The Third Clinical Medical School, Guangzhou University of Chinese Medicine, Jichang Road 12#, District Baiyun, Guangzhou, Guangdong, China.
The First Clinical Medical School, Guangzhou University of Chinese Medicine, Jichang Road 12#, District Baiyun, Guangzhou, Guangdong, China.
BMC Musculoskelet Disord. 2022 May 26;23(1):499. doi: 10.1186/s12891-022-05456-w.
Osteonecrosis of the femoral head (ONFH) may occur in the adolescent and younger adults (AYAs). Total hip arthroplasty (THA) is not the best treatment option for younger patients. Surgical hip dislocation (SHD) combined with bone graft can be used in patients at different stages to reconstruct the bone structure in the head and delay the replacement time. The purpose of this study was to evaluate the effect and potential influencing factors of this surgery for ONFH in AYA patients. METHODS: We conducted a literature review and a retrospective research of our own cases. The Pubmed, Cochrane Library, EMBASE and CNKI databases were searched from 1 January 2001 to 1 October 2021, for clinical studies. A retrospective case series study of 34 patients (38 hips) treated with SHD combined with bone graft was performed.
A total of 13 studies were included and the results showed that SHD combined with bone grafts had better clinical results for patients with pre- or early post-collapse. In the case series study, we retrospectively analyzed 34 patients (38 hips), and the mean follow-up time was 40.77 ± 15.87 months. One patient died and three patients were converted to THA finally. The post-collapse degree and post-lesion size were better than those before the operation (P < 0.05). The iHOT-12 at the last follow-up was significantly higher than that before the operation (P < 0.05). There were significant differences in the results of hip Harris score (HHS), visual analogue scale (VAS) and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) before the operation, 2 years after the operation and at the last follow-up, but the difference was not related to the follow-up time (P < 0.05). There were no significant differences in the final clinical score and arthritic changes among different Japanese Investigation Committee (JIC) classification, the degree of collapse and the size of the necrotic (P > 0.05).
In AYA patients, SHD combined with bone grafting is a potentially good option for hip preservation in ONFH. The differences in JIC classification, collapse degree and lesion size did not affect the final clinical function and the risk of osteoarthritis. Even for very severe cases at collapsed stage, good short-term clinical effects can still be achieved by SHD combined with bone graft.
ChiCTR2100055079 .retrospectively registered.
股骨头坏死（ONFH）可发生在青少年和年轻成年人（AYA）中。全髋关节置换术（THA）不是年轻患者的最佳治疗选择。手术髋关节脱位（SHD）联合植骨可用于不同阶段的患者，以重建头部的骨结构并延迟置换时间。本研究的目的是评估该手术对 AYA 患者 ONFH 的效果和潜在影响因素。
我们进行了文献回顾和我们自己病例的回顾性研究。从 2001 年 1 月 1 日至 2021 年 10 月 1 日，我们检索了 Pubmed、Cochrane Library、EMBASE 和 CNKI 数据库中的临床研究。对 34 例（38 髋）接受 SHD 联合植骨治疗的患者进行了回顾性病例系列研究。
共纳入 13 项研究，结果表明 SHD 联合植骨对塌陷前或早期的患者具有更好的临床效果。在病例系列研究中，我们回顾性分析了 34 例（38 髋）患者，平均随访时间为 40.77±15.87 个月。1 例患者死亡，最终有 3 例患者转为 THA。塌陷后程度和病变后大小均优于术前（P<0.05）。末次随访时 iHOT-12 明显高于术前（P<0.05）。术前、术后 2 年和末次随访时髋关节 Harris 评分（HHS）、视觉模拟评分（VAS）和西安大略和麦克马斯特大学骨关节炎指数（WOMAC）的结果存在显著差异，但与随访时间无关（P<0.05）。不同日本调查委员会（JIC）分类、塌陷程度和坏死大小之间的最终临床评分和关节炎变化无显著差异（P>0.05）。
在 AYA 患者中，SHD 联合植骨是一种潜在的保髋治疗 ONFH 的良好选择。JIC 分类、塌陷程度和病变大小的差异并不影响最终的临床功能和骨关节炎的风险。即使在塌陷期非常严重的情况下，SHD 联合植骨仍可获得良好的短期临床效果。
ChiCTR2100055079. 回顾性注册。
