Iwata H, Torii S, Hasegawa Y, Itoh H, Mizuno M, Genda E, Kataoka Y
Department of Orthopaedic Surgery, Nagoya University School of Medicine, Japan.
Clin Orthop Relat Res. 1993 Oct(295):281-8.
Several reports describe methods of treatment for avascular necrosis of the femoral head (ANFH) involving 0 to 2 mm of collapse. Some cases of ANFH have good prognoses, requiring only non-weight-bearing treatment. Other cases rapidly progress to collapse and complete destruction with enlargement of the necrotic area. The progression of the necrotic area is related to the activity of the original disease, steroid treatment, and the size and location of the necrotic area in the early stages of the disorder. In this report, a vascularized pedicle bone graft was used to treat ANFH, particularly those cases identified as Stage II on the system established by the Japanese Investigation Committee. Surgery involved curettage of necrotic bone, implantation of spongy bone, and application of a vascularized pedicle bone graft. Grafts were taken from the ilium and included the superficial circumflex iliac artery (SCIA). A bony canal was made in the anterior femoral neck, from which the necrotic bone was curetted and to which the bone graft was applied. The deep circumflex iliac artery (DCIA) was also used in combination with the SCIA. The postoperative weight-bearing period was six months. Follow-up periods lasted one to six years. Seventeen of 23 Stage II joints (19 cases) achieved satisfactory results at a mean of three years after surgery. Three Stage II joints and three Stage III joints continue to have significant problems. One of these six has been converted to a dual-bearing type endoprosthesis. The unsuccessful results generally occurred in patients who were treated with steroids.
几份报告描述了针对股骨头缺血性坏死（ANFH）且塌陷程度为0至2毫米的治疗方法。一些ANFH病例预后良好，仅需非负重治疗。其他病例则迅速发展为塌陷并完全破坏，坏死区域扩大。坏死区域的进展与原发病的活动情况、类固醇治疗以及疾病早期坏死区域的大小和位置有关。在本报告中，采用带血管蒂骨移植治疗ANFH，特别是日本调查委员会制定的系统中确定为II期的病例。手术包括刮除坏死骨、植入松质骨以及应用带血管蒂骨移植。移植物取自髂骨，包括旋髂浅动脉（SCIA）。在股骨颈前方制作一个骨通道，从中刮除坏死骨并应用骨移植。旋髂深动脉（DCIA）也与SCIA联合使用。术后负重期为六个月。随访期持续一至六年。23个II期关节中的17个（19例）在术后平均三年时取得了满意的结果。三个II期关节和三个III期关节仍存在严重问题。这六个病例中的一个已转换为双承重型假体。治疗效果不佳的情况通常发生在接受类固醇治疗的患者中。
