91 points. Forty-three (76.8%) of 56 hips remained stable on radiographs. The technique of tantalum rod implantation combined with vascularized iliac grafting may be an effective joint-preserving method for the treatment of intermediate-stage osteonecrosis of the femoral head. A larger group of patients that is compared with a control group is necessary to further research.
股骨头坏死是一种进行性疾病。若不进行手术干预，该病最常导致关节塌陷和恶化。虽然已经实施了许多保关节手术，但尚无统一的治疗方法。作者报告了一种改良的钽棒植入技术联合带血管蒂髂骨移植治疗股骨头坏死的方法。对采用该技术治疗的52例（56髋）股骨头坏死患者（骨循环研究协会分类II-IV期）进行回顾性分析。该技术的主要步骤包括切取带血管蒂髂骨、切除坏死病灶以及联合干预植入。所有患者平均随访60个月。7髋不得不转为全髋关节置换术。整个组的5年保关节成功率为87.5%，骨循环研究协会II期髋为95%，骨循环研究协会III期髋为92%，骨循环研究协会IV期髋为63.6%。与II期和III期髋相比，IV期髋的成功率较低。49髋的平均Harris髋关节评分从50分显著提高至91分。56髋中的43髋（76.8%）在X线片上保持稳定。钽棒植入技术联合带血管蒂髂骨移植可能是治疗中期股骨头坏死的一种有效的保关节方法。需要更大规模的患者组并与对照组进行比较以进一步研究。
