异体螺纹骨笼结合自体松质骨支撑治疗早期股骨头坏死的临床疗效

目的回顾性分析髓心减压及异体螺纹骨笼结合脱钙骨基质和自体骨植入术治疗早期股骨头坏死的临床疗效。方法2000年2月至2007年8月,治疗早期股骨头坏死患者73例78髋,男50例53髋,女23例25髋;年龄27～49岁,平均37岁。采用侧方小切口入路,行髓心减压及异体螺纹骨笼结合脱钙骨基质和自体骨植入术。术后预防性静脉给予抗生素及抗凝治疗;3周内禁止负重,3周后可部分负重,然后逐步过渡至完全负重。采用Harris评分系统评估术后患髋功能的改善情况;术后3、6、12、18及24个月摄正、侧位x线片,观察股骨头修复情况及有无坏死进展。结果57例59髋获得随访,随访时间2—5．5年,平均3．5年。术后24个月进行疗效评估,优40例41髋,良8例9髋,可4例4髋,差（手术失败）5例5髋手术失败的5例患者中SteinbergⅡB期2例、IIC期3例。患者的Harris评分由术前的50～75分,平均（63．5±6．6）分,提高至术后的32～100分,平均（81．1±17．2）分（t=17．6,P=0．0026）,其中手术失败患者的Harris评分由术前的51～61分,平均（53．6±3．9）分,降至术后的32～47分,平均（39．64-3．6）分（t=11．2,P=0．06）。Kaplan．Meier生存率曲线示术后24个月手术成功率为87．2％。X线片表现与临床症状、体征的改变基本相符。结论髓心减压及异体螺纹骨笼结合脱钙骨基质和自体骨植入术治疗早期股骨头缺血性坏死适合于SteinbergI、Ⅱ期股骨头坏死患者。     

异体骨笼结合脱钙骨基质和自体骨植入治疗股骨头坏死的临床观察

目的回顾性分析髓心减压及异体螺纹骨笼结合脱钙骨基质和自体骨植入治疗早期股骨头缺血坏死的临床疗效及其影响因素。方法华中科技大学附属协和医院骨科于2000年2月至2005年10月间收治早期股骨头坏死的患者54例（56髋），年龄为27～51岁，平均38．5岁；所有患者经侧方小切口入路，行髓心减压及异体螺纹骨笼结合脱钙骨基质和自体骨植入。术后预防性地静脉给予抗生素及抗凝治疗；3周内禁止负重，3周后可部分负重，然后逐步过渡至完全负重。所有均获得随访，进行临床和影像学评估。临床评估采用Harris评分系统，评估术后患髋功能的改善情况；影像学评估主要是于术后3、6、12、18及24个月摄取正位及侧位x线平片，观察股骨头修复及有无坏死进展。结果54例患者（56髋）均获得随访，在术后24个月进行疗效评估。参考Harris评分系统，本组优32髋，良15髋，可4髋，差5髋。患者术前的平均Harris评分为62．8分，术后平均评分为81．6分，平均提高了18．7分（P〈0．001）。Kaplan—Meier生存分析表明，术后24个月手术成功率为91％。x线影像学的变化与临床症状、体征的改变基本相符。结论髓心减压及异体螺纹骨笼结合脱钙骨基质和自体骨植入术治疗早期股骨头坏死，其治疗效果优良，适合于Ⅱ期和Ⅱ期股骨头坏死，并能有效防止股骨头塌陷。     

同种异体骨支撑架结合自体骨和DBM治疗股骨头坏死的生物力学研究

[目的]研究同种异体骨支撑架结合自体骨和脱钙骨基质（decalcified bone matrix，DBM）植入治疗股骨头坏死生物力学变化。[方法]建立羊双侧股骨头坏死模型，4周后分为4组：单纯行髓芯减压组（A组）、髓芯减压后植入自体松质骨和OSTEOSET^2 DBM组（B组）、髓芯减压后植入同种异体骨支撑架／自体松质骨OSTEOSE^2 DBM组（C组）和正常对照组。术后分别于5、10、20周对股骨头行影像学、组织学观察和生物力学测定。[结果]影像学和组织学检查结果显示C组在髓芯减压区骨缺损修复及成骨方面较B组略高，B、C两组都较同时期的A组明显增强。生物力学测试结果表明，术后5、10、20周时C组力学强度较A、B两组明显增高．差异有统计学意义（P〈0．05），在10、20周时C组股骨头生物力学强度和正常股骨头己无明显差异。[结论]应用同种异体骨支撑架结合自体骨和脱钙骨基质治疗股骨头坏死，能有效加强股骨头的力学结构，促进坏死骨的修复，防止股骨头关节面的塌陷。     

同种异体螺纹骨笼结合脱钙骨基质治疗成人股骨头缺血性坏死

目的探讨采用同种异体螺纹骨笼结合脱钙骨基质(DBM)治疗早、中期股骨头缺血性坏死(ONFH)的中期随访效果。方法采用同种异体骨支撑架结合DBM治疗40例(60髋)ONFH患者并随访观察。按Ficat分期:Ⅱ期35髋,Ⅲ期25髋。结果 40例(60髋)获随访,时间9年6个月~12年5个月。术后Harris评分为(82.78±10.77),与术前(53.20±15.72)分比较差异有统计学意义(P0.01)。其中优29髋,良20髋,可3髋,差8髋,优良率81.7%。差评的8髋全部行人工全髋关节置换术。结论同种异体螺纹骨笼联合DBM治疗成人ONFH手术损伤小,特别是适合治疗早期ONFH的年轻患者,中期疗效满意,能有效防止股骨头塌陷。     

两种强化股骨头力学结构治疗股骨头坏死临床疗效比较

[目的]比较同种异体骨支撑架/自体松质骨/脱钙骨基质（DBM）与钛合金支撑架/自体松质骨/脱钙骨基质（DBM）分别植入行髓芯减压后的股骨头,强化其力学结构,治疗股骨头坏死的疗效。[方法]2001年1月～2004年8月治疗成人股骨头坏死（FicatⅠ～Ⅲ期）63例（68髋）,在股骨头坏死行髓芯减压后分别植入同种异体骨支撑架/自体松质骨/DBM（A组）和钛合金支撑架/自体松质骨/DBM（B组）,A组32例（34髋）,B组31例（34髋）,分别观察2组病例的手术时间、术中出血量、Harris髋关节评分、X线影像学进展情况及并发症的发生率。[结果]两组所有患者均获得随访,平均随访47个月（24～67个月）,以最后1次随访资料作为最终评价依据。两组在手术时间、术中出血量、Harris评分变化、X线影像学进展情况及并发症的发生率方面均无显著性差异,但两组术后的Harris评分均较术前明显提高,差异有显著性。[结论]同种异体骨支撑架结合自体松质骨和DBM植入治疗成人股骨头坏死,和钛合金支撑架一样能增加股骨头负重区软骨下骨的机械支撑,有利于股骨头坏死的修复与重建。能用同种异体骨支撑架代替钛合金支撑架以加强股骨头软骨下骨的机械强度治疗股骨头坏死。     

髓心减压植骨与钽棒植入治疗股骨头缺血性坏死

目的研究比较髓心减压植骨与钽棒植入治疗股骨头缺血性坏死的临床疗效。方法选择2008年5月至2010年3月我院收治的成人股骨头缺血坏死患者（均为Ficat期）26例（31髋）,男19例,女7例;年龄24～63岁（平均41.3岁）。其中15例（19髋）采用髓心减压植骨术治疗,11例（12髋）采用髓心减压钽棒植入术治疗。记录两种术式的失血量、手术时间、输血量、住院天数、Harris评分和镇痛泵的使用天数。结果所有病例均获得术后随访4～24个月,两组术中失血量、手术时间、输血量、镇痛泵的使用天数比较差异无统计学意义,而住院天数髓心减压钽棒植入组明显长于髓心减压植骨组（P〈0.05）。两组术前Harris评分比较没有统计学意义,两组术后Harris评分较术前均有明显提高（P〈0.05）,术后Harris评分髓心减压钽棒植入组（88.24分）高于髓心减压植骨组（71.84分）,提高22.8%,数据差异有统计学意义（P〈0.05）。结论髓心减压钽棒植入术对早期成人股骨头坏死髋关节功能改善明显优于髓心减压植骨术,但住院天数较长。     

髓芯减压加自体多能干细胞、脱钙骨基质植入治疗早期股骨头坏死

目的:观察髓芯减压加自体多能干细胞、脱钙骨基质(DBM)植入治疗早期股骨头坏死的疗效。方法:采用髓芯减压加自体多能干细胞、DBM植入术治疗股骨头缺血性坏死80例(96髋),男43例,女37例;单髋64例,双髋16例;年龄21~62岁,平均38.4岁;病史8个月~3年,平均1.4年。按ARCO分期标准:Ⅰ期62髋,Ⅱ期34髋。根据术前术后症状、髋关节功能评分、X线及CT结果进行评价,分析其疗效。结果:随访超过2年的52例(61髋)中46髋效果明显,10髋病情缓解,5髋病情无进展,优良率为91.8%(56/61)。髋关节Harris评分由术前平均(49.1±7.5)分增至术后平均(75.2±5.9)分,差异有显著性统计学意义(P<0.01)。结论:髓芯减压加自体多能干细胞、DBM植入术是治疗早期股骨头坏死的一种有效方法。     

股骨头髓心减压自体骨髓细胞加松质骨移植治疗股骨头坏死

目的探讨股骨头髓心减压自体骨髓细胞松质骨移植治疗股骨头缺血坏死的临床疗效。方法对69例（90髋）成人股骨头坏死（ARGO分期Ⅰ-Ⅱ期），采用髓心减压自体骨髓细胞自体松质骨移植，术后采用髋关节Harris评分及影像学评定疗效。结果髓心减压自体骨髓细胞松质骨移植具有手术时间短、出血少，损伤小的优点。术中术后无严重并发症。所有患者获平均34．5个月随访，优良率达86％（P〉005）。结论髓心减压自体骨髓细胞松质骨移植，治疗成人早期股骨头缺血坏死是一种微创安全，有效的治疗方法。     

股骨头髓心减压加异体腓骨移植术治疗股骨头坏死

目的探讨股骨头髓心减压加异体腓骨移植术治疗早期股骨头缺血性坏死的疗效。方法1998年6月～2004年8月，采用股骨头髓心减压加异体腓骨移植术治疗Ⅰ～Ⅲ期股骨头缺血性坏死22例39髋，其中男17例，女5例。年龄22～60岁。术前疼痛时间2～12个月，平均6、5个月。所有患者于术前及术后15d，3个月和6个月行双髋关节功能、常规X线片、ECT、CT和MRI检查。结果患者均获随访3～74个月，平均31．4个月。17例临床症状缓解明显，Harris评分从术前平均78分升至术后91．6分。18例X线片显示髋关节形态基本保持完好，无明显坏死进展。ECT、CT和MRI检查均见植骨成骨征象。有2例4髋于1年半后改行人工全髋关节置换术。另有3例4髋症状有所加重，但未行人工关节置换术。结论股骨头髓心减压加异体腓骨移植术治疗早期股骨头缺血性坏死，手术损伤小，术后关节功能2～4周即可恢复或超过术前水平，临床症状改善。其短期疗效肯定，中长期疗效仍需进一步观察。     

同种异体骨支撑架微创治疗股骨头坏死的临床研究

目的应用改良髓芯减压术结合同种异体骨支撑架加自体骨和脱钙骨基质（decalcified bone matrix，DBM）治疗早期股骨头坏死，探索早期股骨头坏死的微创治疗方法。方法2004年1月～2005年4月，23例24个髋关节采用经大转子下通过股骨颈钻隧道至股骨头骨坏死区，将装有自体松质骨和DBM的同种异体骨支撑架经隧道拧入骨坏死区直至软骨下骨约5mm处，隧道远端用自体髂骨填塞。观察手术前后Harris评分变化、x线影像学表现及是否需进一步治疗。结果本组所有患者均获得随访，平均随访19（12—27）个月，以最后一次随访资料作为最终评价依据。Harris评分，术前优良率为43．5％（10／23）。术后优良率为91．3％（21／23）。22侧髋关节影像学表现保持稳定，无明显并发症发生。结论同种异体骨支撑架植入结合自体松质骨和DBM治疗成人股骨头坏死，增加了股骨头负重区软骨下骨的机械支撑，成骨作用强，有利于股骨头坏死的修复与重建，同时，不破坏患者股骨头本身的血液供应，创伤小，操作简单，值得临床推广使用。     

Free vascularized fibular grafting following failed core decompression for femoral head osteonecrosis

The results of treatment of femoral head osteonecrosis with free vascularized fibular grafting (FVFG) following failed core decompression (core decompression-FVFG [CD-FVFG] group: 32 hips) were reviewed and compared with those of a control group that underwent FVFG only (54 hips). Outcome was considered unsuccessful if total hip arthroplasty was subsequently performed. Total hip arthroplasty was performed in 15 and 20 hips of the CD-FVFG and control groups, respectively. When considering age, sex, and presence of bilateral disease, patients with previous core decompression did not have a significantly different failure rate from patients with FVFG only. However, patients with preoperative stage V osteonecrosis or corticosteroid use had worse outcomes after vascularized fibular grafting if they had a previous core decompression of the femoral head.     

Structural Augmentation with Biomaterial-Loaded Allograft Threaded Cage for the Treatment of Femoral Head Osteonecrosis

Seventy-six patients with femoral head necrosis were allocated to a program of either core decompression (control group) or core decompression and implantation of a biomaterial-loaded allograft threaded cage (treatment group). All patients were followed up prospectively clinically and radiographically. In the control group, no significant improvement in Harris hip score was found, and 13 of the 22 hips had deteriorated to stage III. In the treatment group, the mean Harris hip score was improved from 62.8 to 81.6; the clinical success rate at 36 months postoperatively was 91%. Collapse was seen in 1 hip, and another 3 hips exhibited progressive collapse. The procedure is attractive as a minimally invasive and salvage procedure, which shows encouraging success rates and early clinical results in patients with Steinberg stage I-II osteonecrosis.     

Core decompression in early stages of femoral head osteonecrosis – an MRI-controlled study

We treated 45 hips with idiopathic necrosis of the femoral head stages I-III with core decompression. Average age of patients was 41 (27-68) years and average follow-up 68.9 (31-120) months. In 30 hip joints in stage I, 29 showed no radiographic progression and a complete remission of the changes consistent with necrosis on MRI at the last follow-up. In 27 patients the clinical result based on the Harris Hip Score (HHS) assessment--was excellent (average HHS 91.9 points). Of nine hips in stage II, four had received a total hip arthroplasty, one had deteriorated to stage IV, and four were still classified as stage II (average HHS 95 points). Of six hips in stage III, three had received a total hip arthroplasty and three had deteriorated to stage IV (average HHS 73 points).     

髓芯减压联合自体骨髓干细胞移植治疗股骨头坏死的早期临床观察

目的 观察髓芯减压植骨联合自体骨髓干细胞移植治疗早期股骨头坏死的临床疗效.方法 根据国际骨循环研究学会(Association Research Circulation Osseous,ARCO)骨坏死分期标准,选取Ⅰ、Ⅱ期股骨头坏死32例(39髋),治疗组18例(24髋),对照组14例(15髋).治疗组经过自体骨髓干细胞采集、分离、髓芯减压后,骨髓干细胞和松质骨混合植入;对照组行髓芯减压松质骨植入.结果 所有患者均获18个月的随访,行Harris评分和影像学检查.(1)髋关节Harris评分:治疗组由(55.90±9.71)分升至(81.86±7.95)分,优良率为87.5%;而对照组由(56.69±8.32)分升至(68.14±8.65)分,优良率为60.0%,两组比较差异有统计学意义(P<0.01);(2)髋关节影像学检查:治疗组仅1例(1髋)发展为Ⅲ期塌陷,而对照组2例(2髋)发展为Ⅲ期塌陷;MRI测得坏死面积百分比,治疗组由31.88%±7.59%降至13.20%±9.56%,而对照组由32.64%±6.32%降至21.18%±8.83%,两组比较差异有统计学意义(P<0.05).结论 髓芯减压植骨联合自体骨髓干细胞移植治疗早期股骨头坏死是一种安全、有效的方法,但还需要大样本临床试验及长期随访以进一步验证.     

The use of an injectable calcium sulphate/calcium phosphate bioceramic in the treatment of osteonecrosis of the femoral head

Purpose

The purpose of our study is to describe the rationale, the surgical technique and the early clinical and radiographic results of the treatment of patients with early stage osteonecrosis of the femoral head (ONFH) by performing: core decompression, injection of autologous bone marrow concentrate and the use of a new composite injectable bone substitute (PRO-DENSE^®), as a mechanical supplementation associated with decompression.

Methods

The study included 37 hips (31 patients, 14 females, 17 males; mean age 43.9 years, range 24–56 years) with stages IC–IIIA ONFH. The outcome was determined by the changes in the Harris hip score (HHS), by progression in radiographic stages and by the need for hip replacement. The mean follow-up was 20.6 months (range 12–32 months).

Results

At final follow-up the mean HHS increased from 68 points pre-operatively to 86 points post-operatively. The radiological results showed that 29 hips (78.4  %) improved or had no further collapse. The overall clinical success rate of the procedure was 86.5 %, with three conversions to THA, and a failure rate of only 3.3 % in the pre-collapse group.

Conclusions

We are encouraged by these early results using core decompression, injection of the autologous bone marrow concentrate and backfilling the defect with an injectable bioceramic for the treatment of early stages of ONFH; as far as a conclusion can be drawn from the current data, this treatment seems to relieve hip pain and prevent the progression of ONFH in the majority of the cases.     

基于中日友好医院分型的股骨头坏死保髋手术疗效的影响因素分析

目的:探讨基于中日友好医院（China-Japan Friendship Hospital,CJFH）分型的保髋手术疗效的影响因素。方法:2012年6月至2016年9月接受保髋手术治疗的非创伤性股骨头坏死患者325例432髋。依据CJFH分型行髓芯减压自体骨髓单个核细胞移植141髋（髓芯减压组）和头颈部开窗减压病灶清除...     

Free Vascularized Fibular Grafting Improves Vascularity Compared With Core Decompression in Femoral Head Osteonecrosis: A Randomized Clinical Trial

Background

Management of osteonecrosis of the femoral head remains challenging. Core decompression and free vascularized fibular grafting are commonly used surgical procedures for treatment of osteonecrosis of the femoral head. Few studies, however, have compared these two procedures in a randomized controlled study, in terms of improved vascularity of the femoral head, progression of disease, or hip scores.

Question/purposes

(1) What is the effect of core decompression and fibular grafting on vascularity of the femoral head as measured by single-photon emission CT (SPECT)/CT? (2) Does one of these two methods lead to greater progression of Association Research Circulation Osseous (ARCO) stage as determined by serial MRI? (3) What is the relationship between the change in vascularity of the femoral head and hip function as measured by the Harris hip score (HHS) and progression to THA as an endpoint?

Methods

A randomized controlled trial was performed between June 2010 and October 2012 at Zhongshan Hospital, Fudan University. During the study period, 51 patients who presented with ARCO Stages I to IIIB bilateral osteonecrosis were potentially eligible for inclusion, and 33 patients were identified as meeting the inclusion criteria and offered enrollment and randomization. Six patients declined to participate at the time of randomization, leaving a final sample of 27 participants (54 hips). Bilateral hips of each patient were randomly assigned to surgical options: one side was treated with core decompression and the contralateral side was concurrently treated with fibular grafting. SPECT/CT examinations were performed to quantify radionuclide uptake to evaluate vascularity of the femoral head before treatment and at 6 and 36 months after surgery. With the numbers available, we found no differences between the groups regarding vascularity at baseline (64% ± 8% core decompression-treated hips versus 64% ± 7% in the fibular-grafted hips; 95% CI, ?5% to 5%; p = 0.90). MR images of the hips were obtained before surgery and at 6, 12, 24, and 36 months postoperatively and staged based on the ARCO classification. All patients were assessed clinically before treatment and followed up at 6, 12, 18, 24, 30, and 36 months after treatment using the HHS. We considered a difference in the HHS of 10 as the minimal clinically important difference (MCID). Patient progression to THA was defined as the endpoint for followup. Six patients (22%) were lost to followup.

Results

By SPECT/CT analysis, decompression-treated hips had lower vascularity than fibular-grafted hips at 6 months (68 % ± 6% versus 95% ± 5%; mean difference, ?27%; 95% CI, ?32% to ?23%; p < 0.001) and 36 months (57% ± 4% versus 91% ± 3%; mean difference, ?34%; 95% CI, ?37% to ?32%; p < 0.001). MRI analysis showed no differences between decompression-treated hips and fibular-grafted hips regarding ARCO stage at 12 months (p = 0.306) and 24 months (p = 0.06). Progression of ARCO staging was more severe in the decompression group than the fibular grafting group at 36 months (p = 0.027). The mean HHS was lower in the decompression group than in the fibular grafting group throughout the followup period, although these differences were at or below the MCID of 10 points early on. However, by 18 months, the scores favored fibular grafting (72 ± 4 versus 84 ± 4; mean difference, ?13; 95% CI, ?15 to ?7; p < 0.001), a finding that was maintained at 24, 30, and 36 months. We found no differences between decompression-treated hips and fibular-grafted hips regarding progression to THA at 36 months (two of 21; p = 0.893).

Conclusions

Hips that underwent a vascularized fibular grafting procedure fared better than hips receiving core decompression as measured by improved vascularity and less progression of osteonecrosis as measured by ARCO staging. The mean HHS of the fibular-grafted hips was better than that of the decompression-treated hips during the entire postoperative period, but the differences were modest early on, and for the early postoperative period the differences were unlikely to have been clinically important; by 18 months after surgery, the differences probably were clinically important. The mid-term outcomes associated with vascularized fibular grafting seen in our patients are associated with improvements in femoral head vascularity and the potential for bone revitalization.

Level of Evidence

Level I, therapeutic study.

     

Femoral Head and Neck Fenestration Through a Direct Anterior Approach Combined With Compacted Autograft for the Treatment of Early Stage Nontraumatic Osteonecrosis of the Femoral Head: A Retrospective Study

BackgroundThis study aimed to evaluate the effect of femoral head and neck fenestration combined with compacted autograft (light bulb procedure) through a direct anterior approach for early stage nontraumatic osteonecrosis of the femoral head.MethodsWe conducted a retrospective cohort study investigating 66 hips undergoing the light bulb procedure through the direct anterior approach (light bulb group) and 59 hips undergoing traditional core decompression (control group). Visual analog scale pain scores and range of hip motion were evaluated before discharge to assess the quality of functional recovery. Follow-up was conducted at 6 weeks, 3 months, 6 months, and annually after surgery until 4 years. The clinical effectiveness was evaluated by Harris hip score and the University of California Los Angeles activity-level score. Patients were followed up with postoperative X-ray and computed tomography. Survival was compared between the 2 groups by radiographic progression and receiving total hip arthroplasty.ResultsThere was no significant difference in quality of functional recovery between the 2 groups. There were no significant differences in clinical outcomes within 1 year after surgery. Patients in the light bulb group had significantly better Harris hip scores and University of California Los Angeles activity-level scores from 2 years after surgery to the end of follow-up. During the 4-year follow-up, significantly fewer patients in light bulb group had radiographic progression (22.7% vs 44.1%) or received total hip arthroplasty (15.2% vs 30.5%).ConclusionsThe light bulb procedure through a direct anterior approach offers significantly better results for the treatment of early stage nontraumatic osteonecrosis of the femoral head compared with traditional core decompression.     

Physical therapy alone compared with core decompression and physical therapy for femoral head osteonecrosis in sickle cell disease. Results of a multicenter study at a mean of three years after treatment

BACKGROUND: Osteonecrosis of the femoral head is a common complication in patients with sickle cell disease, and collapse of the femoral head occurs in 90% of patients within five years after the diagnosis of the osteonecrosis. However, the efficacy of hip core decompression to prevent the progression of osteonecrosis in these patients is still controversial. METHODS: In a prospective multicenter study, we evaluated the safety of hip core decompression and compared the results of decompression and physical therapy with those of physical therapy alone for the treatment of osteonecrosis of the femoral head in patients with sickle cell disease. Forty-six patients (forty-six hips) with sickle cell disease and Steinberg Stage-I, II, or III osteonecrosis of the femoral head were randomized to one of two treatment arms: (1) hip core decompression followed by a physical therapy program or (2) a physical therapy program alone. Eight patients withdrew from the study, leaving thirty-eight who participated. RESULTS: Seventeen patients (seventeen hips) underwent decompression combined with physical therapy, and no intraoperative or immediate postoperative complications occurred. Twenty-one patients (twenty-one hips) were treated with physical therapy alone. After a mean of three years, the hip survival rate was 82% in the group treated with decompression and physical therapy and 86% in the group treated with physical therapy alone. According to a modification of the Harris hip score, the mean clinical improvement was 18.1 points for the patients treated with hip core decompression and physical therapy compared with 15.7 points for those treated with physical therapy alone. With the numbers studied, the differences were not significant. CONCLUSIONS: In this randomized prospective study, physical therapy alone appeared to be as effective as hip core decompression followed by physical therapy in improving hip function and postponing the need for additional surgical intervention at a mean of three years after treatment.     

Digital subtraction angiography in selection of the vascularized greater trochanter bone grafting for treatment of osteonecrosis of femoral head

The aim of this report is to present our experience on the use of the digital subtraction angiography (DSA) in selection of the vascularized greater trochanter bone grafting for the treatment of the osteonecrosis of femoral head (ONFH) in early stages. Between January 2005 and June 2007, DSA was used to evaluate the blood perfusion of the early stages ONFH in 32 patients (45 hips). There were 18 males and 14 females with an average age of 30 years old. Twenty‐one hips were in ARCO stage I, and 24 in ARCO stage II. The arterial blood supply insufficiency was found in 22 hips by DSA, and the venous stasis in 23 hips. The hips with artery blood supply insufficiency received the vascularized greater trochanter bone grafting, and the hips with the venous stasis received the core decompression. All of patients were followed‐up with an average of 4.8 years (ranging 2.4–6.6 years). The preoperative Harris Hip score (HHS) in the patients with arterial blood supply insufficiency was 48.18 ± 7.81 and the postoperative HHS was 93.27 ± 3.03. The preoperative HHS in the patients with venous stasis was 44.04 ± 6.40, and the postoperative HHS 92.65 ± 2.93. The postoperative DSA showed an improved perfusion of the femoral head in 44 hips. Our experience showed that DSA would help to select the appropriate procedure for treatment of ONFH in the early stage. © 2013 Wiley Periodicals, Inc. Microsurgery 33:656–659, 2013.