Department of Orthopedic, the First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China.
Institute of Orthopedics, Guangzhou University of Chinese Medicine, Guangzhou, China.
Bone Joint J. 2020 Jul;102-B(7):838-844. doi: 10.1302/0301-620X.102B7.BJJ-2019-1101.R2.
The aim of this study was to report the medium-term outcomes of impaction bone allograft and fibular grafting for osteonecrosis of the femoral head (ONFH) and to define the optimal indications.
A total of 67 patients (77 hips) with ONFH were enrolled in a single centre retrospective review. Success of the procedure was assessed using the Harris Hip Score (HHS) and rate of revision to total hip arthroplasty (THA). Risk factors were studied, including age, aetiology, duration of hip pain, as well as two classification systems (Association Research Circulation Osseous (ARCO) and Japanese Investigation Committee (JIC) systems).
After a mean follow-up period of 8.61 years (SD 1.45), 81.3% (52/64) of enrolled cases had a good or excellent HHS at latest follow-up (declining to 76.0% (38/50) for those with more than eight years of follow-up). Overall survival was 92.1% at eight years' follow-up (95% CI 83.2% to 96.4%). A total of 12 hips (19.0%) failed (reoperation or HHS < 70 points) at final follow-up. Rate of success was adversely affected by increasing age, duration of pain, and more severe disease as measured using the ARCO and JIC classifications, but not by aetiology of the ONFH.
We report favourable medium-term results of this procedure. Best outcomes can be expected in patients matching the following indications: younger than 40 years; less 12-month hip pain before surgery; femoral head collapse being less than 2 mm; and integrated lateral wall of femoral head. Cite this article: 2020;102-B(7):838-844.
本研究旨在报告打压植骨联合腓骨移植治疗股骨头坏死（ONFH）的中期结果，并明确最佳适应证。
本单中心回顾性研究纳入了 67 例（77 髋）ONFH 患者。采用 Harris 髋关节评分（HHS）评估手术效果，并统计全髋关节置换术（THA）翻修率。研究了包括年龄、病因、髋关节疼痛持续时间以及两种分类系统（Association Research Circulation Osseous（ARCO）和 Japanese Investigation Committee（JIC）系统）在内的危险因素。
平均随访 8.61 年（SD 1.45）后，52/64 例（81.3%）患者的 HHS 评分在末次随访时为优或良（8 年以上随访者中，这一比例降至 38/50（76.0%））。8 年随访时的总体生存率为 92.1%（95%CI：83.2%至 96.4%）。最终随访时共有 12 髋（19.0%）失败（翻修或 HHS＜70 分）。成功率受年龄增加、疼痛持续时间延长以及 ARCO 和 JIC 分类中疾病严重程度增加的不利影响，但与 ONFH 的病因无关。
我们报告了该手术的良好中期结果。以下患者的预期效果最佳：年龄＜40 岁；术前髋关节疼痛持续时间＜12 个月；股骨头塌陷＜2mm；以及股骨头外侧壁完整。
