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BACKGROUND:Free vascularized fibular grafting is an effective hip preservation treatment for femoral head osteonecrosis,but its influencing factors are still controversial. OBJECTIVE:To explore the clinical efficacy of free vascularized fibular grafting for femoral head osteonecrosis,and the influence of the etiology and severity of femoral head osteonecrosis on its efficacy. METHODS:Clinical data and clinical efficacy scores of preoperative and postoperative hip joints in 63 patients with femoral head osteonecrosis(73 cases of hip)were enrolled.The subjects were divided into three groups by the etiological classification criteria of femoral head osteonecrosis,including glucocorticoid-associated,alcohol-associated,and idiopathic groups,and also were divided into three groups by the Ficat classification system,including Ficat Ⅱ,Ficat Ⅲ and Ficat Ⅳ groups.The effects of etiological classification and lesion degree on the clinical efficacy of free vascularized fibular grafting for femoral head osteonecrosis were analyzed. RESULTS AND CONCLUSION:(1)The visual analog scale scores in all periods after free vascularized fibular grafting for femoral head osteonecrosis were significantly decreased compared with preoperative data(P<0.001),and Harris scores were significantly increased compared with preoperative data(P<0.001).(2)In the glucocorticoid-associated,alcohol-associated,and idiopathic groups,except the glucocorticoid-associated group,postoperative Harris scores were significantly increased 2 and 3 years after surgery in other groups compared with preoperative data(P<0.05).(3)In the three groups of Ficat Ⅱ,Ficat Ⅲ,and Ficat Ⅳ,the postoperative Harris scores of Ficat Ⅱ and Ficat Ⅲ groups were significantly increased compared with preoperative data(P<0.05),while the difference was not significant in the Ficat Ⅳ group between the preoperative and postoperative data(P>0.05).(4)These results indicate that the clinical effect of free vascularized fibular grafting for the femoral head osteonecrosis is significant,which can reduce hip pain and improve hip joint function.It may not be affected by the etiology,but by the severity of the femoral head osteonecrosis.
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@#Objective To investigate the morbidity and characteristics of adult osteonecrosis of the femoral head (ONFH) in Chengdu, and to further explore its related risk factors.Methods Self-designed questionnaires were used to collect data by the way of household or field survey. From January,2016 to February, 2018, a total of 544 cases (797 hips) diagnosed as ONFH were included in the study. The medical data including general condition, risk factors, diagnosis, disease stages and treatment were collected. Based on the data, the risk factors were analyzed statistically.Results The average age of 544 patients (392 males and 152 females) was 55 years old (range: 19 to 90 years); the bilateral incidence was 46.51% (253 cases). The proportion of Association Research Circulation Osseous stages was accounted respectively 3.64% for stage I, 6.15% for stage II, 8.41% for stage III and 81.81% for stage IV when confirmed ONFH initially. In all the reasons of ONFH, 52.39% were alcohol-associated osteonecrosis, 16.18% for steroid-induced osteonecrosis, 11.58% for traumatic osteonecrosis, 5.88% for dysplastic osteonecrosis, and 13.97% for other reasons.Conclusion The incidence of ONFH was higher in men than in women. Stages III-IV accounted for the highest proportion. The high intake of alcohol or overuse of steroid was the leading causes of adult ONFH, among which alcohol-associated osteonecrosis was the main for the males and steroid-induced osteonecrosis for the females.
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Objective To observe the curative effect of autologous bone marrow stem cells implantation to bone inducing active material combined with core decompression in the treatment of early femoral head osteonecrosis (FHON).Methods From April,2010 to March,2012,in Department of Orthopaedics,the First Affiliated Hospital of Zhengzhou University,a total of 79 adult patients with 108 hips suffered from the early stage FHON were treated with autologous bone marrow stem cells implantation to bone inducing active material combined with core decompression through the core of the femoral canal,male of 65 cases,female of 14 cases,the mean age was 29.5 (20-50) years old.According to the etiology classification:the alcohol-induced FHON was in 54 patients with 66 hips,steroid-induced FHON in 14 patients with 20 hips,steroid and alcohol-induced ONFH was in 11patients with 22 hips.According to association research circulation osseous (ARCO)classifying,Ⅰ-A,Ⅰ-B,Ⅱ-A,Ⅱ-B phases were 6,16,8,and 78 hips,respectively.There were 43 hips in left side and 65 hips in the right side.Results All patients were followed up from 4 to 6 (4.8 ± 0.6) years.Compared with before operation,the scores of all patients were significantly increased (P ＜ 0.05).All patients with hip pain symptoms were relieved or disappeared.The healing tine of the patients in all age groups was statistically significant (P ＜ 0.05),and with the increase of age,the healing time was prolonged.The excellent and good rates of Ⅰ-A,Ⅰ-B,Ⅱ-Aand Ⅱ-B were 100％ (6 / 6),100％ (16/16),100％ (8/8),and 98.7％ (77/78).The X-ray showed that coarse channel osteogenic phenomenon is obvious,there is 1 case collapse of femoral head of stage Ⅱ-B,the rest were not collapse.Conclusion The treatment of early osteonecrosis of the femoral head with autologous bone marrow stem cells implantation to bone inducing active material combined with core decompressionis definitely effective,especially in patients with ARCO:Ⅰ-A,Ⅰ-B and Ⅱ-A phase,and the effect of ARCO:Ⅰ-A and Ⅱ-A is the best.
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Liver transplantation has improved the survival of patients with end stage liver disease. As the rates of success of liver transplantation continue to increase, more patients who have a liver transplant will become candidates for joint replacement due to osteonecrosis. The incidence of osteonecrosis has been variously reported as from 2% to 8.2% after liver transplantation. However, there are only three reports in the English medical literature about total hip arthroplasty for osteonecrosis of the femoral head following liver transplantation, and especially there has not been such a report from Asian countries. We report here on two patients with transplanted livers and who then underwent total hip arthroplasty.
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Humans , Arthroplasty , Asian People , End Stage Liver Disease , Head , Hip , Incidence , Joints , Liver , Liver Transplantation , Osteonecrosis , TransplantsABSTRACT
Disruption of blood supply to the femoral head and subsequent hypoxia are implicated in the pathogenesis of osteonecrosis of the femoral head(ONFH),which frequently leads to the progressive collapse of the femoral head,thus causing degenerative arthritis of the hip joint.But the pathophysiology of osteonecrosis of the femoral head has not been completely elucidated.It is accepted that steroids and alcohol intake are two most common causes of ONFH.Now many theories have been proposed to decipher the etiology and pathogenesis of ONFH,including abnormal lipid metabolism,elevated intraosseous pressure,intravascular coagulation,second collision theory,etc.The purpose of this review is to summarize the etiology and pathogenesis of osteonecrosis of the femoral head.
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[Objective]To explore the expression of OPG/OPGL protein and its significance in rat model of trauma-induced osteonecrosis of the femoral head(ONFH). [Methods]Thirty-two SD rats about 6 months were divided randomly into experimental and control groups.The animal model of femoral head necrosis was established in 32 SD rats by removing round ligaments of femoral head.Animals were sacrificed at 1,2,4 and 6 weeks after operation,respectively.The specimens were examined through histological observation under light microscope.The other side with sham operation served as normal control group.The comparison of fat tissue with hematopoietic tissue in the cavity of bone marrow of femoral head were performed by CMIAS computer-assisted image and statistical analysis.The percentage of empty lacuna in the femoral heads was obtained.Immunohistochemistry was used to determine the expression of OPG/OPGL protein in ONFH.[Results]ONFH was confirmed in experimental group.The model in various stages was successfully duplicated.Compared with normal control group,the percentage of empty lacuna remarkable increase was found in experimental groups in different periods(P