| Objective To analyze the short-term clinical efficacy of patients with osteonecrosis of the femoral head (ONFH) in ARCO Ⅱa to Ⅲa stage who underwent decompression by large channel drilling, removal of the lesion, and bone grafting with autogenous cancellous bone in the femoral head, allogeneic granular bone, and allogeneic fibula.Methods From January 2018 to December 2020, 47 patients (59 hips) with osteonecrosis of the femoral head were enrolled in Sichuan Orthopaedic Hospital. There were 39 males and 8 females, aged from 29 to 51 years, with an average age of 37.2 years. There were 16 hips in stage ARCO Ⅱa, 21 hips in stage ARCO Ⅱb, 13 hips in stage ARCO Ⅱc, and 9 hips in stage ARCO Ⅲa; 46 hips had alcoholic ONFH(alcohol group) and 13 hips had hormonal ONFH(hormone group). After the postoperative outpatient follow-up, the X-ray (anteroposteric and frog radiographs of both hips) was reviewed to observe the morphology of the femoral head and bone integration, and the Harris score of the affected hip was recorded.Results A total of 47 patients (59 hips) were followed up for 24-36 months, with an average follow-up of 30 months. Postoperative pain relief was evident in all patients and disappeared in some patients (Ⅱa 14 hips, Ⅱb 13 hips, Ⅱc 4 hips). Femoral head collapse occurred in 6 patients (9 hips), including 1 hip in stage Ⅱb, 3 hips in stage Ⅱc, and 5 hips in stage Ⅲa. According to the etiology, 6 hips collapsed with alcohol necrosis (13%) and 3 hips collapsed with hormone necrosis (23.1%). There were significant differences in Harris scores between the two groups at the last follow-up compared with those before surgery (P<0.05). The Harris score of alcohol group [(82.7±5.6) scores] was significantly higher than that of hormone group [(78.3±8.3) scores] after operation, and the difference was statistically significant (P<0.05). The hip joint function of patients with different ARCO stages was improved to some extent, among which the excellent and good rate of Ⅱa and Ⅱb was 78.4%, and the excellent and good rate of Ⅱc and Ⅲa was 50% (P<0.05).Conclusion For patients with osteonecrosis of the femoral head at stage ARCO Ⅱa-Ⅲa, large-diameter channel decompression and removal of dead bone are adopted, and autologous cancellous bone and allogeneic granular bone mixture are implanted at the same time, and finally combined with allogeneic fibula bones to strengthen the support, which could effectively prevent collapse of necrotic femoral head in the short term, reduce pain and improve patients' function. |
