Necrosis avascular de la cabeza del fémur en un paciente pediátrico con drepanocitosis: a propósito de un caso / Avascular necrosis of the femoral head in a sickle cell disease pediatric patient: case report

Resumen La drepanocitosis o anemia de células falciformes es una hemoglobinopatía hereditaria que se transmite de forma autosómica recesiva, la cual está asociada con episodios de dolor agudo y daño progresivo a órganos blanco que producen un gran impacto en la esperanza y la calidad de vida de quienes la padecen. La necrosis avascular de la cabeza del fémur es una complicación bien conocida en los pacientes con drepanocitosis presente hasta en un 25 % de los pacientes adultos y tanto en un 12 % de los pacientes pediátricos. A continuación, se presenta el caso de un paciente masculino de 9 años con drepanocitosis, quien en cita de control refirió 15 días de coxalgia y claudicación de la marcha. Tras realizar estudios radiológicos se documentó una necrosis avascular de la cabeza del fémur, convirtiéndose de esta manera en el primer caso documentado en el Hospital Nacional de Niños de Costa Rica de un paciente pediátrico con una necrosis avascular de la cadera del fémur como complicación de su drepanocitosis.

Sickle cell disease is an autosomic recessive hereditary hemoglobin disorder, associated with episodes of acute pain and progressive organ damage with great impact on a patient's life expectancy and quality of life. Avascular necrosis of the femoral head is a well-known complication of sickle cell disease affecting almost 25% of adult patients and just in 12% of pediatric patients. Below is the case of a 9-year-old male patient with sickle cell disease, who on a control appointment reported 15 days of hip pain and gait claudication. After performing radiological studies, avascular necrosis of the femoral head was diagnosed, becoming the first case documented at the National Children Hospital of Costa Rica of avascular necrosis of the femoral head as a complication in a pediatric patient with sickle cell disease.

Research progress on the relationship between steroid-induced avascular necrosis of the femoral head and microRNA / 中国医师杂志

Steroid-induced avascular necrosis of the femoral head (SANFH) is the death of the femoral head caused by long-term use of glucocorticoid (GC). Its pathological manifestations are mainly trabecular bone collapse and increased empty bone lacunas, osteocyte apoptosis rate and autophagy rate. Its pathogenesis is complicated, and the exact pathogenesis is still unclear. MicroRNAs (miRNAs) are a group of endogenous, non-coding small RNAs with an average length of 23 nucleotides. They are responsible for negatively regulating gene expression after transcription by inhibiting target messenger RNAs (mRNAs). MiRNAs play an important role in physiological processes, including cell development, proliferation, differentiation, metabolism, migration and apoptosis. According to bioinformatics analysis, MiRNAs play an important role in regulating gene expression, and it is estimated that more than one-third of human genes are regulated by them. In the past few years, more and more miRNAs have been found to be related to osteonecrosis, such as regulating the proliferation and differentiation of mesenchymal stem cells and osteoblasts. This article aims to review the relationship between steroid-induced femoral head necrosis and miRNAs.

Application of bisphosphonates in avascular necrosis of the femoral head / 中国组织工程研究

BACKGROUND: Animal experiments have shown that bisphosphonates exhibit a preventive effect on femoral head collapse. However, clinical application of bisphosphonates remains disputed. Systematic administration of bisphosphonates has many adverse reactions. There is an increasing number of studies on local application of bisphosphonates. OBJECTIVE: To review the research progress of bisphosphonates in the treatment of avascular necrosis of the femoral head. METHODS: The first authors (GJC and MJH) searched PubMed and CNKI databases to retrieve papers regarding bisphosphonate treatment of osteonecrosis of the femoral head using the search terms “osteonecrosis of the femoral head, bisphosphonates, systemic therapy, topical therapy, osteogenesis, bone destruction, bone remodeling” in English and Chinese. Sixty-two eligible papers were included in the final analysis. RESULTS AND CONCLUSION: It remains disputed whether bisphosphonates inhibit or activate osteoblasts. Current studies have shown that low concentration of bisphosphonates can promote the proliferation of osteoblasts, while high concentration of bisphosphonates can inhibit the proliferation of osteoblasts. Long term systematic application of bisphosphonates can induce mandibular osteonecrosis and other side effects. Topical application of bisphosphonates for treatment of avascular necrosis of the femoral head is still in the experimental stage. The optimal bisphosphonate concentration and the duration of efficacy in the treatment of avascular necrosis of the femoral head have not been determined. These should be clarified by in-depth high-quality experiments prior to clinical application.

Hip preservation experience of avascular necrosis of femoral head according to China-Japan Friendship Hospital classification / 中国修复重建外科杂志

Objective: To sum up staging treatment experiences of hip preservation for avascular necrosis of the femoral head (ANFH) according to China-Japan Friendship Hospital Classification (CJFH Classification). Methods: The literature about hip preservation of ANFH was extensively reviewed, and a staging treatment method for ANFH was set up base on CJFH Classification and the 28 years of clinical experience in this research group. Results: According to CJFH Classification, the ANFH can be rated as types M, C, and L. And the type L is rated as L1, L2, and L3 subtypes. The staging treatment method for ANFH based on CJFH Classification is set up. Conservative treatment was selected for CJFH-M patients because the necrotic area is small and in the medial non-weight-bearing area. Minimally invasive sequestrum clearance, impacting bone graft, and supporting allogenic fibular graft is selected for CJFH-C patients because the necrotic area is also small and in the lateral non-weight-bearing area. If patients are in CJFH-L1, normal bone area is less than 1/3 on hip abduction radiograph, the sequestrum clearance and impacting bone graft via surgical hip dislocation approach can be selected. If patients are in CJFH-L1, normal bone area is more than 1/3 on hip abduction radiograph, the transtrochanteric curved varus osteotomy can be selected. The rotational osteotomy on the base of femoral neck via surgical hip dislocation approach is for CJFH-L2 patients. Total hip arthroplasty via direct anterior approach is for CJFH-L3 patients. Conclusion: The staging treatment method for ANFH according to CJFH Classification has good short-term effectiveness. But the long-term effectiveness needs further follow-up.

Evaluation of multimodal analgesia in treatment of avascular necrosis of femoral head with free vascularized fibular grafting / 中国修复重建外科杂志

Objective: To prospective study the effectiveness and safety of multimodal analgesia (MA) in treatment of avascular necrosis of the femoral head with free vascularized fibular grafting (FVFG). Methods: Sixty patients with avascular necrosis of the femoral head, who were scheduled to unilateral primary FVFG between February 2016 and December 2016 and met the selection criteria, were included in the study. All patients were allocated to two groups according to the method of random number table: MA group ( n=30) and control group ( n=30). There was no significant difference in gender, age, body mass index, side, duration and stage of avascular necrosis of the femoral head, preoperative visual analogue scale (VAS) scores under quiescent and active states, and range of motion (ROM) of hip flexion and abduction before operation ( P>0.05). The patients in the MA group were treated with MA therapy, including oral administration of celecoxib before operation, local anesthetic wound infiltration during operation, and ice compression and oral administration of celecoxib after operation. The patients in control group were only treated with patient-controlled intravenous analgesia pump. The postoperative VAS scores under quiescent and active states, ROM of hip flexion and abduction, prescription of Tramadol and adverse reaction were recorded and compared. Results: The operations were completed successfully in both groups without obvious complications and adverse reaction. The Tramadol was used in 4 cases (13.3%) of MA group and in 11 cases (36.7%) of control group, but no significant difference was found between the two groups ( χ2=4.356, P=0.072). The VAS scores under quiescent state at 6 and 24 hours postoperatively were significantly lower in MA group than in control group ( P0.05). The ROM of hip flexion in MA group was better than that in control group at 1 day postoperatively and the day of discharge ( P0.05). The ROM of hip abduction in MA group was superior to the control group at 1, 2, and 3 days postoperatively and the day of discharge ( P<0.05). Conclusion: The MA can effectively relieve the pain following FVFG and facilitate early functional exercises of the hip. The usage of opioids was also relatively fewer for MA protocol.

Value of virtual reality technology in preoperative planning of transtrochanteric curved varus osteotomy for avascular necrosis of femoral head in adults / 中国修复重建外科杂志

Objective: To research the value of virtual reality (VR) technology in the preoperative planning of transtrochanteric curved varus osteotomy for avascular necrosis of the femoral head (ANFH) in adults. Methods: Between June 2018 and November 2018, 7 patients (11 hips) with ANFH, who were treated with transtrochanteric curved varus osteotomy, were enrolled in the study. There were 4 males (7 hips) and 3 females (4 hips) with an average age of 31.9 years (range, 14-46 years). Among them, 3 patients were unilateral ANFH and 4 patients were bilateral ANFH. There was 1 patient (1 hip) of traumatic ANFH, 2 patients (4 hips) of alcohol-induced ANFH, 2 patients (3 hips) of hormonal ANFH, and 2 patients (3 hips) of idiopathic ANFH. All hips were Association Research Circulation Osseous (ARCO) stage Ⅲ. There were 5 hips for Japanese Investigation Committee (JIC) type C1 and 6 hips for type C2. There were 5 hips for China-Japan Friendship Hospital (CJFH) type L1,1 for type L2, and 5 for type L3. The disease duration ranged from 5 to 12 months (mean, 8 months). Preoperative Harris score was 53.91±7.66. The neck-shaft angle ranged from 128 to 143° (mean, 133.9°). VR technology was adopted for the preoperative planning. CT data were imported into the software to construct the morphology of necrotic area, and the transrtrochanteric varus osteotomy was simulated. The varus angle was designed according to the integrity rate of femoral head. The planned varus angle was 6 to 16° (mean, 9.7°). The transtrochanteric curved varus osteotomy was performed according to the preoperative planning, and the varus angle and loading area were confirmed under fluoroscopy. If the planned varus angle was too small, it would continue to increase under the fluoroscopy until a satisfactory varus angle. Postoperative changes of the neck-shaft angle were calculated and compared with the preoperative planned varus angle (error). The hip function was assessed by using the Harris score. Results: All incisions healed by first intention. All patients were followed up 6-11 months with an average of 8 months. The X-ray film at 2 days after operation showed that the neck-shaft angle was 112-135° (mean, 123.4°). The difference of the neck-shaft angle between pre- and post-operation was 6-16° (mean, 11.0°). Among them, the difference of the neck-shaft angle was consistent with planned varus angle in 5 hips, while the error of the remaining 6 hips was 1-4°. There was 1 patient (1 hip) of osteotomy nonunion at 4 months after operation, 1 patient (1 hip) of proximal femur fracture at 2 months after operation. The rest 5 patients (9 hips) obtained union at the osteotomy. At last follow-up, the Harris score was 82.18±16.35, showing significant difference when compared with preoperative score ( t=-5.195, P=0.000). Conclusion: VR technology is a brand-new preoperative planning method for transtrochanteric curved varus osteotomy in treating ANFH.

Treatment of avascular necrosis of femoral head in patients with human immunodeficiency virus infection by cementless total hip arthroplasty / 中国修复重建外科杂志

Objective: To investigate the effectiveness of cementless total hip arthroplasty (THA) in treatment of avascular necrosis of the femoral head (ANFH) in patients with human immunodeficiency virus (HIV) infection. Methods: The clinical data of 22 patients (35 hips) with HIV infection and ANFH (positive group), who were treated with cementless THA between February 2014 and January 2017, was retrospectively analyzed. Tirty-three cases (43 hips) without HIV infection, who were treated with cementless THA during the same period, were collected as control (negative group). There were significant differences in the age, gender, incidence of bilateral ANFH, and disease duration between 2 groups ( P0.05). The operation time, intraoperative blood loss, rate of blood transfusion, postoperative complications, and hospitalization time were recorded. The hip joint function was evaluated by Harris score and X-ray film was performed to observe the position of the prosthesis. Results: The follow-up time was 13-24 months (mean, 20.2 months) in positive group and 14-25 months (mean, 21.6 months) in negative group. The operation time of negative group was significantly shorter than that of positive group ( t=3.677, P=0.001). However, there was no significant difference in intraoperative blood loss, rate of blood transfusion, and hospitalization time between 2 groups ( P>0.05). There was no significant difference in Harris score between 2 groups before operation and at 1, 3, 6, and 12 months after operation ( P>0.05). There were 2 cases of superficial infection of incision and 1 case of pulmonary infection during hospitalization in positive group, and 1 case of superficial infection of incision and 1 case of venous thrombosis of lower extremity in negative group. No death or loosening and sinking of the prosthesis occurred in both groups during follow-up. Conclusion: Cementless THA is a safe and effective method for ANFH in patients with HIV infection.

Effect of platelet rich plasma combined with core decompression on the repair of steroid-induced avascular necrosis of the femoral head and the MMP/TIMP in rabbits / 中国比较医学杂志

Objective To observe the effect of platelet rich plasma(PRP)combined with core decompression on the steroid-induced avascular necrosis of the femoral head(SANFH)and on MMP/TIM in rabbits.Methods A total of 42 New Zealand white rabbits were used in this study,and were randomly divided into 3 groups(decompression,combination and control groups,each n=14). The rabbit model of SANFH was established by i.m. injecting prednisolone acetate in the decompression group and combination group. The improved Landesberg method was used to make the platelet rich plasma. The decompression group received core decompression treatment while the combination group received PRP combined with core decompression for bone repair. X-ray photography of the hip joint of the two groups were taken at 2,6 and 10 weeks after the surgery,and the Lane-Sandhu X-ray scores and new bone area ratio were compared. Venous blood samples of the 3 groups were collected and the bilateral femoral heads were taken for further examination. The left femoral heads were used for histopathological observation and the right ones were used to determine the expression of the mRNA of MMP-2,MMP-9, TIMP-1, and TIMP-2. Results The levels of MMP-2 and MMP-9 in the decompression group were higher than that in the combination group and control group after surgery. The levels of TIMP-1 and TIMP-2 in the decompression group were significantly lower than the combination group and control group(P < 0.05). The IL-6 level and the rate of empty bone lacunae in the decompression group were significantly higher than the combination group and control group(P < 0.05), and that of the combination group was higher than the control group(P < 0.05). The combination group had a better joint imaging and histopathological evaluation than the decompression group after surgery. Conclusions Our findings demonstrate that PRP combined with core decompression can exert a positive effect on the MMP/TIMP and bone tissue repair in the treatment of steroid-induced avascular necrosis of the femoral head in rabbits.

Expression features of osteoprotegerin, receptor activator of nuclear factor kappa-B and receptor activator of nuclear factor kappa-B ligand in avascular necrosis femoral head / 中国生化药物杂志

Objective To determine the protective effect of osteoprotegerin (OPG), receptor activator of nuclear factor kappa-B (RANK) and RANK ligand (RANKL) on avascular necrosis femoral head.Methods Necrotic tissue or corresponding normal tissues were collected from 29 avascular necrosis femoral head patients.Quantitative Real TimePCR ( qPCR ) is used to evaluate mRNA expression of OPG , RANK and RANKL.OPG and RANKL protein levels were estimated by Western blot.Results The results of qPCR showed that the expression of OPG in the necrotic tissue was significantly higher than that in the normal tissue (4.56 ±0.37) (3.39 ±0.52) (P<0.05).The expression levels of RANKL mRNA in necrotic tissues and normal tissues were (0.86 ±0.11) and (0.31 ±0.08), respectively,the difference was statistically significant (P<0.05).The expression levels of RANK mRNA in necrotic tissues and normal tissmes were(0.87 ±0.12), (0.56 ±0.13) respectively,the difference was statistically significant (P<0.05).The ratio of RANKL/OPG and RANK/OPG in normal tissues were 0.69 and 0.52, respectively.In the necrotic tissues, RANKL/OPG and RANK/OPG ratios were 1.35 and 0.61, respectively.Results of Western blot showed that the expression of OPG in necrotic tissues was consistent with that in normal tissues.The expression of RANKL protein was detected in all samples , and the expression of RANKL protein in necrotic tissue and normal tissue was almost the same.RANK protein expression was not detected in all samples.Conclusion OPG, RANK and RANKL play important roles in progress of bone remodeling in necrotic area and in disturbance of bone homeostasis and might have an effect on bone destruction and subsequent collapse of hip joint.

The Result of Total Hip Arthroplasty after Failure of Multiple Screw Fixation for Femoral Neck Fracture / 대한정형외과학회잡지

PURPOSE: The purpose of this study is to analyze the result of secondary total hip arthroplasty (THA) after primary internal fixation failure in femoral neck fracture patients and compare the results with primary THA for femoral neck fracture. MATERIALS AND METHODS: Among the femoral neck fracture patients, we analyzed clininal and radiologic results of those who underwent secondary THA after internal fixation failure and those who underwent THA as early treatment. Cases with patients over age 40 years and with at least two year of follow-up period were used for analysis. Periopertive conditions of patients were evaluated by using surgery time, bleeding amounts and period to start gait using walker or crutch after surgery. Clinical results were assessed by using Harris hip score and Western Ontario and McMaster Universities Osteoarthritis Index, and radiologic results were derived by observing follow-up simpe X-ray. RESULTS: The group of secondary THA had longer surgery time, more bleeding amount and longer period to start gait. But between the two groups, there was no difference of clinical and radiologic result at final follwing up. Both of two group had excellent clinical and radiological results. CONCLUSION: THA after internal fixation showed excellent clinical and radiologic results that was comparable to compare with primary THA.

Expression of glucocorticoid receptor in steroid-induced juvenile rabbit model of avascular necrosis of the femoral head and its significance / 中华实用儿科临床杂志

Objective To detect the expression of glucocorticoid receptor(GR) in juvenile rabbit modal of avascular necrosis of the femoral head,and explore the possible etiology of avascular necrosis of the femoral head in children.Methods Sixty New Zealand albino rabbits(50％ female and 50％ male),2 months old,body weight 1.4-1.7 kg,were randomly divided into 2 groups:steroid injection group (SIG) and control group(CG).The SIG(n =48):Prednisolone acetate of 7.5 mg/kg was injected into each rabbit twice a week for 8 weeks.The CG(n =12):9 g/L saline of 0.3 mL/kg was injected into each rabbit twice a week for 8 weeks.The immunohistochemistry and image analysis were used to detect the expression of GR.The SIG was divided into disease group(DG) and non-disease group(NDG).The expressions of GR were compared among DG,NDG and CG.Results In the 8th week after the first injection in SIG,31 out of 48 rabbits survived,and 7 out of 31 rabbits(22.85％) developed femoral head avascular necrosis.GR expression in DG was 100.00％ (7/7 cases),while in NDG and CG they were 20.83％ (5/24 cases) and 16.67％ (1/6 cases).Significant difference was found between DG and NDG/CG(all P ＜ 0.01),but not between NDG and CG.GR expression density in femoral cartilage in DG was higher than in NDG and CG(all P ＜ 0.01).GR expression IOD in femoral cartilage was 7942.21 ± 1886.94,but in DG and NDG they were extremely low or undetectable,which were 627.56 ± 281.85 and 571.48 ± 260.22,separately,and there was significant difference (all P ＜ 0.01).Conclusions Simple gluteal injection of glucocorticoid can lead to juvenile rabbits avascular necrosis of femoral head.GC and GR might play an important role in the onset and development of avascular necrosis of femoral head in juvenile rabbits.

Avascular Necrosis of the Femoral Head in a Patient with Poliomyelitis Treated by THA with a Large-diameter Metal Head - A Case Report - / 대한고관절학회지

Total hip arthroplasty (THA) can be a good treatment option for avascular necrosis (AVN) of the femoral head. However, because dislocation can frequently occur after surgery, THA is a concern in patients with a neuromuscular disease, such as cerebral palsy or poliomyelitis. In patients with poliomyelitis, only one case of AVN of the femoral head in the affected limb has been reported in the English literature. Here, the authors report on a case of AVN of the femoral head in a patient with poliomyelitis, who was treated with a large diameter femoral head metal-on-metal THA using a modified minimally invasive-2-incision technique.

A Comparative Study between CT and MRI in Diagnosing the Avascular Necrosis of the Femoral Head with Meta-analysis / 实用放射学杂志

Objective To evaluate the value of computed tomography(CT) and magnetic resonance imaging(MRI) in diagnosis of avascular necrosis of the femoral head(ANFH). Methods The literatures of ANFH diagnosed with CT and MR imaging published in the last ten years were collected by searching. Of that,21 literatures were correspond for the standards in this study and were select-ed. These literatures in diagnosing ANFH with CT and MR imaging were analysed with Meta-analysis by the sofeware of StataSE10.1. Results MRI was more effective than CT in diagnosing ANFH. There was significantly different in statistics between them [OR=0.13,95%CI(0.03～0.51)]. Conclusion In comparison with CT,MRI is the better method in diagnosing ANFH.

Inducing an animal model of avascular necrosis of the femoral head through exercise / 中华物理医学与康复杂志

Objective To establish an immature rabbit model of avascular necrosis of the femoral head in-duced by exercise. Methods Ten male, immature New Zealand white rabbits were subjected to large range, in- tense passive movement and concentric impingement on their right hips for 4 weeks. The left hips were used as self-controls. Then X-ray and magnetic resonance imaging, gross anatomical observation and histological examination were used to evaluate avascular necrosis of the femoral head. Result After 4 weeks, avascular necrosis of the femoral head was successfully replicated. Increased bone density, decreased osteoepiphysis height and indistinct bone trabec-ula were found in X-rays of the right hips. In MRI images obvious joint hydrops could be detected in all right hips, and schistic low signal areas in the femoral head could be seen in TIWI and T2WI images. Thin bone trabeculae of low density, with irregular and broken structures, were also found in H-E sections. Conclusion An immature rab-bit model of avascular necrosis of femoral head can be successfully induced through large range, intense, passive movement and concentric impingement.

Analysis of factors related to free vascularized fibular grafting for avascular necrosis of the femoral head / 中华显微外科杂志

is lesion size and staging in pre-operative and etiologies are the risk factors associated with postoperative progression.

The Clinical Observation on the Treatment of Avascular Necrosis of Femoral Head with Comprehensive Therapy Dominated by Medical Ozone / 国际中医中药杂志

Objective To investigate the clinical effect of treating avascular necrosis of femoral head with comprehensive therapy dominated by medical ozone. Methods Joint cavity of femoral articulation was performed blockage and injected with fluids for eliminating inflammation and reliving pain. After 5 to 10 minutes interval, if the patients did not show any abnormal reaction, medical Ozone with the concentration of 30%, 8 to 10ml, was injected to the joint cavity. Meanwhile, needle-knife therapy was used to reduce pressure inside the cavity. Traditional Chinese medicine was also used for the treatment. Results of all 183 femoral articulations of 135 cases, the therapeutic result of 38 articulations perfect, occupying 20.8% (38/183), 88 were good, occupying 48.1% (88/183), 31 were normal, occupying 16.9% (31/183) and 26 were bad, occupying 14.2% (26/183).The total effective rate was 85.8% (157/183). Conclusion The treatment of avascular necrosis of femoral head with comprehensive therapy dominated by medical ozone had outstanding therapeutic effects.

The effect of ultrashortwave therapy on the expression of BMP-2 in the early stages of steroid-induced avascular necrosis of the femoral head / 中华物理医学与康复杂志

Objective To observe the effect of ultrashortwave therapy on the expression of BMP-2 in steroid-induced avascular necrosis of the femoral head(SANFH). Methods Thirty New-Zealand white rabbits were randomly divided into two groups:a normal group(4 rabbits)and an intervention group(26 rabbits).An animal model of steroid-induced avascular necrosis of the femoral head was induced through the intravenous injection of horse blood serum and the intraperitoneal injection of methylprednisolone in the intervention group.X-ray examination confirmed the successful induction of SANFH in 20 of the rabbits,who were then subdivided at random into an uhrashortwave therapy group(1 0 rabbits)and a model group(1 0 rabbits).The rabbits in the ultrashortwave group were treated with ultrashortwave therapy in two 1 5-day courses,with a 5-day interval between them. Non-thermal ultrashortwave therapy was given in the first course,then mild thermal uhrashortwave therapy was given in the second.Those in the model group were reared without ultrashortwave therapy.All the animals were sacrificed immediately after the end of the last treatment,and their femoral heads were sampled to observe the expression of BMP-2 using real time fluorescent quantitative PCR. Results The expression of BMP-2 mRNA in the intervention group was only one fifth of that observed in the normal group.It was 2.7 to 10 times that observed in the model group.Both differences were significant at the 1% confidence level. Conclusion Ultrashortwave therapy can promote the expression of BMP-2 and improve reactivation in avascular necrosis of the femoral head.

Avascular Necrosis of the Femoral Head after Intertrochanteric Fracture

PURPOSE: We wanted to evaluate the incidence and causative factors of avascular necrosis (AVN) of the femoral head after intertrochanteric fracture. MATERIALS AND METHODS: Between 1994 and 2004, 383 cases of intertrochanteric fractures were internally fixed. Among them, 287 cases were followed more than one year; these cases were the subjects of this review. The average follow-up period was 5.3 years (range: 1.6 to 9.3 years). We retrospectively reviewed the medical records and radiographs of the patients who developed AVN of the femoral head after sustaining intertrochanteric fracture. RESULTS: Seven patients (2.4%) were found to have developed AVN during the follow-up. No patients were thought to be at risk for nontraumatic osteonecrosis of the femoral head due to steroid or alcohol abuse. Good reduction and good implant position were achieved in all patients. The duration from injury to the development of AVN was from 1 year to 3.8 years. The possible etiologies were initial vigorous trauma to the head and iatrogenic damage of the blood supply during reduction and fixation of the fracture. CONCLUSION: The patients who sustained inter trochanteric fracture should be monitored for development of AVN, and especially if there was an unstable fracture.

Effect on avascular necrosis of the femoral head with vascular endothelial growth factor / 中国矫形外科杂志

[Objective]To explore a new method for the therapy of avaseular necrosis of the femoral head with vascular endothelial growth factor(VEGF).[Method]Thirty New Zealand white rabbits were chosen as experimental animals and avascularnecrosis of the femoral head model of 22 rabbits were established.Animals were egually divided into three groups:VEGF group,natural repair group,normal group.The medicament was injected to the femoral head by percutaneous injection in group A and normal saline in group B.The repairing process of bone necrosis of femoral head were studied.[Result]Compared to the untreated model group(group C),the femoral head of VEGF groups showed significant new vessel formation,number of empty bone lacunae decreased and hematopoietic tissue improving in marrow cavity.X-ray film and CT revealed evident that veGF could enhance repairing of the femoral head.[Conclusion]Pereutaneous injection of VEGF to the necro femoral head could significantly enhance bone tissue angiogenesis and ameliorated repair of osteonecrosis,thus providing a potential method for the treatment of the femoral head necrosis.

Research and advancement of treating avascular necrosis of the femoral head / 介入放射学杂志

To undertake retrospective analysis of the research and advancement of treating avascular necrosis of the femoral head.After comparing the superiority and inferiority of different treatments and the present therapeutic status many therapeutic methods for avascular necrosis of the femoral head have been performed,commonly according to the staging of necrosis.Conservative therapy is suitable for stage 0 ～Ⅰ,interventional therapy is suitable for stage Ⅱ～Ⅲ,operation is adapted for stage Ⅱ～ Ⅲ and femoral head collapse or degenerative changes.Avascular necrosis of the femoral head is a chronic and dysfunctional illness.Comprehensive treatment according to different stage is now the most popular.Interventional therapy is the study focus of the avascular necrosis of the femoral head meanwhile.(J Intervent Radiol,2006,15: 636-639)