Fan-shaped decompression and allograft fibula supporting internal fixation for treatment of early femoral head necrosis in adults

doi:10.3969/j.issn.2095-4344.2013.44.017

Abstract

Abstract:

BACKGROUND: Traditional core decompression and allograft fibula supporting can reduce the stress load within femoral head and improve mechanical properties of femoral head. However, it cannot provide supports for maintaining the stability of five pathological areas following femoral head necrosis.
OBJECTIVE: To observe the clinical effect of fan-shaped decompression and allograft fibula supporting internal fixation in treatment of early femoral head necrosis in adults, taking allograft fibula grants as the control.
METHODS: Forty patients with early femoral head necrosis were randomly divided into treatment group and control group, receiving fan-shaped decompression plus allograft fibula supporting internal fixation and traditional decompression plus allograft fibula grafting, respectively. The therapeutic effects in two groups were observed and compared. After treatment, patients were detected by bilateral hip anteroposterior films, Harris scoring and X-ray ARCO staging to evaluate the collapse severity and restoration of necrosis.
RESULTS AND CONCLUSION: At the last follow-up, Harris scores in the treatment group were significantly higher and the repairing effect was better than control group (P < 0.05). In treatment group, 18 hips restored well (72%) and 7 hips delayed or failed to restore (28%); in control group, 9 hips restored well (60%) and 6 hips delayed or failed to restore (40%). Our findings indicate that, fan-shaped decompression plus allograft fibula supporting internal fixation yields a more complete decompression, a higher stability of femoral head and a more reliable supporting, compared with traditional decompression plus allograft fibula grafting.

Key words: organ transplantation, tissue transplantation, femoral head necrosis, fibula, internal fixator

CLC Number:

R318

Figures/Tables 6

References

[1]Harris WH. Hybrid total hip replacement: rationale and intermediate clinical results. Clin Orthop Relat Res. 1996;333: 155-164.
[2]庞智晖,欧志学,魏秋实,等.辨塌论治在钽棒治疗早期股骨头坏死中的运用临床研究[J].中国中医骨伤科杂志,2012,20(1):26-29.
[3]何伟,李勇,张庆文,等.自体或同种异体腓骨联合打压植骨治疗股骨头坏死的初步研究[J].中国修复重建外科杂志,2009,23(5): 530-533.
[4]于学忠,刘玉杰,张伯勋,等.多孔髓芯减压并关节清理治疗早期股骨头缺血性坏死[J].军医进修学院学报,2007,28(2):90-91.
[5]陈雷雷,何伟.股骨头缺血性坏死相关生物力学研究进展[J].中国骨伤,2011,24(2):174-176.
[6]Aldridge JM 3rd, Urbaniak JR. Avascular necrosis of the femoral head: role of vascularized bone grafts. Orthop Clin North Am. 2007;38(1):13-22.
[7]许伟华,杨述华,李宝兴,等.同种异体皮质骨支撑骨笼联合自体骨移植治疗股骨头坏死[J].中国修复重建外科杂志,2009,23(5): 527-529.
[8]柴伟,王岩,王志刚,等.记忆合金网球治疗成人股骨头缺血性坏死[J].中国修复重建外科杂志,2008,22(2):239-241.
[9]史风雷,吕夫新,李晓辉,等.内支撑术治疗成人股骨头坏死的临床观察和有限元分析[J].中国骨与关节损伤杂志,2008,23(3): 186-188.
[10]王锐英,张其亮,傅德皓,等.钛合金支撑架植入治疗股骨头缺血性坏死的动物实验研究[J].中国矫形外科杂志,2007,15(7): 538-540.
[11]Veillette CJ, Mehdian H, Schemitsch EH, et al. Survivorship analysis and radiographic outcome following tantalum rod insertion for osteonecrosis of the femoral head .J Bone Joint Surg Am. 2006; 88(Suppl3) :48-55.
[12]钟贵华.髓芯减压植骨与多孔钽棒植入修复非创伤性股骨头坏死[J].中国组织工程研究, 2012,12(29):5501-5505.
[13]黄文武.髓芯减压术与髓芯减压并钽棒植入术治疗早期股骨头缺血坏死的近期疗效比较[J].中国现代医药杂志,2011,13(12): 43-45.
[14]Tanzer M, Bobyn JD, Krygier JJ, et al. Histopathologic retrieval analysis of clinically failed porous tantalum osteonecrosis implants. J Bone Joint Sung Am. 2008;90(6): 1282-1289.
[15]李当科,史风雷,李晓辉,等.内稳定支撑术治疗成人股骨头坏死的效果[J].齐鲁医学杂志,2011,26(1):53-54.
[16]史风雷,张美超.建立股骨头坏死有限元模型的方法[J].中国组织工程研究与临床康复,2008,12(30):5890-5891.
[17]孙永强,工上增,张国永,等.股骨头坏死增强力学结构和防止塌陷的临床和实验研究进展[J].中国骨与关节损伤杂志,2009,24(12): 1148-1150.
[18]刘宏建,王义生,韩松辉,等.双支撑骨柱移植治疗股骨头缺血性坏死的生物力学研究[J].中医正骨杂志, 2004,16(4):3-5.