Yadav Navin Kumar, Pradhan Pavan, Pratap Singh Madhur Anand, Kumar Surendra, Yadav Ashok
Department of Orthopaedics, Baba Raghav Das Medical College, Gorakhpur, IND.
Cureus. 2024 Jul 19;16(7):e64902. doi: 10.7759/cureus.64902. eCollection 2024 Jul.
Osteonecrosis of the hip is defined as necrosis of the bone tissue due to some form of vascular insult, subsequently leading to the collapse of the femoral head and secondary osteoarthritis, which leads to pain and impaired joint function. This disease is widely known to affect middle-aged groups; however, in the Indian population, even younger people are more commonly affected. The disease has a debilitating effect on the activities of daily living (ADL) and the productivity of individuals and has financial consequences. With the increased utilization of magnetic resonance imaging (MRI) in society, the disease is diagnosed in its early stages. Hip-preserving surgery like tensor fascia lata (TFL) muscle pedicle iliac bone grafting should be given a chance to preserve the native femoral head.
At a tertiary care teaching hospital in Gorakhpur, India, an observational clinical study was carried out. This study comprised 40 patients, ages 18-50 years, with femoral head osteonecrosis (stages II and III of the Ficat-Arlet staging system), who came to our institute's orthopedic outpatient department. Patients were treated with multiple drillings, curettage, and cheilectomy of the femoral head, in addition to TFL muscle pedicle bone grafting. The Harris hip score (HHS) was utilized to assess the clinical results, and the radiological assessment focused on signs of revascularization.
In our study, the most prevalent age group was 20-30 years (67.5%), with a male predominance (85%). Among our cohort of 40 patients, the HHS indicated excellent outcomes (90-100) in 14 cases (35%), good outcomes (80-89) in 19 cases (47.5%), fair outcomes (70-79) in six cases (15%), and poor outcomes (<70) in one case (2.5%), at the time of the final follow-up. The final follow-up period varied from one to 10 years.
TFL muscle pedicle bone grafting procedure provides excellent clinical and radiological outcomes, especially in young patients in whom femoral head-preserving surgery is preferred over total hip arthroplasty. This procedure is effective in both early and advanced stages of femoral head osteonecrosis, provided there are no arthritic changes. It reduces symptoms and improves functional outcomes.
股骨头坏死被定义为由于某种形式的血管损伤导致的骨组织坏死，随后导致股骨头塌陷和继发性骨关节炎，进而引起疼痛和关节功能受损。众所周知，这种疾病多影响中年人群；然而，在印度人群中，甚至更年轻的人也更常受到影响。该疾病对日常生活活动（ADL）和个人生产力有削弱作用，并产生经济后果。随着社会中磁共振成像（MRI）应用的增加，该疾病在早期阶段就能被诊断出来。像阔筋膜张肌（TFL）肌蒂髂骨移植这样的保髋手术应该有机会保留天然股骨头。
在印度戈勒克布尔的一家三级医疗教学医院进行了一项观察性临床研究。本研究包括40例年龄在18至50岁之间、患有股骨头坏死（Ficat-Arlet分期系统的II期和III期）的患者，他们来到我院骨科门诊。除了TFL肌蒂骨移植外，患者还接受了股骨头的多次钻孔、刮除和切骨术。采用Harris髋关节评分（HHS）评估临床结果，放射学评估重点关注血管再生的迹象。
在我们的研究中，最常见的年龄组是20至30岁（67.5%），男性占主导（85%）。在我们的40例患者队列中，末次随访时，HHS显示14例（35%）为优秀结果（90 - 100），19例（47.5%）为良好结果（80 - 89），6例（15%）为中等结果（70 - 79），1例（2.5%）为差结果（<70）。末次随访期从1年到10年不等。
TFL肌蒂骨移植手术提供了优异的临床和放射学结果，特别是在那些比起全髋关节置换术更倾向于保髋手术的年轻患者中。只要没有关节炎改变，该手术在股骨头坏死的早期和晚期阶段均有效。它能减轻症状并改善功能结果。
