| Background and purposes Osteonecrosis of the femoral head can be seen frequently among the orthopaedics patients, it can be seen usually in the young and middle-aged people, according to one study based upon its natural process, about 80% femoral head will collapse if it were not treated in about 1~3 years time. If the femoral head collapse, the patients will suffer joing pain and joint function failure, the severe have no other but total hip replacement. There are a lot of therapeutic methods for the patints who have suffered from this disease. From 1988, we have treated 348 patients(389hips) with double bone strut grafting, achieved a good effect, it can effectively relief hip joint pain, recover its function, improve the motion of the joint and prevent the femoral head's collapse, prolong the hip joint's life-span, prevent total hip replacement (TH R)or postpone the time of THR. Though this measure have been used hi clinical for at least 18 years, it is still unknown of its long tune effect and which factors affect its curative effect. We have followed up the operation patients, observe and analyse the relation of the stage and lesion size of the femoral head to its long time effect, discuss its application scope.Methods From 1988, we have treated 348 patients (389hips) suffered from osteonecrosis of the femoral head by using dead bone removing and double bone strut grafting, we have collected the materials of 192 patients(218 hips), average 35.8 (16-60) years old, according to ARCO staging system, the hip number in stageIIB. IIC. fflA. OB. IIIC. IVA. IVB. IVCwasl5.19. 39. 44. 43. 21. 18.19 respectively. Operation method: First , taking out iliac bone strut and pedicle strut bone of quadrate muscle of thigh with chisel, the size of both bone strut are all about 1.4cmX1.0cmX3.5~5.0cm, then, opening a window beneath the femoral head in the posterior of the femoral neck, weeding out dead bone in the femoral head completely, until reach the subchondral, transplanting with bone marrow pat first, lay it under the subchondral, compress it tightly with a special rod, recover the sphericity shape of the femoral head, place iliac bone chips around the cavity, put the iliac bone strut under the core of the femoral head, finaly, transplant the pedicle strut bone of quadrate muscle of thigh at the upside of the center, shut the window o After operation, the patient should keep in bed for at least 3 months, based on the femoral head reossification showing in X-ray, to decide whether or not the patient can walk. Prohibit alchol and cortisone.Results 192 patients (218 hips) have been followed up for average 7.3 (2-15) years. According to standards of Chinese Society of Osteonecrosis, the hip was graded from pain, function, expansion of joint movement and X-ray before and at the time of follow-up. The good and excellent result in ARCO IIB. II C. IHA. ffl B. fflC. IVA. IVB. IVC was 93.3%. 84.2%. 92.3%. 79.5%. 58.1%. 76.2%. 50%, 42.1% respectively, the total good and excellent rate is 72.9% 0 There are significant difference on the scores of pain, function, expansion of joint movement, X-rays, total scores before operation and at the time of follow-up (p<0.01). There are significant difference on the outcome in different staging groups (pO.Ol), the outcome is different in different staging groups. The recollapse rate in stage II B. IIc, mA, ma, me, IVA, IVB, ivcwas6.7%, 15.8%, 12.8%, 22.7%, 44.2%,47.6%, 66.7%, 78.9% respectively, total recollapse rate was 34.4%, There are significant difference of recollapse rate in different staging groups (p<0.01) .There are 36 (43 hips) cases who have been followed up for at least 10 years, the average followuptimewasl2.3 (10~15) years, the hip number in stage II B, II C, fflA, HIB, Die, IVA, IVB, IVCwas3, 4, 8, ll, 8, 4, 2, 3 respectively, and the good and excellent results in stage II ,IEt,IVwas 85.7%, 70.4%, 44.4% respectively,the total good and excellent result was 67.4%, the recolapse rate in stage II , III, IV was 14.3%, 66.7%, 100%repectively. Conclusions1 . Double st...
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