| Background and Objective:Osteonecrosis of the femoral head(ONFH)is a disease in which the blood supply to the femoral head is interrupted or damaged,resulting in the death of bone cells and bone marrow components and subsequent repair,which in turn leads to structural changes in the femoral head,collapse of the femoral head,and joint dysfunction.ONFH is divided into two categories:traumatic and non-traumatic.Traumatic ONFH is mainly seen in hip trauma,necrosis due to interruption of blood flow.Non-traumatic ONFH is more common in young people between the ages of 30and 50.There are more than 40 pathogenic factors.The most common causes are alcohol and steroid.In recent years,the prevalence of non-traumatic ONFH has increased year by year.About 80%of patients who have not been effectively treated will have collapse of the femoral head within 1 to 4 years.The joint function is destroyed and the disability rate is extremely high.Most patients have to undergo total hip arthroplasty(THA),increase the economic burden of patients,and may require revision surgery due to loosening and sinking of the prosthesis,seriously affecting the quality of life of patients.Bone grafting is a common clinical method for the treatment of ONFH.Bone grafting pedicled with femoral quadratus for pre-collapse ONFH has many advantages,such as relieving pain,restoring function,preventing collapse,delaying or avoiding THA.In order to understand the long-term efficacy and influencing factors after bone grafting pedicled with femoral quadratus for non-traumatic osteonecrosis of the femoral head,this retrospective study is performed on 697 patients 751 hips.Research methods:From March 1988 to January 2014,1218 patients with 1420 hips sufferd from non-traumatic ONFH were treated with bone grafting pedicled with femoral quadratus in our department,a total of 697 patients with 751 hips were obtained with at least 5 years of follow-up.(1)Simple bone grafting pedicled with femoral quadratus:640 patients with 681hips,375 male patients with 403 hips,265 female patients with 278 hips,average32.1(20~50)years old.According to the cause classification:alcohol-induced ONFH was in 321 patients with 344 hips,steroid-induced ONFH was in 259 patients with271 hips,alcohol and steroid-induced ONFH was in 60 patients with 66 hips.According to the association of the academic research circulation osseous(ARCO)staging system,the hip number in stage IC(necrotic area greater than 40%of the total femoral head),IIB,IIC,IIIA was 68,150,322,and 141 respectively.329 hips on the left and 352 hips on the right.Follow-up time ranged from 5 to 20 years,with an average of 8.5 years.Among them:i)Mid-term follow-up:averange follow-up 6.5(5~9.9)years,480patients with 511 hips,280 male patients with 300 hips,200 female patients with 211hips,average 32.2(21~50)years old.According to the cause classification:alcohol-induced ONFH was in 236 patients with 254 hips,steroid-induced ONFH was in 204 patients with 213 hips,alcohol and steroid-induced ONFH was in 40patients with 44 hips.The hip number in stage IC,IIB,IIC,and IIIA was 68,104,241,and 98 respectively.246 hips on the left and 265 hips on the right.ii)Long-term follow-up:average follow-up 14.6(10~20)years,160 patients with 170 hips,95 male patients with 103 hips,65 female patients with 67 hips,average 31.9(20~50)years old.According to the cause classification:alcohol-induced ONFH was in 85 patients with 90 hips,steroid-induced ONFH was in 55 patients with 58 hips,alcohol and steroid-induced ONFH was in 20 patients with 22 hips.The hip number in stage IIB,IIC,and IIIA was 46,81,and 43 respectively.83 hips on the left and 87 hips on the right.(2)Bone grafting pedicled with femoral quadratus augmented with a titanium mesh:From January 2007 to January 2014,57 patients with 70 hips sufferd from non-traumatic ONFH were treated with bone grafting pedicled with femoral quadratus augmented with a titanium mesh in our department.32 male patients with39 hips,25 female patients with 31 hips,average 31.5(20~50)years old.According to the cause classification:alcohol-induced ONFH was in 30 patients with 36 hips,steroid-induced ONFH was in 21 patients with 25 hips,alcohol and steroid-induced ONFH was in 6 patients with 9 hips.All belong to the IIC stage.32 hips on the left and 38 hips on the right.Follow-up time ranged from 5 to 12 years,with an average of 7.5 years.The efficacy was evaluated by reference to the percentile method,including 60points for clinical evaluation(25 points for pain,18 points for function,17 points for joint activity),and 40 points for X-ray evaluation.The grading criteria were:excellent?90 points,good 75~89 points,fair 60~74 points,and poor<60 points.SPSS 22.0software was used for statistical analysis.Result:Simple bone grafting pedicled with femoral quadratus:i)480 patinets with 511hips have been followed-up average 6.5(5~9.9)years,of which 249 hips were excellent,165 hips were good,53 hips were fair and 44 hips were poor,the total excellent and good rate was 81.0%.In the IC period,42 hips were excellent,20 hips were good,4 hips were fair and 2 hips were poor,the excellent and good rate was91.2%.In the IIB period,56 hips were excellent,34 hips were good,8 hips were fair and 6 hips were poor,the excellent and good rate was 86.5%.In the?C period,116hips were excellent,82 hips were good,24 hips were fair and 19 hips were poor,the excellent and good rate was 82.2%.In the?A period,35 hips were excellent,29 hips were good,17 hips were fair and 17 hips were poor,the excellent and good rate was65.3%.The efficacy was decreased in turn,and the difference was statistically significant(?~2=26.006,P=0.002).ii)160 patinets 170 hips have been followed-up average 14.6(10~20)years,of which 57 hips were excellent,69 hips were good,20hips were fair and 24 hips were poor,the total excellent and good rate was 74.1%.In the IIB period,18 hips were excellent,20 hips were good,4 hips were fair and 4 hips were poor,the excellent and good rate was 82.6%.In the IIC period,29 hips were excellent,33 hips were good,7 hips were fair and 12 hips were poor,the excellent and good rate was 76.5%.In the?A period,10 hips were excellent,16 hips were good,9 hips were fair and 8 hips were poor,the excellent and good rate was 60.5%.The efficacy was decreased in turn,and the difference was statistically significant(?~2=6.155,P=0.046).A total of 640 patients with 681 hips have been followed-up average 8.5(5~20)years,of which 306 hips were excellent,234 hips were good,73hips were fair and 68 hips were poor,the total excellent and good rate was 79.3%.In the IC period,42 hips were excellent,20 hips were good,4 hips were fair and 2 hips were poor,the excellent and good rate was 91.2%.In the IIB period,74 hips were excellent,54 hips were good,12 hips were fair and 10 hips were poor,the excellent and good rate was 85.3%.In the?C period,145 hips were excellent,115 hips were good,31 hips were fair and 31 hips were poor,the excellent and good rate was 80.7%.In the?A period,45 hips were excellent,45 hips were good,26 hips were fair and25 hips were poor,the excellent and good rate was 63.8%.The efficacy was decreased in turn,and the difference was statistically significant(?~2=35.534,P=0.000).There was a significant increase in the scores at the last follow-up and preoperative scores,and the differences were statistically significant(P=0.000).Bone grafting pedicled with femoral quadratus augmented with a titanium mesh:57 patinets with 70 hips have been followed-up average 7.5(5~12)years,38 hips were excellent,20 hips were good,7 hips were fair and 5 hips were poor,the excellent and good rate was 82.9%.In the patients younger than 30 years,the averange healing time of the grafting bone in the femoral head was 3.5(3.4~3.9)months.The average healing time of the grafting bone in the femoral head was 4.5(4.0~4.9)months in patients aged 30~39years.The average healing time of the grafting bone in the femoral head was 5.5(5.0~5.9)months in patients aged 40~50 years.The postoperative collapse rates of IC,IIB,IIC,and IIIA in the simple bone grating pedicled with femoral quadratus were8.8%,19.3%,24.8%,and 53.2%respectively,and the total collapse rate was 27.9%.The collapse rate of bone grating pedicled with femoral quadratus augmented with a titanium mesh was 25.7%.Conclusion:1.Bone grafting pedicled with femoral quadratus is an effective method for the treatment of ARCO IC(necrotic area greater than 40%of the total femoral head),IIB,IIC ONFH.Especially benifit for young patients with pre-collapse ONFH.2.The long-term effect of bone grafting pedicled with femoral quadratus is associated with the stage and the range of osteonecrosis,femoral head with collapse or not and the degree of collapse,and the effect shows a downtrend over time. |
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