Patients with necrosis of the femoral head and taking hormone for a long time after fibular graft: eight hips receiving total hip replacement

doi:10.3969/j.issn.2095-4344.2014.53.004

Abstract

Abstract:

BACKGROUND: For patients with autoimmune diseases, long-term use of hormone is a factor for the onset of osteonecrosis. After free vascularized fibular graft, long-term use of hormone is required due to the need of treatment. This condition possibly caused a decrease in curative effect of operation. Few reports concerned the effects of above-mentioned cases.
OBJECTIVE: To observe the mid-term and long-term results of free vascularized fibular graft in patients who still took hormone for a long time postoperatively.
METHODS: A total of 54 patients (96 hips) with steroid-induced avascular necrosis of femoral head after free vascularized fibular graft from September 2003 to December 2013 were retrospectively analyzed. All subjects had taken hormone for more than 6 months. Harris Hip Score, 36-Item Short-Form Health Survey and imaging
data (radiographs and magnetic resonance imaging) were compared and analyzed before and after transplantation. Follow-up was performed for 1-10 years.
RESULTS AND CONCLUSION: Compared with before transplantation, mean Harris Hip Score increased 13.2 during final follow-up (P < 0.05). Mean physiological score of 36-Item Short-Form Health Survey increased 11.0 (P < 0.05). Mean psychological score of 36-Item Short-Form Health Survey increased 9.4 (P < 0.05). Radiographs revealed that 61 affected hips (63%) were improved; 14 affected hips (15%) were stable; 21 affected hips (22%) worsened. Of them, 8 hips (8%) underwent total hip replacement. Free vascularized fibular graft can remarkably elevate the function of affected limbs and patient’s quality of life in patients who have to take hormone for a long time. It is an effective, reliable and stable manner.

中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程

全文链接：

Key words: : femur head necrosis, hormones, fibula, quality of life

CLC Number:

R318

Wang Yan-mao, Zhang Chang-qing, Ding Hao, Chen Sheng-bao. Patients with necrosis of the femoral head and taking hormone for a long time after fibular graft: eight hips receiving total hip replacement[J]. Chinese Journal of Tissue Engineering Research, 2014, 18(53): 8547-8552.

Figures/Tables 3

2.3 并发症及转归所有患者均从术后第1天开始进行功能锻炼，直至患肢完全负重，术后无患者出现急性并发症，10侧患髋出现了创伤性血肿(10%)，4侧(4%)患肢出现了下肢深静脉血栓，但均通过口服抗凝药物得到有效控制，8侧(8%)患肢出现了术后拇趾背伸困难及感觉异常，保守治疗后病情逐渐好转。在随访的过程中，共有8侧(8%)患髋最终进行了全髋关节置换，其中包括2髋Steinberg分期Ⅲ期(4.5%)，以及6髋Ⅳ期(25%)。另外有一部分患者影像学检查显示病情进一步地恶化，但未进行全髋关节置换，而是选择服用镇痛药物或减免患肢负重来降低疼痛感，主要原因是由于患者年龄较轻，综合人工关节的使用寿命及个人经济条件所作出的决定。 2.4 Harris评分使用Harris评分量表对比了患髋治疗前后髋关节的功能情况。术前96侧患髋总体Harris评分平均值为71.7±9.8，其中Ⅱ期患髋平均值为80.2±3.6，Ⅲ期患髋平均值为72.0±5.4，Ⅳ期患髋平均值为61.4±9.0。在最近一次的随访中，总体Harris评分平均值为84.9±12.0(P < 0.05)，Ⅱ期患髋平均值为92.6±6.8(P < 0.05)，Ⅲ期患髋平均值为84.6±11.6(P < 0.05)，Ⅳ期患髋平均值为76.4±11.0 (P < 0.05)(图1)。术后相对于术前总体Harris评分平均值增加13.2，Ⅱ期患髋增加12.4，Ⅲ期患髋增加12.6，Ⅳ期患髋增加15.0。 2.5 生活质量评价量表(SF-36)评分 SF-36评价量表分为生理评分及心理评分两方面。术前54例患者生理评分平均值为75.8±6.0，心理评分平均值为71.0±8.4。在最近一次的随访中，患者术后总体生理评分平均值为86.8±7.2 (P < 0.05)，平均提升11.0；心理评分平均值为80.4±12.0 (P < 0.05)，平均提升9.4。相较于术前，无论在生理或是心理方面，患者都有着显著的提升，见图2。"

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