Comparison of sartorius muscle-pedicle and circumﬂex iliac deep bone ﬂap grafts in the treatment of early non-traumatic osteonecrosis of femoral head in young adults

Objective & Hypothesis:Objective: The aim of this study was to retrospectivelycompare and evaluate the midterm curative effect of two different bone ﬂap grafts in the treatment of early non-traumatic osteonecrosis of the femoral head (ONFH).

📊

Key Findings & Data:Methods: A total of 180 patients (199 hips) with early non-traumatic ONFH received surgical treatment by sartorius muscle-pedicle bone ﬂap graft (SMBF) (104 patients, 64 males and 40 females; mean age 34.67 ± 3.24years) orcircumﬂex iliac deep bone ﬂap graft (CIDBF) (76 patients, 44 males and 32 females; mean age: 35.54 ± 3.37 years) from July 2004 to July 2009.

💡

Conclusion & Impact:Level of evidence: Level III, Therapeutic Study.

🔬Design:Research Article

📍Scope:2004 Verileri

⚙️Variables:Domain Parameters

Özet

Objective: The aim of this study was to retrospectivelycompare and evaluate the midterm curative effect of two different bone ﬂap grafts in the treatment of early non-traumatic osteonecrosis of the femoral head (ONFH). Methods: A total of 180 patients (199 hips) with early non-traumatic ONFH received surgical treatment by sartorius muscle-pedicle bone ﬂap graft (SMBF) (104 patients, 64 males and 40 females; mean age 34.67 ± 3.24years) orcircumﬂex iliac deep bone ﬂap graft (CIDBF) (76 patients, 44 males and 32 females; mean age: 35.54 ± 3.37 years) from July 2004 to July 2009. The comparison between the groups was made with Harris score before and after surgery, length of incision, operative time, amount of bleeding, postoperative X-ray. Association Research Circulation Osseous (ARCO) staging was performed. Results: The preoperative Harris hip score of twogroups were 68.26 ± 1.26 and 69.35 ± 1.31, respectively. Patients' ARCO staging indicated 36 hips of stage IIa, 115 hips of stage IIb and 48 hips of stage IIc. The etiology of ONFH mainly including hormones (93 patients), alcohol (64 patients) and other (23 patients). The mean follow-up time of SMBF and CIDBF groups were (51.78 ± 2.35) and (52.73 ± 3.71) months, respectively. The time of removing sutures, operation time, amount of bleeding and length of incision in SMBF group were superior to those in the CIDBF group, and those differences between the SMBF and CIDBF groups were not signiﬁcant (all p values > 0.28). The Harris score between the two groups was similar after operation and postoperative 12 month, and the difference was not statistically signiﬁcant (p > 0.05), whereas the difference of the postoperative 24 and 48 months was statistically signiﬁcant (p ˂ 0.05). X-ray analysis showed improvement of osteonecrosis in both two groups after surgery, and as time went on, the total hip amount decreased, the replacement amount increased. Conclusion: Both bone ﬂap grafts appear to be effective methods for treatment of early osteonecrosis of femoral head (ARCOⅡ), and the SMBF is a relatively simple technique and easy for mastering, and it is a reliable method for clinical application. Level of evidence: Level III, Therapeutic Study.

🔖

Cite This Article

ZHANG, L., FAN, Y., ZHANG, Y., CHEN, X., LİU, Y. (2019). Comparison of sartorius muscle-pedicle and circumﬂex iliac deep bone ﬂap grafts in the treatment of early non-traumatic osteonecrosis of femoral head in young adults. Acta Orthopaedica et Traumatologica Turcica, Cilt: 53 - Sayı: 4, 255–259. https://ajindex.com/articles/353495

References (14)

Helbig L, Simank HG, Kroeber M, Schmidmaier G, Grützner PA, Guehring T. Core decompression combined with implantation of a demineralised bonematrix for non-traumatic osteonecrosis of the femoral head. Arch Orthop Trauma Surg. 2012
132(8):1095e1103. Fukushima W, Fuioka M, Kubo T, et al. Nationwide epidemiologic survey of idiopathic osteonecrosis of the femoral head. Clin Orthop Relat Res. 2010
468(10):2715e2724. Wang YS, Zhang Y, Li JW, et al. A modiﬁed technique of bone grafting pedicled with femoral quadratus for alcohol-induced osteonecrosis of the femoral head. Chin Med J. 2010
123(20):2847e2852. Sugioka Y, Hotokebuchi T, Tsutsui H. Transtrochanteric anterior rotational osteotomy for idiopathic and steroid-induced necrosis of the femoral head. Indications and long-term results. Clin Orthop Relat Res. 1992
277(4):111e120. Fairbank AC, Bhatia D, Jinnah RH, Hungerford DS. Long-term results of core decompression for ischaemic necrosis of the femoral head. Bone Joint Surg Br. 1995
77(1):42e49. Koo KHI, Kim R, Ko GH, Song HR, Jeong ST, Cho SH. Preventing collapse in early osteonecrosis of the femoral head: a randomised clinical trial of core decompression. Bone Joint Surg Br. 1995
77(6):870e874. Mont MA, Carbone JJ, Firbank AC. Core decompression versus nonoperative management for osteonecrosis of the hip. Clin Orthop Relat Res. 1996
324(5): 169e178. Buckley PD, Gearen PF, Petty RW. Structural bone-grafting for early atraumatic avascular necrosis of the femoral head. Bone Joint Surg Am. 1991
73(9): 1357e1364. Scully SP, Aaron RK, Urbaniak JR. Survival analysis of hips treated with core decompression or vascularized ﬁbular grafting because of avascular necrosis. Bone Joint Surg Am. 1998
80(9):1270e1275. Smith KR, Bonﬁglio M, Montgomery WJ. Non-traumatic necrosis of the femoral head treated with tibial bone-grafting: a follow-up note. Bone Joint Surg Am. 1980
62(5):845e847. Matsusaki H, Noguchi M, Kawakami T, et al. Use of vascularized pedicle iliac bone graft combined with trans-trochanteric rotational osteotomy in the treatment of avascular necrosis of the femoral head. Arch Orthop Trauma Surg. 2005
125(2):95e101. Smith-Petersen MN. Approach to and exposure of the hip joint for mold arthroplasty. J Bone Joint Surg Am. 1949
31A(1):40e46. Zhao D, Xu D, Wang W, Cui X. Iliac graft vascularization for femoral head osteonecrosis. Clin Orthop Relat Res. 2006
442(1):171e179. Kang JS, Moon KH, Kwon DG, et al. The natural history of a symptomatic osteonecrosis of the f