LONG-TERM EFFECTⅣENESS OF TRANSPIANTATION OF ILIAC BONE FLAP PEDICLED WITH DEEP ILIAC CIRCUMFLEX VESSELS FOR AVASCULAR NECROSIS OF FEMORAL HEAD AT STAGE Ⅱ AND Ⅲ_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

WUMin , GUANJianzhong ,  XIAOYuzhou , ZHOUJiansheng , DAIXiusong , WANGZhaodong , CHENXiaotian

Department of Orthopedics, the First Affiliated Hospital of Bengbu Medical College, Laboratory of Tissue and Transplant in Anhui Province, Bengbu Anhui, 233003, P.R.China;

Corresponding?author：

XIAOYuzhou, Email: xiaoyuzhou1@aliyun.com

Keywords：

Avascular necrosis of femoral head; Vascular pedicled periosteal flap; Long-term effectiveness

DOI：

10.7507/1002-1892.20160272

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Objective To assess the long-term effectiveness of the transplantation of iliac bone flap pedicled with deep iliac circumflex vessels for treating avascular necrosis of femoral head (ANFH) at Ficat stage Ⅱ and Ⅲ. Methods Thirty-two cases (43 hips) of ANFH underwent iliac bone flap transplantation pedicled with deep iliac circumflex vessels between October 2000 and February 2006, and the clinical data were retrospectively reviewed. Of 32 cases, 27 were male (38 hips), and 5 were female (5 hips), aged 21-52 years (mean, 36.6 years); there were 8 cases (11 hips) of hormone ANFH, 18 cases (23 hips) of alcoholic ANFH, and 6 cases (9 hips) of idiopathic ANFH. The disease duration ranged from 2-52 months (mean, 8.2 months). According to Ficat staging criteria, 26 hips were classified as stage Ⅱ and 17 hips as stage Ⅲ. The preoperative Harris hip score (HSS) was 68.2±8.4. The HHS scores and X-ray photograph were compared between at pre-and post-operation to assess the outcomes clinically and radiologically. Results All incisions healed by first intention. Two cases had numbness of the lateral femoral skin. Four patients (6 hips) failed to be followed up, and the other 28 cases were followed up 98-187 months (mean, 129.3 months). Five patients (6 hips) showed aggravation or no relief with progression to stage Ⅳ at 8-69 months, who received total hip arthroplasty. The 10-year survival rate was 83.78% (31/37). The HHS score was significantly increased to 86.7±9.0 at last follow-up (t=-48.313, P=0.000). The hip function was excellent in 9 hips, good in 13 hips, and fair in 9 hips, and the success rate was 75.68%. Radiographic examination showed signs of bone remodeling at 6-8 weeks. After bone healing, the femoral head density gradually became uniform. Until last follow-up, ANFH progressed from Ficat stage Ⅱ to Ⅲ in 5 hips, from Ficat stage Ⅱ to Ⅳ in 3 hips, and from Ficat stage Ⅲ to Ⅳ in 3 hips; complete hip shape, continuous Shenton line, and normal joint space were observed in the other 26 hips, and the radiographic success rate was 70.27% (26/37). Conclusion The pedicled iliac bone flap transplantation for ANFH at Ficat stage Ⅱ and Ⅲ can provide good osteogenesis and vascular reconstruction of the femoral head. The long-term follow-up effectiveness is satisfactory.

Citation： WUMin, GUANJianzhong, XIAOYuzhou, ZHOUJiansheng, DAIXiusong, WANGZhaodong, CHENXiaotian. LONG-TERM EFFECTⅣENESS OF TRANSPIANTATION OF ILIAC BONE FLAP PEDICLED WITH DEEP ILIAC CIRCUMFLEX VESSELS FOR AVASCULAR NECROSIS OF FEMORAL HEAD AT STAGE Ⅱ AND Ⅲ. Chinese Journal of Reparative and Reconstructive Surgery, 2016, 30(11): 1326-1330. doi: 10.7507/1002-1892.20160272 Copy

1.	Pakos EE, Megas P, Paschos NK, et al. Modified porous tantalum rod technique for the treatment of femoral head osteonecrosis. World J Orthop, 2015, 6(10): 829-837.
2.	Lee GW, Park KS, Kim DY, et al. Results of total hip arthroplasty after core decompression with tantalum rod for osteonecrosis of the femoral head. Clin Orthop Surg, 2016, 8(1): 38-44.
3.	Amanatullah DF, Strauss EJ, Di Cesare PE. Current management options for osteonecrosis of the femoral head: part 1, diagnosis and nonoperative management. Am J Orthop (Belle Mead NJ), 2011, 40(9): E186-92.
4.	Hong YC, Zhong HM, Lin T, et al. Comparison of core decompression and conservative treatment for avascular necrosis of femoral head at early stage: a meta-analysis. Int J Clin Exp Med, 2015, 8(4): 5207-5216.
5.	Amanatullah DF, Strauss EJ, Di Cesare PE. Current management options for osteonecrosis of the femoral head: part II, operative management. Am J Orthop (Belle Mead NJ), 2011, 40(10): E216-225.
6.	Ishizaka M, Sofue M, Dohmae Y, et al. Vascularized iliac bone graft for avascular necrosis of the femoral head. Clin Orthop Relat Res, 1997, (337): 140-148.
7.	王斌, 李康華, 廖前德, 等.帶旋髂深血管髂骨瓣移植治療股骨頭缺血性壞死.中國修復重建外科雜志, 2005, 19(6): 443-445.
8.	于志亮, 張寧, 楊義, 等.帶旋髂深血管蒂髂骨瓣及松質骨移植治療成人股骨頭缺血性壞死.中國修復重建外科雜志, 2013, 27(7): 860-863.
9.	Zhao D, Xu D, Wang W, et al. Iliac graft vascularization for femoral head osteonecrosis. Clin Orthop Relat Res, 2006, (442): 171-179.
10.	吳敏, 官建中, 肖玉周, 等.帶旋髂深血管蒂骨膜瓣植入治療未成年股骨頸骨折術后股骨頭缺血性壞死.中國修復重建外科雜志, 2015, 29(3): 275-279.
11.	吳敏, 官建中, 肖玉周, 等.帶旋髂深血管蒂髂骨膜瓣移植治療青少年陳舊性股骨頸骨折.中華顯微外科雜志, 2015, 38(3): 238-241.
12.	Civinini R, De Biase P, Carulli C, et al. The use of an injectable calcium sulphate/calcium phosphate bioceramic in the treatment of osteonecrosis of the femoral head. Int Orthop, 2012, 36(8): 1583-1588.
13.	黃恭康.股骨頭缺血性壞死顯微外科治療的基礎.中華顯微外科雜志, 2000, 23(4): 248-249.
14.	Liu ZH, Guo WS, Li ZR, et al. Porous tantalum rods for treating osteonecrosis of the femoral head. Genet Mol Res, 2014, 13(4): 8342-8352.
15.	Hamanishi M, Yasunaga Y, Yamasaki T, et al. The clinical and radiographic results of intertrochanteric curved varus osteotomy for idiopathic osteonecrosis of the femoral head. Arch Orthop Trauma Surg, 2014, 134(3): 305-310.
16.	Zhang CQ, Sun Y, Chen SB, et al. Free vascularised fibular graft for post-traumatic osteonecrosis of the femoral head in teenage patients. J Bone Joint Surg (Br), 2011, 93(10): 1314-1319.
17.	Eisenschenk A, Lautenbach M, Schwetlick G, et al. Treatment of femoral head necrosis with vascularized iliac crest transplants. Clin Orthop Relat Res, 2001, (386): 100-105.
18.	陸曉生, 彭昊, 凌尚準.病灶清除髓心減壓帶旋髂深血管蒂髂骨瓣移植治療股骨頭壞死.中國矯形外科雜志, 2010, 18(19): 1656-1657.
19.	Chen CC, Lin CL, Chen WC, et al. Vascularized iliac bone-grafting for osteonecrosis with segmental collapse of the femoral head. J Bone Joint Surg (Am), 2009, 91(10): 2390-2394.
20.	Taylor GI, Townsend P, Corlett R. Superiority of the deep circumflex iliac vessels as the supply for free groin flaps. Clinical work. Plast Reconstr Surg, 1979, 64(6): 745-759.
21.	Huang GK, Liu ZZ, Shen YL, et al. Microvascular free transfer of iliac bone based on the deep circumflex iliac vessels. J Microsurg, 1980, 2(2): 113-120.

1. Pakos EE, Megas P, Paschos NK, et al. Modified porous tantalum rod technique for the treatment of femoral head osteonecrosis. World J Orthop, 2015, 6(10): 829-837.
2. Lee GW, Park KS, Kim DY, et al. Results of total hip arthroplasty after core decompression with tantalum rod for osteonecrosis of the femoral head. Clin Orthop Surg, 2016, 8(1): 38-44.
3. Amanatullah DF, Strauss EJ, Di Cesare PE. Current management options for osteonecrosis of the femoral head: part 1, diagnosis and nonoperative management. Am J Orthop (Belle Mead NJ), 2011, 40(9): E186-92.
4. Hong YC, Zhong HM, Lin T, et al. Comparison of core decompression and conservative treatment for avascular necrosis of femoral head at early stage: a meta-analysis. Int J Clin Exp Med, 2015, 8(4): 5207-5216.
5. Amanatullah DF, Strauss EJ, Di Cesare PE. Current management options for osteonecrosis of the femoral head: part II, operative management. Am J Orthop (Belle Mead NJ), 2011, 40(10): E216-225.
6. Ishizaka M, Sofue M, Dohmae Y, et al. Vascularized iliac bone graft for avascular necrosis of the femoral head. Clin Orthop Relat Res, 1997, (337): 140-148.
7. 王斌, 李康華, 廖前德, 等.帶旋髂深血管髂骨瓣移植治療股骨頭缺血性壞死.中國修復重建外科雜志, 2005, 19(6): 443-445.
8. 于志亮, 張寧, 楊義, 等.帶旋髂深血管蒂髂骨瓣及松質骨移植治療成人股骨頭缺血性壞死.中國修復重建外科雜志, 2013, 27(7): 860-863.
9. Zhao D, Xu D, Wang W, et al. Iliac graft vascularization for femoral head osteonecrosis. Clin Orthop Relat Res, 2006, (442): 171-179.
10. 吳敏, 官建中, 肖玉周, 等.帶旋髂深血管蒂骨膜瓣植入治療未成年股骨頸骨折術后股骨頭缺血性壞死.中國修復重建外科雜志, 2015, 29(3): 275-279.
11. 吳敏, 官建中, 肖玉周, 等.帶旋髂深血管蒂髂骨膜瓣移植治療青少年陳舊性股骨頸骨折.中華顯微外科雜志, 2015, 38(3): 238-241.
12. Civinini R, De Biase P, Carulli C, et al. The use of an injectable calcium sulphate/calcium phosphate bioceramic in the treatment of osteonecrosis of the femoral head. Int Orthop, 2012, 36(8): 1583-1588.
13. 黃恭康.股骨頭缺血性壞死顯微外科治療的基礎.中華顯微外科雜志, 2000, 23(4): 248-249.
14. Liu ZH, Guo WS, Li ZR, et al. Porous tantalum rods for treating osteonecrosis of the femoral head. Genet Mol Res, 2014, 13(4): 8342-8352.
15. Hamanishi M, Yasunaga Y, Yamasaki T, et al. The clinical and radiographic results of intertrochanteric curved varus osteotomy for idiopathic osteonecrosis of the femoral head. Arch Orthop Trauma Surg, 2014, 134(3): 305-310.
16. Zhang CQ, Sun Y, Chen SB, et al. Free vascularised fibular graft for post-traumatic osteonecrosis of the femoral head in teenage patients. J Bone Joint Surg (Br), 2011, 93(10): 1314-1319.
17. Eisenschenk A, Lautenbach M, Schwetlick G, et al. Treatment of femoral head necrosis with vascularized iliac crest transplants. Clin Orthop Relat Res, 2001, (386): 100-105.
18. 陸曉生, 彭昊, 凌尚準.病灶清除髓心減壓帶旋髂深血管蒂髂骨瓣移植治療股骨頭壞死.中國矯形外科雜志, 2010, 18(19): 1656-1657.
19. Chen CC, Lin CL, Chen WC, et al. Vascularized iliac bone-grafting for osteonecrosis with segmental collapse of the femoral head. J Bone Joint Surg (Am), 2009, 91(10): 2390-2394.
20. Taylor GI, Townsend P, Corlett R. Superiority of the deep circumflex iliac vessels as the supply for free groin flaps. Clinical work. Plast Reconstr Surg, 1979, 64(6): 745-759.
21. Huang GK, Liu ZZ, Shen YL, et al. Microvascular free transfer of iliac bone based on the deep circumflex iliac vessels. J Microsurg, 1980, 2(2): 113-120.

Chinese Journal of Reparative and Reconstructive Surgery

LONG-TERM EFFECTⅣENESS OF TRANSPIANTATION OF ILIAC BONE FLAP PEDICLED WITH DEEP ILIAC CIRCUMFLEX VESSELS FOR AVASCULAR NECROSIS OF FEMORAL HEAD AT STAGE Ⅱ AND Ⅲ

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