The clinical recent curative effect observation of arthroscopy assisted lesion accurate bone marrow core decompression, bone graft and titanium rod support in treatment of early stage osteonecrosis of the femoral head
Yang Xinming*, Hu Changbo, Shi Wei, Du Yakun, Zhang Lei
*Department of Orthopaedics, the First Affiliated Hospital of Hebei North University, Zhangjiakou 075000, China
Abstract：Objective To assess the curative effect of arthroscopy assisted lesion accurate bone marrow core decompression, bone graft and titanium rod support on the stage Ⅱ femoral head necrosis.Methods All the patients (including 58 patients 74 hips) were diagnosed as stage Ⅱ femoral head necrosis according to the ARCO staging system from April 2003 to December 2013. Among these patients, 11 patients (15 hips) were stage ⅡA, 25 patients (34 hips) were stage ⅡB and 22 patients (25 hips) were stage ⅡC. Being located by C-arm and assisted by arthroscopy, minimally-invasive percutaneous accurate pulp core decompression and lesion clearance within the femoral head were accurately performed, and then, the OAM composite of autologous bone marrow was implanted and the femoral head was supported using the titanium rod. The pain score, Harris hip score and X-ray observation for disease progression were achieved at 6, 12, 24 and 36 months postoperatively, Kaplan-Meier survival curve was used for the survival analysis, and treatment outcome.Results This group of all cases of postoperative pathological histology showed as osteonecrosis. All patients were followed up 24-36 months. The VAS score and the Harris score and the ODI after operation were better than those of before the surgery. The difference had statistical significance (all P values<0.05). As for the X-ray staging, 5 cases (5 hips) progressed from stage ⅡB to stage ⅡC, the femoral head of 6 cases (6 hips) staged IIC collapsed at 24 months after the operation and then underwent THRA after 30 months. The total improvement rate after the surgery was 79.73% (93.33% for ⅡA, 82.35% for IIB and 68.00% for ⅡC). The total survival rate of these patients was 76.8% (95% CI, 64.2%-90.1%).Conclusions Arthroscopy assisted accurate bone marrow core decompression, bone graft and titanium rod support are effective and can prevent the femoral head from collapsing in treating the stage Ⅱ osteonecrosis of the femoral head, with accurate positioning and minimally invasive operation characteristics. But for stage ⅡC patients who have a history of the use of hormone, this surgery should be chosen carefully because the outcome is always very poor.
杨新明, 胡长波, 石蔚, 杜雅坤, 张磊,. 关节镜辅助下精准髓芯减压、植骨、钛棒支撑治疗股骨头早期坏死近期临床疗效观察[J]. 中华解剖与临床杂志, 2017, 22(6): 474-480.
Yang Xinming*,Hu Changbo,Shi Wei,Du Yakun,Zhang Lei. The clinical recent curative effect observation of arthroscopy assisted lesion accurate bone marrow core decompression, bone graft and titanium rod support in treatment of early stage osteonecrosis of the femoral head. Chinese Journal of Anatomy and Clinics, 2017, 22(6): 474-480.
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2017, Vol. 22 
