[Treatment of osteonecrosis of femoral head with minimally invasive vascularized bone grafting].
OBJECTIVE
To evaluate the clinical effect of treatment of osteonecrosis of the femoral head (ONFH) by minimally invasive vascularized bone grafting.


METHODS
232 ONFH patients (232 hips), 146 males and 86 females, aged 39.8 (22 - 55), 114 being at the Ficat and Arlet stage II, 96 at stage III, and 22 at stage IV, were treated with minimally invasive vascularized bone grafting: pedicled iliac bone flap bone flap with ascending branch of the lateral femoral circumflex artery (ALFCA) in 83 cases, pedicled greater trochanter bone flap with transversal branch of the lateral femoral circumflex artery (TLFCA) in 66 cases, pedicled greater trochanter bone flap with gluteal muscle branch of ascending branch of the lateral femoral circumflex artery (GALFCA) in 54 cases, and pedicled greater trochanter bone flap with double blood vessels (TLFCA and GALFCA) in 29 cases. The mean incision length was 9.8 cm (7 - 11 cm). All patients were followed up for 39 months (10 - 62 months) and were assessed clinically and radiologically according to Harris scoring. Selective digital subtraction angiography was performed in 58 cases to confirm the blood reconstruction of femoral head.


RESULTS
The postoperative Harris score was 87.8, higher than the preoperative Harris score (57). The clinical success rate was 87.5% and the radiological success rate was 79.7%. Kaplan-Meier survivorship curves showed that the overall survival rate was 90.09%, the survival rates of the patients at the Ficat stage II and Ficat stage III were 96.49% and 88.54% respectively, both significantly higher than that of the patients at the Ficat stage IV (63.64%, P < 0.01, P = 0.0084). DSA demonstrated satisfactory filling of the vessel pedicles and abundant blood supply in 56 of the 58 necrotic femoral heads. Twenty-three cases had to undergo total hip replacement 16 - 58 month after the minimally invasive vascularized bone grafting.


CONCLUSIONS
Blood supply of bone flap and blood reconstruction of femoral head can be achieved by using minimally invasive vascularized bone grafting in treatment of osteonecrosis of the femoral head with a satisfactory clinical effect in early to mid-term follow-up.
Zhao
De-wei
DW
Department of Orthopedics, Zhongshan Hospital of Dalian University, Dalian 116001, China.
Wang
Ben-jie
BJ
D000328:Adult; D015901:Angiography, Digital Subtraction; D016025:Bone Transplantation / Q000379:methods*; D005260:Female; D005271:Femur Head Necrosis / Q000000981:diagnostic imaging / Q000601:surgery*; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures; D013524:Surgical Flaps; D016019:Survival Analysis; D014182:Transplantation, Autologous; D055815:Young Adult