Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, Shogoin, Kawahara-cho 54, Sakyo-ku, Kyoto, 606-8507, Japan.
Rehabilitation Unit, Kyoto University Hospital, Kyoto, Japan.
J Orthop Surg Res. 2021 Feb 17;16(1):141. doi: 10.1186/s13018-021-02288-7.
Half of osteonecrosis of the femoral head (ONFH) patients suffer femoral head collapse at initial diagnosis, and more than half are bilaterally affected. This study developed a percutaneous autologous impaction bone graft (IBG) technique as a modification of core decompression (CD). We also summarized the short-term results and treatment efficacy of percutaneous autologous IBG in advanced ONFH.
Twenty patients (12 males, 8 females) with nontraumatic, postcollapse ONFH except one case underwent CD (10-mm core diameter) and reverse IBG. Radiological changes of the ONFH stage and type were analyzed. Survival analysis using Kaplan-Meier estimates was performed with conversion to total hip arthroplasty (THA) as the endpoint. In addition, the Harris hip score (HHS) and University of California, Los Angeles (UCLA) activity rating scale were evaluated.
Percutaneous autologous IBG was performed successfully, with an average operation time of < 1 h and small blood loss, and 7 patients (35%) needed conversion to THA at an average of 17 months postoperatively. We observed radiological progressive change in 60% of the patients during a mean observation period of 3 years. The mean clinical scores, except data recorded, after THA significantly improved (before vs. after 3 years: UCLA activity score, 3.7 vs. 5.2 [P = 0.014]; HHS, 57.6 vs. 76.5 points [P = 0.005]). In addition, 6 patients showed radiological progression but no clinical deterioration.
Percutaneous autologous IBG was technically simple and minimally invasive, but short-term results were unsatisfactory for advanced ONFH. Indications for this procedure should be carefully examined to improve it in order to enable bone formation.
半数股骨头坏死（ONFH）患者在初诊时即出现股骨头塌陷，超过半数为双侧受累。本研究对核心减压（CD）进行改良，提出经皮自体打压植骨（IBG）技术。我们还总结了经皮自体 IBG 治疗晚期 ONFH 的短期结果和疗效。
20 例非创伤性、塌陷后 ONFH 患者（男 12 例，女 8 例），除 1 例患者接受 CD（10mm 骨芯直径）联合逆行 IBG 外，其余均接受经皮自体 IBG。分析 ONFH 分期和类型的影像学变化。采用 Kaplan-Meier 估计进行生存分析，以全髋关节置换术（THA）转换为终点。此外，还评估了 Harris 髋关节评分（HHS）和加利福尼亚大学洛杉矶分校（UCLA）活动评分量表。
经皮自体 IBG 手术均成功完成，平均手术时间<1h，出血量少，7 例（35%）患者术后平均 17 个月需要转换为 THA。在平均 3 年的观察期内，我们观察到 60%的患者影像学出现进展性变化。THA 后除记录数据外，其余临床评分均显著改善（术前 vs. 术后 3 年：UCLA 活动评分，3.7 vs. 5.2[P=0.014]；HHS，57.6 vs. 76.5 分[P=0.005]）。此外，6 例患者影像学进展但无临床恶化。
经皮自体 IBG 技术简单、微创，但对晚期 ONFH 的短期效果并不理想。应仔细检查该手术的适应证，以改善其疗效，促进骨形成。
