Elmalı Nurzat, Ertem Kadir, Karakaplan Mustafa, Pepele Demet, Dağgez Cihat, Topgül Haldun
Department of Orthopedics and Traumatology, Medical Faculty of İnönü University, Turgut Özal Medical Center, 44280 Malatya, Turkey.
Eklem Hastalik Cerrahisi. 2014;25(1):2-7. doi: 10.5606/ehc.2014.02.
This study aims to evaluate clinical and radiological findings of a series of patients with avascular necrosis of the femur head (ANFH) treated by core decompression and vascular pedicled iliac crest grafting.
This retrospective study included 26 hips of 22 patients (14 males, 8 females; mean age 36 years; range 16 to 48 years) with ANFH using the vascularized iliac bone grafting between March 2003 and July 2010 in our clinic. The main predisposing factor was steroid use in 13 patients. All patients were assessed clinically according to the Harris hip score and by radiographs by the Association Internationale de Recherche sur la Circulation Osseuse (ARCO) staging system.
The mean follow-up was 36 (range 14 to 62) months. Eleven hips (42%) had stage II and 15 hips (58%) had stage III ANFH. The mean Harris scores increased from 52 (range 31 to 63) to 82.8 (range 62 to 90) after surgery. Based on clinical outcomes, 18 hips (69%) were presented as excellent and good, while eight hips presented fair and poor. According to the ARCO staging system, satisfactory results were provided in 17 (65%) of the 26 hips. Two of four hips at preoperatively stage II progressed to stage III, two other hips to stage IV. Five hips at stage III preoperatively progressed to stage IV and these hips had to undergo hip replacement.
Our results suggest that core decompression and the vascular pedicled iliac bone grafting are effective in early stages of ANFH.
本研究旨在评估一系列经髓芯减压和带血管蒂髂骨移植治疗的股骨头缺血性坏死（ANFH）患者的临床和影像学表现。
本回顾性研究纳入了2003年3月至2010年7月在我院采用带血管蒂髂骨移植治疗的22例患者（14例男性，8例女性；平均年龄36岁；年龄范围16至48岁）的26个髋关节。主要诱发因素是13例患者使用了类固醇。所有患者均根据Harris髋关节评分进行临床评估，并通过国际骨循环研究协会（ARCO）分期系统进行X线片评估。
平均随访时间为36（范围14至62）个月。11个髋关节（42%）为II期，15个髋关节（58%）为III期ANFH。术后Harris评分平均从52（范围31至63）提高到82.8（范围62至90）。根据临床结果，18个髋关节（69%）为优和良，8个髋关节为中差。根据ARCO分期系统，26个髋关节中有17个（65%）取得了满意的结果。术前II期的4个髋关节中有2个进展为III期，另外2个髋关节进展为IV期。术前III期的5个髋关节进展为IV期，这些髋关节不得不接受髋关节置换。
我们的结果表明，髓芯减压和带血管蒂髂骨移植在ANFH的早期阶段是有效的。
