[CLINICAL APPLICATION OF THREE DIMENSIONAL PRINTED NAVIGATION TEMPLATES FOR TREATMENT OF OSTEONECROSIS OF FEMORAL HEAD WITH PEDICLED ILIAC BONE GRAFT].
OBJECTIVE
To investigate the feasibility and early effectiveness to treat osteonecrosis of the femoral head (ONFH) with pedicled iliac bone graft assisted by individual digital design and three dimensional (3D) printed navigation templates.


METHODS
Between February and June 2014, 15 patients (24 hips) with ONFH underwent pedicled iliac bone graft assisted by individual digital design and 3D printed navigation templates. There were 11 males (17 hips) and 4 females (7 hips) with a mean age of 38 years (range, 18-56 years) and a mean disease duration of 7.5 months (range, 1-24 months); the left hip was involved in 2 cases, the right hip in 4 cases, and both hips in 9 cases. There were 7 cases (12 hips) of steroid-induced ONFH, 5 cases (8 hips) of alcohol-induced ONFH, 1 case (1 hip) of traumatic ONFH, and 2 cases (3 hips) of idiopathic ONFH. The preoperative Harris score was 56.60 ± 6.97. According to Association Research Circulation Osseous (ARCO) staging system, 5 hips were classified as stage IIB, 8 hips as stage IIC, 6 hips as stage IIIB, and 5 hips as stage IIIC. The navigation templates were designed and printed to assist accurate location and debridement of necrosis area according to preoperative CT scanning at the beginning of pedicled iliac bone grafting procedure.


RESULTS
The mean operation time was 135 minutes (range, 120-160 minutes), mean amount of bleeding was 255 mL (range, 200-300 mL). All the wounds healed primarily, no complication of deep vein thrombosis or infection was observed. All patients were followed up 12-16 months (mean, 14 months). The location of necrosis area was in accordance with preoperative design, which was removed completely without penetration of joint surface, pedicled iliac bone graft was performed at the right site according to postoperative imaging examination. Radiographically, graft fusion was achieved at 2.7 months (range, 2-3 months) in all patients. All the hips had no collapse during follow-up. Hip pain was relieved, and range of motion was improved. The Harris score was significantly improved to 89.53 ± 5.83 at last follow-up (t = 14.3 19, P = 0.000). The results were excellent in 12 hips, good in 10 hips, and fair in 2 hips according to Harris score standard.


CONCLUSIONS
Pedicled iliac bone graft assisted by individual digital design and 3D printed navigation templates for treatment of adult ONFH has the advantages of accurate location and complete debridement of necrosis area, so satisfactory results can be obtained.
Kaifu
K
Yu
Yongqing
Y
Xu
Hongbo
H
Tan
Xiaoqing
X
He
Dixin
D
Cai
Tianhua
T
Zhou
Haotian
H
Luo
Jiazhang
J
Duan
D000328:Adult; D016025:Bone Transplantation / Q000379:methods*; D003646:Debridement; D005240:Feasibility Studies; D005260:Female; D005265:Femoral Neck Fractures / Q000601:surgery*; D005270:Femur Head / Q000601:surgery*; D005271:Femur Head Necrosis / Q000209:etiology / Q000601:surgery*; D006615:Hip; D006801:Humans; D007085:Ilium / Q000637:transplantation; D008297:Male; D011184:Postoperative Period; D016059:Range of Motion, Articular; D013524:Surgical Flaps / Q000098:blood supply