Department of Orthopaedic Surgery, University of Ulsan College of Medicine, Asan Medical Center 88, Olympic-Ro 43-Gil, Songpa-Gu, Seoul, 05505, South Korea.
Department of Orthopaedic Surgery, Seuol National University Hospital, Seoul, South Korea.
Arch Orthop Trauma Surg. 2020 Nov;140(11):1655-1663. doi: 10.1007/s00402-020-03364-z. Epub 2020 Feb 7.
We aimed to present the clinical outcomes of multiple drilling and multiple matchstick-like bone allograft for large osteonecrotic lesions of the femoral head as a joint-preserving surgery.
Between March 2014 and March 2018, 57 patients (77 hips) who underwent multiple drilling and multiple matchstick-like bone allograft for large lesions (≥ 30%) in osteonecrosis of the femoral head (ONFH) were included. Harris hip scores (HHS) and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) were obtained preoperatively and at the latest follow-up. Plain radiographs were obtained every 3 months. Femoral head collapse ≥ 2 mm was defined as a radiological failure, and conversion to total hip arthroplasty (THA) was regarded as a clinical failure.
After exclusion of 5 patients (5 hips) who lost to follow-up, 52 patients (34 men, 18 women; 72 hips) were finally enrolled. The mean follow-up period was 3.4 (range 2-4.5) years. Nineteen hips (28.4%) required conversion to THA at a mean of 21.6 (range 6-42) months postoperatively. In the remaining 53 hips (71.6%) with clinical success, the mean HHS and WOMAC improved from 63 and 31.3 preoperatively to 80.6 and 16.3 at the final follow-up, respectively (p < 0.001). Radiological failure occurred in four hips (6%). The overall failure rate was 31.9% (23/72 hips), and the mean survival duration until failure was 21.2 months (6-42 months). The lesion size, lesion location, and the use of corticosteroids as the cause of ONFH were associated with clinical failure.
Multiple drilling and multiple matchstick-like bone allograft may be a useful treatment option for alleviating the symptoms in ONFH patients with large lesions who want to preserve their hips.
我们旨在介绍一种保髋手术，即通过多次钻孔和多次移植火柴状骨移植物治疗大面积股骨头坏死（ONFH）的骨坏死病变。
2014 年 3 月至 2018 年 3 月，我们纳入了 57 例（77 髋）接受多次钻孔和多次移植火柴状骨移植物治疗大面积（≥30%）ONFH 病变的患者。我们分别在术前和随访时获得了 Harris 髋关节评分（HHS）和西安大略和麦克马斯特大学骨关节炎指数（WOMAC）评分。每 3 个月拍摄一次骨盆正位 X 线片。如果股骨头塌陷≥2mm，则定义为影像学失败，如果需要进行全髋关节置换术（THA）则定义为临床失败。
在排除了 5 例（5 髋）失访的患者后，最终纳入了 52 例患者（34 例男性，18 例女性；72 髋）。平均随访时间为 3.4（2-4.5）年。术后平均 21.6（6-42）个月时，19 髋（28.4%）需要转换为 THA。在其余 53 髋（71.6%）临床成功的患者中，HHS 和 WOMAC 分别从术前的 63 和 31.3 改善至末次随访时的 80.6 和 16.3（p<0.001）。4 髋（6%）出现影像学失败。总的失败率为 31.9%（23/72 髋），平均失效时间为 21.2 个月（6-42 个月）。病变大小、病变位置和使用皮质激素作为 ONFH 的病因与临床失败相关。
多次钻孔和多次移植火柴状骨移植物可能是治疗有保髋意愿的大面积股骨头坏死患者的一种有效方法。
