[Treatment of osteonecrosis of femoral head by core decompression combining with autologous cortical sustaining bone and cancellous bone graft].

OBJECTIVE

To study the effect of core decompression combining with autologous cortical sustaining bone and cancellous bone graft in treating osteonecrosis of the femoral head (ONFH).

METHODS

From February 2004 to May 2008, 64 patients (77 hips) with ONFH were treated with core decompression combining with autologous cortical sustaining bone and cancellous bone graft, including 45 males and 19 females and aging 23 to 60 years with an average age of 43 years. There were 51 cases of unilateral ONFH and 13 cases of bilateral ONFH. ONFH was caused by alcohol in 39 cases (47 hips), by steroid in 21 cases (26 hips), and by trauma in 4 cases (4 hips). The disease course was 1-12 years. The pain time was 2-14 months (average 7 months). All the cases underwent imageology and postoperation pathology examination to confirm the diagnosis of ONFH. According to Association Research Circulation Osseous (ARCO) international classification of osteonecrosis, 17 cases (23 hips) were classified as stage I A, 2 cases (3 hips) as stage I B, 21 cases (24 hips) as stage II A, 2 cases (2 hips) as stage II B, 4 cases (4 hips) as stage II C, and 18 cases (21 hips) as stage III A. The outcome was evaluated both clinically by Harris score and radiologically by imageology.

RESULTS

A total of 59 cases (69 hips) were followed up for 12-62 months with an average of 32.1 months. The Harris score was 87.12 +/- 8.68 at 12 months after operation, showing significant difference (P < 0.05) when compared with the preoperative one (68.38 +/- 14.49). The results were excellent in 39 hips, good in 18 hips, fair in 6 hips, and poor in 6 hip; and the excellent and good rate was 82.6%. Radiographic evaluation was 21 hips (30.4%) of grade I, 42 hips (60.9%) of grade II, and 6 hips (8.7%) of grade III. One case had the complication of ilium bone donor site, 21 cases had little pain or numbness, and the other cases had no uncomfortable complication.

CONCLUSION

The method of core decompression combining with autologous cortical sustaining bone and cancellous bone graft can improve the means of bone grafts, prevent the collapse of the femoral head, and is less traumatic than common procedures. Clinical effects are obvious and effective.