In order to evaluate the long-term effect of total hip replacement (THR) in patients with steroid-induced femoral head necrosis, 40 cases of 50 hips received THR patients were followed up for an average of 8.5 years after operation. Evaluation was carried act according to Harris score system. In these cases, average score was seventy-five points. Revision rate among them was 2% after four years and 18% after five to eight and a half years, with as overall rate of 20%. It was found that the main reason for revision was looseness of the prosthesis. In this follow-up, it showed that besides foreigen body reaction, abnormal osseous remodelling was the main factor in long-term failure of this arthroplasty. It was also proved that it was a good selection to perform cemented total hip replacement in younger patients, which could improve living quality.
Eight cases(10 hips) of avascular necrosis of femoral head in adults were treated with transplantation of sartorius musculo-skeletal graft through the greater trochanter since August 1990. The patients were followed up for 12 to 20 months,with disappearance of pain in 7 cases. The degree of hip motion was markedly increased. The good results rated 87.5 percent.
From March. 1987 to March. 1989,we have treated 8cases of children with avascular necrosis of the femoral headby synovectomy of the hip and lateral circumflex femoralartery pedicled iliac bone graft to the femoral neck. Satisfac- tory therapeutic results were achived. The advantages of thisoperation are : 1. the microcirculation of the femoral headwas improved-by intraarticular decompression. 2. the venouspressure decreased by osteotomy at femoral head and neck.3. iliac bone graft can prevent femoral head coiiapsc.4.the blood supply of the femoral head was recstablished by vascularized iliac bone gredt.
目的:加深和提高对股骨头缺血坏死影像学诊断的认识,并对人工全髋关节置换术前、术后的影像学价值进行评估。方法:回顾性分析58例作全髋关节置换术患者的术前股骨头缺血坏死的X线(DR)、CT和MRI影像学改变特征,并对人工全髋关节置换术后X线(DR)片进行评估。 结果:58例患者,术前采用X线、CT及MRI诊断股骨头缺血坏死累计80个股骨头。其中64个股骨头行人工全髋置换 (6名患者为双侧),12个股骨头行钻孔减压植骨术,4个股骨头为非手术治疗。行人工全髋关节置换64个中,术后证实股骨头缺血坏死42个,髋关节发育不良继发骨关节病20个,创伤性骨关节炎2个。结论:股骨头缺血坏死中晚期患者,X线(DR)检查简便易行,结合CT、MRI检查,诊断准确率很高;人工全髋置换术是目前治疗晚期股骨头缺血坏死的最好选择。
ObjectiveTo study the clinical efficacy of core decompression and allogeneic nonvascularized fibular grafting on patients with different femoral head necrotic area. MethodsBetween January 2010 and December 2011, 59 hips in 59 patients with Ficat stage Ⅱ osteonecrosis of femoral head were treated with core decompression and allogeneic nonvascularized fibular grafting. Fifty-four patients (54 hips) were followed up. According to the necrotic area of femoral head, patients were divided into three groups: 6 hips in type A, 37 hips in type B and 11 hips in type C. We analyzed the outcomes by changes in radiographic images, Harris hip scores, hip activity and visual analogue scale (VAS) pain scores. The mean follow-up time was 40.1 months. ResultsThe postoperative X-ray images were good with no fibula prolapse, fracture or infection. Six femoral heads collapsed in patients of type C group. No head collapsed in patients grouped into type A or type B. The three groups' Harris hip scores were better than those before surgery (P<0.05). But the Harris hip score of patients with femoral head collapse was as bad as that before surgery (P>0.05). The Harris score of group C was significantly lower than group A and B (P<0.01). The joint movements of type A and type B patients were similar with those before surgery, and the VAS pain score was lower. But patients of type C suffered worse joint movement and the pain was not relieved. ConclusionThe clinical efficacy of femoral head necrotic patients treated with core decompression and allogeneic nonvascularized fibular grafting is generally good. But the risk of femoral head collapse in type C patients is high, and the clinic outcome is worse than patients of type A and B. Therefore this type of surgery is more suitable for patients with type A and B femoral head necrotic area.