Strategy and discussion of hip joint preserving surgery treatments for adult osteonecrosis of the femoral head_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

 ZHAO Dewei ^1,2 , XIE Hui ^1,2

1. Department of Orthopaedics, Affiliated Zhongshan Hospital of Dalian University, Dalian Liaoning, 116001, P.R.China;
2. Department of Biomedical Engineering, Faculty of Electronic Information and Electrical Engineering, Dalian University of Technology, Dalian Liaoning, 116024, P.R.China;

Corresponding?author：

ZHAO Dewei, Email: zhaodewei2000@163.com

Keywords：

Osteonecrosis of the femoral head; hip joint preserving surgery; treatment strategy

DOI：

10.7507/1002-1892.201806029

Video：

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As a common disease in orthopedics, osteonecrosis of the femoral head (ONFH) frequently occurs among young and middle-aged people. Hip joint preserving surgery has attracted more and more attention due to the fact that artificial joint prosthesis has a certain useful life and the rate of hip joint revision is high and the higher risk of many complications. There are a large number of operative methods for preserving hip joint in clinical practice without definitive effectiveness. How to choose appropriate surgical methods at the right time is also a continuous understanding. The pathological process of necrosis of the femur helps to choose the choice of the femoral head necrosis for the treatment of hip operation. Core decompression and impaction bone grafting with simple operative methods can relieve internal pressure of femoral head and pain symptoms, but they cannot remove necrotic bone completely. Hence, they are only used for ONFH in the early stage. Vascularized bone transplantation can fill defects of the former, as it can not only completely remove necrotic bone, but also provide bone graft with nourishing vessels for femoral head, being beneficial to reconstruct the bone structure of femoral head. Subsequently, the application of tantalum rod can provide mechanical support for femoral head to prevent the collapse of femoral head. Hip joint preserving surgery, in recent years, has been performed increasingly, and has obtained improvement in clinical effects. The multiple combination of a variety of its operative methods provides more effective treatments for ONFH. It is an essential notion that hip joint preserving surgery, however with any operative method, should as far as possible select a surgical plan with little trauma, simple methods, and little injury of hip joint bone structure based on ensuring the effectiveness.

Citation： ZHAO Dewei, XIE Hui. Strategy and discussion of hip joint preserving surgery treatments for adult osteonecrosis of the femoral head. Chinese Journal of Reparative and Reconstructive Surgery, 2018, 32(7): 792-797. doi: 10.7507/1002-1892.201806029 Copy

1.	中國醫師協會骨科醫師分會顯微修復工作委員會, 中國修復重建外科專業委員會骨缺損及骨壞死學組, 中華醫學會骨科分會顯微修復學組. 成人股骨頭壞死臨床診療指南 (2016). 中華骨科雜志, 2016, 36(15): 945-954.
2.	Zhao DW, Yu M, Hu K, et al. Prevalence of nontraumatic osteonecrosis of the femoral head and its associated risk factors in the chinese population: results from a nationally representative survey. Chin Med J (Engl), 2015, 128(21): 2843-2850.
3.	張鶴山, 李子榮. 股骨頭壞死診斷與治療的專家建議. 中華骨科雜志, 2007, 27(2): 146-148.
4.	趙德偉, 程亮亮. 國內股骨頭壞死保留髖關節手術治療的十年回顧. 中華骨科雜志, 2017, 37(3): 183-192.
5.	鄭召民, 崔力揚. 髓芯減壓術治療成人股骨頭壞死. 中國骨腫瘤骨病, 2005, 4(2): 117-119.
6.	Bozic KJ, Zurakowski D, Thornhill TS. Survivorship analysis of hips treated with core decompression for nontraumatic osteonecrosis of the femoral head. J Bone Joint Surg (Am), 1999, 81(2): 200-209.
7.	Beltran J, Knight CT, Zuelzer WA, et al. Core decompression for avascular necrosis of the femoral head: correlation between long-term results and preoperative MR staging. Radiology, 1990, 175(2): 533-536.
8.	王秀利, 王義生, 吳學建, 等. 自體骨髓干細胞種植骨誘導活性材料移植聯合髓芯減壓術治療早期股骨頭壞死. 中華顯微外科雜志, 2017, 40(2): 142-145.
9.	Zhao D, Cui D, Wang B, et al. Treatment of early stage osteonecrosis of the femoral head with autologous implantation of bone marrow-derived and cultured mesenchymal stem cells. Bone, 2012, 50(1): 325-330.
10.	趙德偉. 加強對股骨頭缺血性壞死病理生理的認識. 中華關節外科雜志 (電子版), 2014, 8(5): 560-562.
11.	Yang S, Wu X, Xu W, et al. Structural augmentation with biomaterial-loaded allograft threaded cage for the treatment of femoral head osteonecrosis. J Arthroplasty, 2010, 25(8): 1223-1230.
12.	朱旭日, 杜斌, 孫光權, 等. 髓芯減壓打壓植骨腓骨支撐術與頭頸部開窗打壓植骨術治療早中期股骨頭壞死療效比較. 中國骨與關節損傷雜志, 2015, 30(4): 343-345.
13.	Wang CJ, Huang CC, Wang JW, et al. Long-term results of extracorporeal shockwave therapy and core decompression in osteonecrosis of the femoral head with eight- to nine-year follow-up. Biomed J, 1900, 35(6): 481-485.
14.	蔣瑋, 尚希福, 王姚斐, 等. 打壓植骨術治療股骨頭壞死的近期療效. 臨床骨科雜志, 2013, 16(2): 178-181.
15.	王亦進, 欒艦, 崔學芬, 等. 非創傷性股骨頭壞死 69 例 83 髖: 帶血管蒂臀中肌骨瓣移植復合骨形態發生蛋白和自體松質骨的修復. 中國組織工程研究, 2011, 15(43): 8159-8162.
16.	Rosenwasser MP, Garino JP, Kiernan HA, et al. Long term followup of thorough debridement and cancellous bone grafting of the femoral head for avascular necrosis. Clin Orthop Relat Res, 1994, (306): 17-27.
17.	Mont MA, Etienne G, Ragland PS. Outcome of nonvascularized bone grafting for osteonecrosis of the femoral head. Clin Orthop Relat Res, 2003, (417): 84-92.
18.	韋標方, 韋偉, 孫丙銀, 等. 高位股骨頭頸開窗植骨支撐術治療早期股骨頭壞死. 中華骨科雜志, 2014, 34(7): 777-782.
19.	Feng Y, Wang S, Jin D, et al. Free vascularised fibular grafting with OsteoSet 2 demineralised bone matrix versus autograft for large osteonecrotic lesions of the femoral head. Int Orthop, 2011, 35(4): 475-481.
20.	Gao YS, Liu XL, Sheng JG, et al. Unilateral free vascularized fibula shared for the treatment of bilateral osteonecrosis of the femoral head. J Arthroplasty, 2013, 28(3): 531-536.
21.	Wang B, Zhao D, Liu B, et al. Treatment of osteonecrosis of the femoral head by using the greater trochanteric bone flap with double vascular pedicles. Microsurgery, 2013, 33(8): 593-599.
22.	Zeng YR, He S, Feng WJ, et al. Vascularised greater trochanter bone graft, combined free iliac flap and impaction bone grafting for osteonecrosis of the femoral head. Int Orthop, 2013, 37(3): 391-398.
23.	Zhao D, Wang B, Lin G, et al. Will a vascularized greater trochanter graft preserve the necrotic femoral head? Clin Orthop Relat Res, 2010, 468(5): 1316-1324.
24.	Sotereanos DG, Plakseychuk AY, Rubash HE. Free vascularized fibula grafting for the treatment of osteonecrosis of the femoral head. Clin Orthop Relat Res, 1997, (344): 243-256.
25.	Soucacos PN, Beris AE, Malizos K, et al. Treatment of avascular necrosis of the femoral head with vascularized fibular transplant. Clin Orthop Relat Res, 2001, (386): 120-130.
26.	張長青, 李鴻帥, 張開剛, 等. 改良吻合血管游離腓骨移植術治療股骨頭壞死. 中華全科醫師雜志, 2006, 5(2): 84-86.
27.	王坤正, 同志勤, 王春生, 等. 吻合血管游離腓骨移植治療股骨頭壞死. 中華顯微外科雜志, 2000, 23(4): 254-256.
28.	趙德偉. 帶血管蒂骨瓣移植治療股骨頭壞死的經驗與技巧. 中華顯微外科雜志, 2009, 32(4): 265-266.
29.	趙德偉, 崔振江, 王永林, 等. 帶旋髂深血管蒂髂骨膜移植治療股骨頭無菌性壞死的體會. 鐵道醫學, 1989, 17(1): 15-16.
30.	王義生, 殷力, 吳學建, 等. 帶肌蒂骨瓣移植術治療股骨頭壞死. 中華關節外科雜志 (電子版), 2008, 2(1): 3-6.
31.	Zhao D, Xiaobing Y, Wang T, et al. Digital subtraction angiography in selection of the vascularized greater trochanter bone grafting for treatment of osteonecrosis of femoral head. Microsurgery, 2013, 33(8): 656-659.
32.	趙德偉, 王本杰. 微創帶血管蒂骨瓣轉移術在股骨頭缺血性壞死中的應用. 中華醫學雜志, 2007, 87(29): 2036-2040.
33.	Zhao D, Huang S, Lu F, et al. Vascularized bone grafting fixed by biodegradable magnesium screw for treating osteonecrosis of the femoral head. Biomaterials, 2016, 81: 84-92.
34.	Zhao D, Cui D, Lu F, et al. Combined vascularized iliac and greater trochanter graftings for reconstruction of the osteonecrosis femoral head with collapse: reports of three cases with 20 years follow-up. Microsurgery, 2012, 32(7): 546-551.
35.	Tsao AK, Roberson JR, Christie MJ, et al. Biomechanical and clinical evaluations of a porous tantalum implant for the treatment of early-stage osteonecrosis. J Bone Joint Surg (Am), 2005, 87 Suppl 2: 22-27.
36.	許偉華, 楊述華, 馮勇, 等. 多孔鉭棒植入治療股骨頭壞死的適應證及臨床療效觀察. 中華骨與關節外科, 2010, 3(1): 28-32.
37.	Aldegheri R, Taglialavoro G, Berizzi A. The tantalum screw for treating femoral head necrosis: rationale and results. Strategies Trauma Limb Reconstr, 2007, 2(2-3): 63-68.
38.	Zhao D, Liu B, Wang B, et al. Autologous bone marrow mesenchymal stem cells associated with tantalum rod implantation and vascularized iliac grafting for the treatment of end-stage osteonecrosis of the femoral head. Biomed Res Int, 2015, 2015: 240506.
39.	Ito H, Tanino H, Yamanaka Y, et al. Long-term results of conventional varus half-wedge proximal femoral osteotomy for the treatment of osteonecrosis of the femoral head. J Bone Joint Surg (Br), 2012, 94(3): 308-314.
40.	史振滿, 史疆, 王鑫, 等. 轉子間外展截骨治療股骨頭壞死塌陷的長期觀察. 創傷外科雜志, 2010, 12(2): 143-145.

1. 中國醫師協會骨科醫師分會顯微修復工作委員會, 中國修復重建外科專業委員會骨缺損及骨壞死學組, 中華醫學會骨科分會顯微修復學組. 成人股骨頭壞死臨床診療指南 (2016). 中華骨科雜志, 2016, 36(15): 945-954.
2. Zhao DW, Yu M, Hu K, et al. Prevalence of nontraumatic osteonecrosis of the femoral head and its associated risk factors in the chinese population: results from a nationally representative survey. Chin Med J (Engl), 2015, 128(21): 2843-2850.
3. 張鶴山, 李子榮. 股骨頭壞死診斷與治療的專家建議. 中華骨科雜志, 2007, 27(2): 146-148.
4. 趙德偉, 程亮亮. 國內股骨頭壞死保留髖關節手術治療的十年回顧. 中華骨科雜志, 2017, 37(3): 183-192.
5. 鄭召民, 崔力揚. 髓芯減壓術治療成人股骨頭壞死. 中國骨腫瘤骨病, 2005, 4(2): 117-119.
6. Bozic KJ, Zurakowski D, Thornhill TS. Survivorship analysis of hips treated with core decompression for nontraumatic osteonecrosis of the femoral head. J Bone Joint Surg (Am), 1999, 81(2): 200-209.
7. Beltran J, Knight CT, Zuelzer WA, et al. Core decompression for avascular necrosis of the femoral head: correlation between long-term results and preoperative MR staging. Radiology, 1990, 175(2): 533-536.
8. 王秀利, 王義生, 吳學建, 等. 自體骨髓干細胞種植骨誘導活性材料移植聯合髓芯減壓術治療早期股骨頭壞死. 中華顯微外科雜志, 2017, 40(2): 142-145.
9. Zhao D, Cui D, Wang B, et al. Treatment of early stage osteonecrosis of the femoral head with autologous implantation of bone marrow-derived and cultured mesenchymal stem cells. Bone, 2012, 50(1): 325-330.
10. 趙德偉. 加強對股骨頭缺血性壞死病理生理的認識. 中華關節外科雜志 (電子版), 2014, 8(5): 560-562.
11. Yang S, Wu X, Xu W, et al. Structural augmentation with biomaterial-loaded allograft threaded cage for the treatment of femoral head osteonecrosis. J Arthroplasty, 2010, 25(8): 1223-1230.
12. 朱旭日, 杜斌, 孫光權, 等. 髓芯減壓打壓植骨腓骨支撐術與頭頸部開窗打壓植骨術治療早中期股骨頭壞死療效比較. 中國骨與關節損傷雜志, 2015, 30(4): 343-345.
13. Wang CJ, Huang CC, Wang JW, et al. Long-term results of extracorporeal shockwave therapy and core decompression in osteonecrosis of the femoral head with eight- to nine-year follow-up. Biomed J, 1900, 35(6): 481-485.
14. 蔣瑋, 尚希福, 王姚斐, 等. 打壓植骨術治療股骨頭壞死的近期療效. 臨床骨科雜志, 2013, 16(2): 178-181.
15. 王亦進, 欒艦, 崔學芬, 等. 非創傷性股骨頭壞死 69 例 83 髖: 帶血管蒂臀中肌骨瓣移植復合骨形態發生蛋白和自體松質骨的修復. 中國組織工程研究, 2011, 15(43): 8159-8162.
16. Rosenwasser MP, Garino JP, Kiernan HA, et al. Long term followup of thorough debridement and cancellous bone grafting of the femoral head for avascular necrosis. Clin Orthop Relat Res, 1994, (306): 17-27.
17. Mont MA, Etienne G, Ragland PS. Outcome of nonvascularized bone grafting for osteonecrosis of the femoral head. Clin Orthop Relat Res, 2003, (417): 84-92.
18. 韋標方, 韋偉, 孫丙銀, 等. 高位股骨頭頸開窗植骨支撐術治療早期股骨頭壞死. 中華骨科雜志, 2014, 34(7): 777-782.
19. Feng Y, Wang S, Jin D, et al. Free vascularised fibular grafting with OsteoSet 2 demineralised bone matrix versus autograft for large osteonecrotic lesions of the femoral head. Int Orthop, 2011, 35(4): 475-481.
20. Gao YS, Liu XL, Sheng JG, et al. Unilateral free vascularized fibula shared for the treatment of bilateral osteonecrosis of the femoral head. J Arthroplasty, 2013, 28(3): 531-536.
21. Wang B, Zhao D, Liu B, et al. Treatment of osteonecrosis of the femoral head by using the greater trochanteric bone flap with double vascular pedicles. Microsurgery, 2013, 33(8): 593-599.
22. Zeng YR, He S, Feng WJ, et al. Vascularised greater trochanter bone graft, combined free iliac flap and impaction bone grafting for osteonecrosis of the femoral head. Int Orthop, 2013, 37(3): 391-398.
23. Zhao D, Wang B, Lin G, et al. Will a vascularized greater trochanter graft preserve the necrotic femoral head? Clin Orthop Relat Res, 2010, 468(5): 1316-1324.
24. Sotereanos DG, Plakseychuk AY, Rubash HE. Free vascularized fibula grafting for the treatment of osteonecrosis of the femoral head. Clin Orthop Relat Res, 1997, (344): 243-256.
25. Soucacos PN, Beris AE, Malizos K, et al. Treatment of avascular necrosis of the femoral head with vascularized fibular transplant. Clin Orthop Relat Res, 2001, (386): 120-130.
26. 張長青, 李鴻帥, 張開剛, 等. 改良吻合血管游離腓骨移植術治療股骨頭壞死. 中華全科醫師雜志, 2006, 5(2): 84-86.
27. 王坤正, 同志勤, 王春生, 等. 吻合血管游離腓骨移植治療股骨頭壞死. 中華顯微外科雜志, 2000, 23(4): 254-256.
28. 趙德偉. 帶血管蒂骨瓣移植治療股骨頭壞死的經驗與技巧. 中華顯微外科雜志, 2009, 32(4): 265-266.
29. 趙德偉, 崔振江, 王永林, 等. 帶旋髂深血管蒂髂骨膜移植治療股骨頭無菌性壞死的體會. 鐵道醫學, 1989, 17(1): 15-16.
30. 王義生, 殷力, 吳學建, 等. 帶肌蒂骨瓣移植術治療股骨頭壞死. 中華關節外科雜志 (電子版), 2008, 2(1): 3-6.
31. Zhao D, Xiaobing Y, Wang T, et al. Digital subtraction angiography in selection of the vascularized greater trochanter bone grafting for treatment of osteonecrosis of femoral head. Microsurgery, 2013, 33(8): 656-659.
32. 趙德偉, 王本杰. 微創帶血管蒂骨瓣轉移術在股骨頭缺血性壞死中的應用. 中華醫學雜志, 2007, 87(29): 2036-2040.
33. Zhao D, Huang S, Lu F, et al. Vascularized bone grafting fixed by biodegradable magnesium screw for treating osteonecrosis of the femoral head. Biomaterials, 2016, 81: 84-92.
34. Zhao D, Cui D, Lu F, et al. Combined vascularized iliac and greater trochanter graftings for reconstruction of the osteonecrosis femoral head with collapse: reports of three cases with 20 years follow-up. Microsurgery, 2012, 32(7): 546-551.
35. Tsao AK, Roberson JR, Christie MJ, et al. Biomechanical and clinical evaluations of a porous tantalum implant for the treatment of early-stage osteonecrosis. J Bone Joint Surg (Am), 2005, 87 Suppl 2: 22-27.
36. 許偉華, 楊述華, 馮勇, 等. 多孔鉭棒植入治療股骨頭壞死的適應證及臨床療效觀察. 中華骨與關節外科, 2010, 3(1): 28-32.
37. Aldegheri R, Taglialavoro G, Berizzi A. The tantalum screw for treating femoral head necrosis: rationale and results. Strategies Trauma Limb Reconstr, 2007, 2(2-3): 63-68.
38. Zhao D, Liu B, Wang B, et al. Autologous bone marrow mesenchymal stem cells associated with tantalum rod implantation and vascularized iliac grafting for the treatment of end-stage osteonecrosis of the femoral head. Biomed Res Int, 2015, 2015: 240506.
39. Ito H, Tanino H, Yamanaka Y, et al. Long-term results of conventional varus half-wedge proximal femoral osteotomy for the treatment of osteonecrosis of the femoral head. J Bone Joint Surg (Br), 2012, 94(3): 308-314.
40. 史振滿, 史疆, 王鑫, 等. 轉子間外展截骨治療股骨頭壞死塌陷的長期觀察. 創傷外科雜志, 2010, 12(2): 143-145.

Chinese Journal of Reparative and Reconstructive Surgery

Strategy and discussion of hip joint preserving surgery treatments for adult osteonecrosis of the femoral head

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