Treatment of femoral head necrosis with surgical dislocation through fovea bone grafting combined with autologous bone marrow concentrate and platelet-rich plasma gel
Tang Yanfeng, Li Hongjun, Yang Yuxia, Li Wuyin, Xi Jianing, Yue Chen, Wang Huichao, Liu Youwen
Department of Hip Injury, Luoyang Orthopedic Hospital of Henan Province, Orthopedic Hospital of Henan Province, Luoyang 471002, China
Abstract：Objective To explore the efficacy of the removal of dead bone graft in the head recess via surgical dislocation approach of hip joint combined with autologous bone marrow concentrate and platelet rich gel in the treatment of femoral head necrosis (FHN).Methods The data of a total of 23 patients (26 hips) treated with the removal of dead bone graft in the head recess via surgical dislocation approach of hip joint combined with autologous bone marrow concentrate and platelet rich gel were retrospectively analyzed,there were 15 male patients (18 hips) and 8 female patients (8 hips) aged 21-53 years, with an average age of 36.2 year; 12 patients (15 hips) with hormone FHN, 8 patients (8 hips) with alcohol-induced FHN and 3 patients (3 hips) with idiopathic FHN. Association Research Circulation Osseous staging was as follows: stage Ⅱb 5 hips, Ⅱc 12 hips, Ⅲa 5 hips, Ⅲb 3 hips, Ⅲc 1 hip. Autologous platelet-rich plasma and bone marrow concentrate were prepared before surgery, platelet concentration in platelet-rich plasma, as well as the content of vascular endothelial growth factor (VEGF) and transforming growth factor-β(TGF-β), and the number of bone marrow mononuclear cells in the bone marrow concentrate were determined.Bone marrow concentrate and platelet-rich plasma gel test gels were prepared under aseptic conditions. The femoral head was exposed via the surgical dislocation approach of the hip joint to remove the dead bone graft in the opening of the femoral head recess; autologous bone marrow concentrate and platelet rich gel were prepared. The mixture of iliac bone grain and gel was used to press the bone graft through the femoral head recess forward. The operative time and intraoperative blood loss were recorded, and postoperative complications were observed.Reexamination was carried out 3, 6 and 12 months after the operation. The imaging data of the last postoperative follow-up visit were analyzed for imaging evaluation. The efficacy was evaluated according to hip Harris score and pain VAS score.Results Platelet concentration was(1.82±0.29) ×106/μL, in which the concentrations of VEGF and TGF-β were (504.32±52.13) pg/mL and (134.19±20.52)ng/mL, respectively.The number of monocytes in bone marrow concentrate was (8.17±1.54) ×105/L. All patients successfully underwent the surgery. The operation time was 80-125 min, with an average of 108 min. Intraoperative blood loss was 250-400 mL, with an average of 320 mL. Follow-up visits were paid to all of the 23 patients for 26-42 months (average 36.6 months). One patient had delayed healing of the osteotomy end of the greater trochanter, healing occurred 4 months after the second operation; In 11 cases (11 hips), different degrees of articular surface collapse occurred, including 10 hip joint surface collapse 1.0-3.0(1.9±0.82) mm, with acceptable joint space. Bone density under the articular surface collapse was close to normal, and joint function was normal, which was not treated.The necrosis area of the femoral head in one case accounted for about 60% of the volume of the femoral head. After 17 months of operation, the articular surface collapsed by 3.5 mm, and the joint function was limited. Therefore, an artificial total hip replacement was performed.The femoral head grafts of the 25 hips were reconstructed; the average Harris score during the last follow-up visit was (87.38±8.21) points, which was higher than the preoperative (58.92±10.42) points, VAS (2.58±1.58) score was lower than the preoperative score (7.42±1.2).The differences were statistically significant(t=26.630, 26.718, all P values<0.01).Conclusions The treatment of nontraumatic FHN with the removal of dead bone graft in the head recess via surgical dislocation approach of hip joint can directly remove necrotic bone under direct vision. The combined application with autologous bone marrow concentrate and platelet rich gel provides cell scaffold, bone marrow stromal stem cells and growth factors to promote the repair of FHN.
倘艳锋, 李红军, 杨玉霞, 李无阴, 习嘉宁, 岳辰, 王会超, 刘又文. 外科脱位入路头凹植骨联合自体骨髓浓集液和富血小板血浆凝胶治疗非创伤性股骨头坏死的疗效分析[J]. 中华解剖与临床杂志, 2020, 25(3): 285-291.
Tang Yanfeng, Li Hongjun, Yang Yuxia, Li Wuyin, Xi Jianing, Yue Chen, Wang Huichao, Liu Youwen. Treatment of femoral head necrosis with surgical dislocation through fovea bone grafting combined with autologous bone marrow concentrate and platelet-rich plasma gel. Chinese Journal of Anatomy and Clinics, 2020, 25(3): 285-291.
中国医师协会骨科医师分会显微修复工作委员会, 中国修复重建外科专业委员会骨缺损及骨坏死学组, 中华医学会骨科分会显微修复学组. 成人股骨头坏死临床诊疗指南(2016)[J]. 中华骨科杂志, 2016, 36(15): 945-954. DOI:10.3760/cma.j.issn.0253-2352.2016.15.001.The Microsurgery Department of the Orthopedics branch of the Chinese Medical Doctor Association, The group from the Osteonecrosis and Bone Defect branch of the Chinese Association of Reparative and Reconstructive Surgery, The Microsurgery and Reconstructive surgery group of the Orthopedics branch of the Chinese Medical Association. Chinese guideline for the diagnosis and treatment of osteonecrosis of the femoral head (2016) [J]. Chin J Orthop, 2016, 36(15): 945-954. DOI:10.3760/cma.j.issn.0253-2352.2016.15.001
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