The Early Clinical Effect Of Free Vascularized Fibular Grafting In The Treatment Of Osteonecrosis Of The Femoral Head

Objective: To analyze the clinical effect of free vascularized fibular grafting in the treatment of Osteonecrosis of the femoral head(ONFH).Toevaluate the operation effect,analyze the factors influencing the operation effect,and explore the selection of operation indications.The purpose of this study is to provide reference for the treatment of ONFH.Methods: From March 2014 to December 2018,we collected and followed up the patients who were hospitalized in the First Affiliated Hospital of Guangxi Medical University and were treated with free vascularized fibular grafting for ONFH.The follow-up evaluation included VAS pain score and Harris score.All patients were taken the X-ray at preoperative period and postoperative follow-up.They were divided into groups according to the etiology and Ficat stage.Harris score was used as the evaluation standard to compare the clinical effect of different etiology and Ficat stage.Result:1.Follow up: A total of 82 patients(98Hips)were treated with FVFG,and63 patients(73 Hips)were followed up in this study,average age 37.85±9.62,mean follow-up time 35.81±12.54 Months.2.VAS pain score:73 hips Average preoperative VAS pain score 5.52±1.89 points,The postoperative follow-up data of 6,12,24,36 months and the VAS pain score were 2.38±1.89 points,2.45±1.87 points,2.69±1.79 points,2.95±1.69 points.There were significant differences between preoperative and postoperative follow-up in VAS pain scores(P<0.001).3.Harris score:73 hips Average preoperative Harris score 61.82±15.74 points,The postoperative follow-up data of 6,12,24,36 months and the Harris score were 86.25±14.03 points,84.10±14.66 points,83.05±11.82 points,81.15±12.29 points.There were significant differences between preoperative and postoperative follow-up in Harris score(P<0.001).The excellent rates were 78.1%,76.7%,71.2% and 64.1% in 6 months,12 months,24 months and 36 months follow-up respectively4.Comparison of Harris scores of patients with different etiology and Ficat stage:there was statistically significant difference between preoperativeand postoperative Harris scores in patients with alcoholic,idiopathic and corticosteroidsinduced.(P < 0.05);There was significant difference between the preoperative and postoperative Harris scores of Ficat Ⅱ(P < 0.001);There was significant difference between the preoperative and postoperative Harris scores of Ficat Ⅲ(P< 0.001);There was no significant difference between the preoperative and postoperative Harris scores of Ficat Ⅳ(P>0.05).Conclusion: Free vascularized fibular grafting is a feasible operation method for the patients with ONFH,which can effectively relieve the pain of the hip,improve the function of the hip joint,and delay or prevent the further collapse of the femoral head.It is better for the patients with Ficat stage II or Ficat stage III.