Clinical research of correlation between osteonecrosis and steroid / 中华外科杂志

<p><b>OBJECTIVE</b>To explore the correlation between the dosage of corticosteroid, time of onset and incidence of osteonecrosis (ON) in patients with SARS.</p><p><b>METHODS</b>From July 2003 to January 2004, general survey carried out for ON in 551 patients with SARS. Five hundred and fifty-one patients except 12 were administrated by corticosteroid from 80 mg to 30 000 mg. The age of patients was (33 +/- 9) years old ranging from 19 to 59 years old. One hundred and thirty-one were male, and four hundred and twenty were female. MRI and X-ray film were taken in all patients including both hips, knees, shoulders, ankles and wrists. CT scan was taken in partial patients. Common classification system were used for staging of hip (ARCO), knee (Lotka) and shoulder (Cruess). Independent test, rank-sum test and multiple factor logistic regression analysis were used for statistical analysis.</p><p><b>RESULTS</b>No osteonecrosis was detected in 12 patients without corticosteroid. Osteonecrosis was detected in 176 patients (32.7 percent) among 539 patients. There were ON of femoral head in 130 cases (210 hips), ON of knee in 98 cases (130 knees), ON of humeral head in 21 cases (36 shoulders), ON of talus and calcaneus in 16 cases (26 ankles), ON of scaphoid and lunate in 11 cases (17 wrists), ON of patella in 3 cases (4 patella), ON of ilium in 1 case and bone infarction (femur, tibia) in 18 cases. One hundred and nineteen cases (195 hips) with ONFH were in stage I (IA 45 hips, IB 77 hips, IC 73 hips). Eleven cases (15 hips) were in stage II. All osteonecrosis of the knee and humoral head was stage I. Thirty-four patients with ON had one joint affected, 45 patients had 2 joints, 93 patients had more than 3 joints. The dosage of corticosteroid was (5842 +/- 4988) mg in ON group and (2719 +/- 2571) mg in non-ON group (P < 0.0001). The duration of steroid was (38 +/- 17) d in ON group and (27 +/- 15) d in non-ON group (P < 0.01). The dosage of pulse treatment was (340 +/- 207) mg/d in ON group and (211 +/- 160) mg/d in non-ON group (P < 0.01). The duration of pulse treatment was (28 +/- 13) d in ON group and (18 +/- 11) d in non-ON group (P < 0.01). All patients with ON were detected within 6 months from administration.</p><p><b>CONCLUSION</b>About one-third patients with SARS who were treated with a high dose of corticosteroid occurred osteonecrosis. ON is frequently multiple focuses. The actual time of onset of ON is early of steroid used. MRI is golden standard for early diagnosis of ON. The patients who were treated with a high dose of corticosteroid should be inspected initially by MRI.</p>

Transtrochateric rotational osteotomy for osteonecrosis of the femoral head / 中华外科杂志

<p><b>OBJECTIVE</b>To explore the indications, operative technique and clinical results of the transtrochanteric rotational osteotomy (TRO) for osteonecrosis of the femoral head (ONFH).</p><p><b>METHODS</b>Nineteen patients (23 hips) with ONFH underwent TRO from October 1992 to May 2001 were reviewed. There were 14 males and 5 females. The age was ranging from 22 to 43 years old with an average age of 33.4 years old. The etiology were as followed: alcoholism 10 cases (12 hips); steroid 6 cases (7 hips); trauma 2 cases (2 hips); caisson disease 1 case (2 hips). Ficat stage: II 8 cases 8 hips; III 11 cases 15 hips. Harris hip score 46 to 74 with mean score 56 preoperatively. In order to determine the location and extent of osteonecrosis, A-P view and accurate lateral view (the film should be placed parallel to the femoral neck with the hip in precisely 90 degrees and flexion 45 degrees of abduction and neutral rotation) were taken in both hips preoperatively. The surgical technique described by Sugioka were used in all patients.</p><p><b>RESULTS</b>Seventeen patients (19 hips) were followed up ranging from 18 to 11 years with mean 54 months. The Harris hip score was from 55 to 94 with mean 80.5. Fourteen hips score more than 80 and good to excellent rate was 73.2%. Harris score were less than 79 in 5 cases and 4 hips of these 5 hips were revised by total hip arthroplasty. The rotation angle was from 55 degrees to 80 degrees with mean 60 degrees .</p><p><b>COMPLICATIONS</b>The circumflex femoral medial artery injury was found in 1 hip; subtrochanteric fracture was found in 2 hips and 1 osteotomy site nonunion occurred.</p><p><b>CONCLUSION</b>TRO can be used to treat ONFH. The indications include: (1) younger patients (less than 45 years old). (2) Ficat stage II and III with more than one third intact articular surface of the femoral head. The better results could be obtained using posterior rotation and lager rotational angle. The Sugioka osteotomy should be used carefully because of its complicated surgical technique.</p>

Vascularized iliac bone grafting for avascular necrosis of the femoral head / 中华外科杂志

<p><b>OBJECTIVE</b>To evaluate the indications for vascularized iliac bone grafting in the treatment of osteonecrosis of the femoral head and operative results.</p><p><b>METHODS</b>From October 1993 to August 2000, Twenty-six hips of 18 patients with osteonecrosis of the femoral head underwent vascularized iliac bone grafting. Clinical evaluation was made according to Harris Hip Score and ARCO staging system.</p><p><b>RESULTS</b>Twenty-three hips of 16 patients were followed up for 31.5 months (6 - 74 months) on average. The mean Harris hip score was 76 patients (mean 61.7). Thirteen hips (medial 8 hips, central 3 hips, lateral 2 hips) were graded > 80 points by Harris hip score were. The incidence of radiographic collapse 20% was (medial), 40% (central) and 75% (lateral) respectively.</p><p><b>CONCLUSIONS</b>Vascularized iliac bone grafting is effective for the treatment of osteonecrosis of the femoral head in short and middle term. We recommend this procedure for the patients with ONFH in ARCO stage I, stage IIA, IIB medial and central, and stage IIC medial.</p>