A Retrospective Study Of The Efficacy Of Bone Flap Transplantation Combined With Porous Silicon Rod In The Treatment Of Steroid-induced Femoral Head Necrosis

Objective:This article systematically reviews the treatment of steroid-induced osteonecrosis of the femoral head,and discusses the clinical efficacy of vascularized iliac bone grafting combined with porous metallic rod implantation for patients with steroid-induced osteonecrosis of the femoral head.Methods:We retrospectively analyzed 17 patients(26 hips)with steroid-induced osteonecrosis of the femoral head who were admitted to Zhongshan Hospital Affiliated to Dalian University from June 2015 to June 2017.All cases were non-traumatic avascular necrosis of the femoral head.There is a clear history of hormone therapy and related imaging studies support the diagnosis of osteonecrosis of the femoral head.The ARCO staging method was used to determine the severity of femoral head necrosis in patients,including 16 hips with Stage II femoral head necrosis and 10 hips with Stage III.Harris hip scores were recorded preoperatively and at the last follow-up;the VAS pain scores were recorded preoperatively and postoperatively;the progress of femoral head necrosis was assessed according to postoperative radiographs;patient satisfaction questionnaire was filled in and evaluated.Patient’s satisfaction with the overall surgical procedure.Result:All patients enrolled were effectively followed up for 8-25 months and the average follow-up time was 18.1 months.From the last follow-up,the hip function score was increased from 71.7±9.8(range 52-83)before surgery to 88.9±9.3(range 56-100)postoperatively,with an excellent and good rate of 84.6%;femoral head necrosis.Stage II 16 hips,hip function score before surgery 78.7±2.9 points(range 74-83points)to postoperative 92.1±6.8 points(range 79-100 points),excellent rate was87.5%;femoral head necrosis III stage 10 hips The hip function score was 60.6±6.0(range 52-68)before operation and 83.6±10.4(range 56-94)before the final follow-up,and the excellent and good rate was 80%.The patient’s VAS pain score was reduced from 5.8±1.5 preoperatively to 2.5±1.7 postoperatively.At the last follow-up radiograph,21 cases(80%)of the femoral head were significantly improved compared with the preoperative one.Three hips(11.5%)showed no change,and only two hips collapsed(7.7%).The overall score of the patient satisfaction questionnaire was 88.8±7.1.Conclusion:After surgical treatment with vascularized bone graft combined with porous metal rod implantation,the hip function in patients with steroid-induced femoral head necrosis was significantly improved.This treatment can effectively delay the further progress of femoral head necrosis.Delaying or even avoiding artificial total hip replacement surgery is an effective method of hip replacement surgery.