Wan Junming, Hu Yanqing, Li Jiachun, Zeng Yuqing, Ren Haiyong
Department of Joint Surgery, The Seventh Affiliated Hospital, Sun Yet-Sun University, No. 628 Zhenyuan Road, Shenzhen, 518107, Guangdong, China.
Department of Joint Surgery, South China Hospital Affiliated to Shenzhen University, Shenzhen, 518111, Guangdong, China.
Int Orthop. 2022 Sep;46(9):1955-1962. doi: 10.1007/s00264-022-05418-w. Epub 2022 May 10.
Treatment of ONFH at an early stage is a challenging issue. The modified minimally invasive core decompression combined with bone graft implantation remains controversial. This study aimed to compare the early-middle outcomes of four groups with different bone grafts.
A total of 182 patients (192 hips) with ONFH at the ARCO II stage were randomly divided into four groups. The free fibular graft group (FFG), free vascularized fibular graft group (FVFG), autologous iliac bone group (ABG), and β-tricalcium bioceramics phosphate graft (β-TCPG) group. Each group was treated with the modified minimally invasive core decompression and bone graft implantation. The operation time and blood loss were recorded by the same observer. The clinical outcome was evaluated by the Harris Hip Score and VAS score (before, 14 days after surgery, and at the last follow-up). The radiographic progression of ONFH was evaluated at least 36 months of follow-up.
All cases were successful without any complications after the operation. The patients were followed up for 42 to 48 (44.62 ± 1.81) months. There were statistically significant differences among the four groups in operation time (F value = 1520.67; P < 0.01) and blood loss (F value = 5366.81; P < 0.01). The Harris Hip Score in each group was improved significantly from pre-operation to last follow-up (all P < 0.01). At the last follow-up, the difference in the Harris Hip Score in each group was not statistically significant (F value = 0.54; P = 0.984). The VAS scores in each group were decreased significantly from the pre-operation to14 days after surgery (all P < 0.01). At 14 days after surgery, the difference in the VAS score in each group was not statistically significant (F value = 0.64; P = 0.59). At the last follow-up, three hips collapsed on the femoral head in the FFG group, two in the FVFG group, two in the ABG group, and three in the β-TCPG group.
The four different bone graft implantation showed satisfactory early-middle outcomes. As compared to other bone grafts, the β-TCP bioceramics graft has the advantages of shorter operation time and lesser blood loss. It may be a choice as a bone graft for the treatment of ONFH at an early stage.
早期股骨头坏死（ONFH）的治疗是一个具有挑战性的问题。改良微创髓芯减压联合骨移植术仍存在争议。本研究旨在比较四组不同骨移植的早中期疗效。
182例（192髋）ARCO II期ONFH患者被随机分为四组。即游离腓骨移植组（FFG）、游离带血管腓骨移植组（FVFG）、自体髂骨组（ABG）和β - 磷酸三钙生物陶瓷移植组（β - TCPG）。每组均接受改良微创髓芯减压及骨移植术。由同一名观察者记录手术时间和失血量。通过Harris髋关节评分和视觉模拟评分法（VAS评分）（术前、术后14天及末次随访时）评估临床疗效。至少随访36个月评估ONFH的影像学进展。
所有病例术后均成功，无任何并发症。患者随访42至48（44.62±1.81）个月。四组在手术时间（F值 = 1520.67；P < 0.01）和失血量（F值 = 5366.81；P < 0.01）方面存在统计学显著差异。每组的Harris髋关节评分从术前到末次随访均有显著改善（均P < 0.01）。在末次随访时，每组Harris髋关节评分的差异无统计学意义（F值 = 0.54；P = 0.984）。每组的VAS评分从术前到术后14天均显著降低（均P < 0.01）。术后14天时，每组VAS评分的差异无统计学意义（F值 = 0.64；P = 0.59）。在末次随访时，FFG组有3个股骨头塌陷，FVFG组有2个，ABG组有2个，β - TCPG组有3个。
四种不同的骨移植术显示出令人满意的早中期疗效。与其他骨移植相比，β - TCP生物陶瓷移植具有手术时间短、失血量少的优点。它可能是早期ONFH治疗中骨移植的一种选择。
