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The Recent Clinical Observation of Allogeneic Fibular with Holes Implantation for the Treatment of Femoral Head Necrosis

Author: YaoHao
Tutor: ZuoWenHai
School: Hebei Medical University
Course: Surgery
Keywords: femoral head necrosis metal Tan rod core decompress-sion allograft fibula transplantation perforated free vascularized
CLC: R687.3
Type: Master's thesis
Year: 2013
Downloads: 14
Quote: 0
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Abstract


Objective: To retrospective study the recent clinical effect andindications of allogeneic fibular with holes implantation for the treatmentof for provide objective basis for minimally treatment of the femoral headnecrosis hip.Methods: In the period from June2009to May2010, Patients ofANFH in Bone Disease Division of the Third Hospital of Hebei MedicalUniversity, met the inclusion criteria underwent perforated implantationof allogeneic fibula, after discharge follow-up and information of103patients (132hips), male81cases,22females; ages20-70years old, withan average of43.2years old; the single hip in74cases, double hip29cases. Pathogenic incentives:43cases of alcoholic,38cases ofsteroid-induced, trauma12cases, the unknown remain incentivesaccounted for10cases. Steinberg stage:13hips in stage Ⅰ, Ⅱ of53hips,Ⅲa of40hips, IIIb26hips. Follow-up2.0years to2.5years, an averageof2.3years. Before and after implantation, use the Harris hip score ofsystem to score the hip function assessment;3,6,12,18,24months later,photo anteroposterior X piece, to observa the repair of the femoral headand the progress of necrosis.According to clinical data, to evaluate theclinical efficacy of femoral head.Results:1The operative time of all patients and the amount of bleeding: unilateraloperation time was30min (20-40min), a unilateral blood loss was50ml(30-70ml), and duration of hospitalization was7days (5-15days).2Related complications after surgery: there are51patients and65hips(50%) patients have pain in leg, improved markedly after7days. noapparent bone allograft rejection reaction and wound infection, fracture, nerve injury and deep vein thrombosis, and other complications.3The head pain symptoms of necrosis of the femoral have improvedwithin3months after surgery,94cases of122hip pain symptomsimproved significantly.4In postoperative, the Haris score each period were: the Steinberg Ⅰ sta-ge in the preoperative and postoperative3,6,12,18,24the score were(74.73±5.51),(92.72±2.43)(94.42±4.58),(95.00±1.87),(94.00±1.80),(94.31±1.80), pairwise comparisons differences (P <0.05); Stein-berg Ⅱa period before surgery,3,6,12,18,24score (74.47±2.55),(91.44±3.16),(93.5±2.02),(94.36±1.39),(93.64±1.69),(93.82±2.04) every one compare is differe (P <0.05); Steinberg Ⅱb period beforesurgery,3,6,12,18,24the scores were (74.40±3.07),(89.67±3.34),(92.81±2.46),(93.93±1.44),(93.44±2.03),(92.85±2.03), pairwisecomparisons differences (P <0.05); Steinberg Ⅱc of preoperative andpostoperative3,6,12,18,24scores were (73.81±4.76),(88.93±3.45),(92.67±3.65),(93.23±3.86),(92.00±4.00),(91.00±1.71), comparedwith a difference (P <0.05); Steinberg IIIa period before surgery,3,6,12,18,24ratings were (60.46±6.53),(88.53±4.16),(91.94±2.65),(91.66±3.03),(91.13±2.91),(91.89±1.75), pairwise comparisons are different(P <0.05); Steinberg Ⅲ b period before surgery, after3,6,12,18,24ratings were (58.71±8.54),(86.76±4.18),(90.35±3.01),(90.95±3.10),(88.39±3.45),(86.89±2.25), pairwise comparisons differences (P <0.05)Prompt postoperative joint function and staging of osteonecrosis of thefemoral head and is closely related to staging the sooner, the higher thescore the better, function.5According to the results of hip imaging,3,6,12and18months aftersurgery, when the total efficiency:100%,100%,96.2%,90.2%, in the24months after surgery,106hip significant improvement, no change in7hips,10hips deteriorated9hips failure, the total effective rate of85.6%.Conclusions:The core decompression of femoral head to reduce its internal pressure, reduce pain. Implanted perforated allograft fibula afterautologous bone channels around the fast from porosity long into closecontact with the implanted fibular, can enhance the mechanical support.The clinical efficacy of many factors, patients younger the better, thepreoperative staging sooner the better efficacy. Perforated allograft fibulaimplantation is a minimally invasive treatment of femoral head necrosistechnology changed the surgical trauma, no significant complications,faster recovery, does not destroy the femoral head articular capsule couldsignificantly prolong the collapse of the femoral head time, and nosignificant impact on the future for further treatment. This surgicaltreatment of adults with early femoral head necrosis effect is significant,especially suitable for young adults with SteinbergⅠ,ⅡstageⅢa period.

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CLC: > Medicine, health > Surgery > Orthopaedic Surgery ( movement system diseases,orthopedic surgery ) > Orthopedic surgery and surgery > Bone surgery
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