Treatment of osteonecrosis of the femoral head with vascularized bone grafting_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

DING Haibo ¹ , WANG Yang ¹ ,  LU Yun ²

1. Tianjin Medical University, Tianjin, 300070, P.R.China;
2. Department of Hand and Foot Surgery and Reparative and Reconstructive, Tianjin Union Medical Center, Tianjin, 300121, P.R.China;

Corresponding author：

LU Yun, Email: tedaluyun@163.com

Keywords：

Osteonecrosis of the femoral head; vascularized bone grafting; hip-preserving operation; microsurgery

DOI：

10.7507/1002-1892.202006053

Video：

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Objective To summarize the current progress of vascularized bone grafting in the treatment of osteonecrosis of the femoral head (ONFH), and to provide reference for treatment of ONFH.Methods The literature at home and abroad on the treatment of ONFH with vascularized bone grafting was reviewed, and the mechanism, operating methods and effectiveness, indications, and complications were summarized.Results Vascularized bone grafting is a commonly used clinical hip-preserving operation. By replacing necrotic bone tissue with vascularized bone, it can rebuild the blood circulation system, promote the healing of the necrotic area, and provide biomechanical support for the necrotic area of the femoral head, prevent the joint surface collapse. The main operations include the vascularized iliac bone flap grafting, the vascularized greater trochanter bone flap grafting, and the vascularized fibular grafting. The clinical application has achieved certain effectiveness, and the different procedures are suitable for different types of patients. The procedures need to be selected based on the patient’s overall condition, the cause of ONFH, the necrosis stage, and the degree of the evaluation.Conclusion Vascularized bone grafting has a definite effectiveness in the treatment of ONFH in the young and middle-aged. It can significantly improve hip joint function, control the further development of the disease to a great extent, effectively delay or even avoid hip arthroplasty. It is a reliable hip-preserving operation worthy of promotion.

Citation： DING Haibo, WANG Yang, LU Yun. Treatment of osteonecrosis of the femoral head with vascularized bone grafting. Chinese Journal of Reparative and Reconstructive Surgery, 2021, 35(3): 381-386. doi: 10.7507/1002-1892.202006053 Copy

1.	Wang A, Ren M, Wang J. The pathogenesis of steroid-induced osteonecrosis of the femoral head: A systematic review of the literature. Gene, 2018, 671: 103-109.
2.	Zhang CF, Fang XY, Huang ZD, et al. Addition of bone marrow stem cells therapy achieves better clinical outcomes and lower rates of disease progression compared with core decompression alone for early stage osteonecrosis of the femoral head: a systematic review and meta-analysis. J Am Acad Orthop Surg, 2020. doi: 10.5435/JAAOS-D-19-00816.
3.	Aurégan JC, Villain B, Bégué T. What is the rate of patients undergoing a total hip arthroplasty after core decompression and insertion of a tantalum rod in osteonecrosis of the femoral head: a systematic review. Int Orthop, 2018, 42(7): 1631-1638.
4.	Kobayashi S, Kubo T, Iwamoto Y, et al. Nationwide multicenter follow-up cohort study of hip arthroplasties performed for osteonecrosis of the femoral head. Int Orthop, 2018, 42(7): 1661-1668.
5.	Gadinsky NE, Klinger CE, Sculco PK, et al. Femoral head vascularity: implications following trauma and surgery about the hip. Orthopedics, 2019, 42(5): 250-257.
6.	Atilla B, Bakırcıoğlu S, Shope AJ, et al. Joint-preserving procedures for osteonecrosis of the femoral head. EFORT Open Rev, 2020, 4(12): 647-658.
7.	Zuo W, Ma JH, Cui W, et al. Comparison of total hip arthroplasty after two types of failed hip preserving procedures with primary total hip arthroplasty. Orthop Surg, 2020, 12(1): 162-169.
8.	Tomaru Y, Yoshioka T, Sugaya H, et al. Ten-year results of concentrated autologous bone marrow aspirate transplantation for osteonecrosis of the femoral head: a retrospective study. BMC Musculoskelet Disord, 2019, 20(1): 410.
9.	Pang Y, Zheng X, Pei F, et al. A retrospective study to compare the efficacy and postoperative outcome of total hip arthroplasty with internal screw fixation in patients with avascular necrosis of the femoral head. Med Sci Monit, 2019, 25: 3655-3661.
10.	Min BW, Cho CH, Son ES, et al. Highly cross-linked polyethylene in total hip arthroplasty in patients younger than 50 years with osteonecrosis of the femoral head: a minimum of 10 years of follow-up. J Arthroplasty, 2020, 35(3): 805-810.
11.	Agarwala S, Vijayvargiya M. Bisphosphonate combination therapy for non-femoral avascular necrosis. J Orthop Surg Res, 2019, 14(1): 112.
12.	Nazal MR, Parsa A, Martin SD. Mid-term outcomes of arthroscopic-assisted core decompression of precollapse osteonecrosis of femoral head-minimum of 5 year follow-up. BMC Musculoskelet Disord, 2019, 20(1): 448.
13.	Zalavras CG, Lieberman JR. Osteonecrosis of the femoral head: evaluation and treatment. J Am Acad Orthop Surg, 2014, 22(7): 455-464.
14.	顾长源, 杜斌, 孙光权, 等. 股骨头坏死保髋治疗常用术式的利与弊. 中国组织工程研究, 2020, 24(21): 3379-3386.
15.	Asmus A, Vogel K, Vogel A, et al. Pedicled vascularized iliac bone graft for treatment of osteonecrosis of the femoral head. Oper Orthop Traumatol, 2020, 32(2): 127-138.
16.	Tomaru Y, Yoshioka T, Sugaya H, et al. Hip preserving surgery with concentrated autologous bone marrow aspirate transplantation for the treatment of asymptomatic osteonecrosis of the femoral head: retrospective review of clinical and radiological outcomes at 6 years postoperatively. BMC Musculoskelet Disord, 2017, 18(1): 292.
17.	Zhang L, Fan Y, Zhang Y, et al. 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 Orthop Traumatol Turc, 2019, 53(4): 255-259.
18.	夏远军, 章莹, 谢会斌, 等. 腓骨瓣移植治疗股骨头坏死的研究进展. 中国骨科临床与基础研究杂志, 2015, 7(4): 230-235.
19.	赵德伟, 王本杰, 王卫明, 等. 股骨头修复与重建术后血运重建的数字减影血管造影评价. 中华医学杂志, 2006, 86(7): 438-441.
20.	Zhao D, Xiaobing Y, Wang T, et al. Digital subtraction angiography in selection of the vascularized greater trochanter bone grafting for treatment of osteonecrosis of femoral head. Microsurgery, 2013, 33(8): 656-659.
21.	Fontecha CG, Roca I, Barber I, et al. Femoral head bone viability after free vascularized fibular grafting for osteonecrosis: SPECT/CT study. Microsurgery, 2016, 36(7): 573-577.
22.	Meyers MH. The treatment of osteonecrosis of the hip with fresh osteochondral allografts and with the muscle pedicle graft technique. Clin Orthop Relat Res, 1978, (130): 202-209.
23.	Cui G, Wei R, Hou C, et al. Transplantation of iliac bone flaps pedicled with sartorius muscular fascia around superficial circumflex iliac vessels in the treatment of osteonecrosis of the femoral head. Exp Ther Med, 2016, 11(6): 2201-2208.
24.	Liu Y, Zhao D, Wang WM, et al. Hemodynamic changes in osteonecrosis treatment of the femoral head with iliac bone flaps pedicled with the lateral femoral circumflex artery ascending branch: A 10-year report. Technol Health Care, 2016, 24 Suppl 2: S493-498.
25.	吴敏, 官建中, 肖玉周, 等. 带旋髂深血管蒂髂骨瓣植入治疗 FicatⅡ期及Ⅲ期股骨头缺血性坏死的远期疗效. 中国修复重建外科杂志, 2016, 30(11): 1326-1330.
26.	Zhao D, Xie H, Xu Y, et al. Management of osteonecrosis of the femoral head with pedicled iliac bone flap transfer: A multicenter study of 2190 patients. Microsurgery, 2017, 37(8): 896-901.
27.	Zhao DW, Liu BY, Wang BJ. Vascularized greater trochanter bone flap transfer for treatment of ARCO stage-ⅡB to ⅢB osteonecrosis of the femoral head. JBJS Essent Surg Tech, 2019, 9(2): 1-7.
28.	Zhao DW, Wang BJ, Guo L, et al. Will a vascularized greater trochanter graft preserve the necrotic femoral head? Clin Orthop Relat Res, 2010, 468(5): 1316-1324.
29.	Fan D, Liu B, Tian S. Clinical follow-up study of the reconstruction of the femoral head with transferred vascularized greater trochanter bone graft for association research circulation osseous Ⅲ-Ⅳ osteonecrosis of the femoral head. Ann Plast Surg, 2020, 84(5S Suppl 3): S215-S221.
30.	Zeng YR, He S, Feng WJ, et al. Vascularised greater trochanter bone graft, combined free iliac flap and impaction bone grafting for osteonecrosis of the femoral head. Int Orthop, 2013, 37(3): 391-398.
31.	张天一, 董巍, 米盼盼, 等. 三维有限元分析大转子骨瓣转移治疗股骨头缺血坏死应力分布变化. 中国组织工程研究, 2018, 22(7): 1090-1095.
32.	Aldridge JM, Urbaniak JR. Avascular necrosis of the femoral head: role of vascularized bone grafts. Orthop Clin North Am, 2007, 38(1): 13-22.
33.	Pederson WC, Person DW. Long bone reconstruction with vascularized bone grafts. Orthop Clin North Am, 2007, 38(1): 23-35.
34.	Wood MB. Free vascularized fibular grafting-25 years’ experience: tips, techniques, and pearls. Orthop Clin North Am, 2007, 38(1): 1-12.
35.	Ünal MB, Cansu E, Parmaksızoğlu F, et al. Treatment of osteonecrosis of the femoral head with free vascularized fibular grafting: Results of 7. 6-year follow-up. Acta Orthop Traumatol Turc, 2016, 50(5): 501-506.
36.	Cao L, Guo C, Chen J, et al. Free vascularized fibular grafting improves vascularity compared with core decompression in femoral head osteonecrosis: a randomized clinical trial. Clin Orthop Relat Res, 2017, 475(9): 2230-2240.
37.	董帅, 蔡喜雨, 朱征威. 吻合血管游离腓骨移植治疗股骨头缺血性坏死技术总结及手术器械改进. 中国修复重建外科杂志, 2017, 31(2): 129-133.
38.	Gao YS, Chen SB, Jin DX, et al. Modified surgical techniques of free vascularized fibular grafting for treatment of the osteonecrosis of femoral head: results from a series of 407 cases. Microsurgery, 2013, 33(8): 646-651.
39.	胡剑秋, 程栋, 杨胜相, 等. 单切口游离腓骨移植治疗Ⅱ期股骨头缺血性坏死28例. 中华显微外科杂志, 2019, 42(6): 599-602.
40.	张少成, 胡万坤, 朱红伟. 不同种带血管骨移植治疗股骨头坏死的远期效果对比. 中华临床医师杂志 (电子版), 2009, 3(8): 1379-1383.
41.	Yen CY, Tu YK, Ma CH, et al. Osteonecrosis of the femoral head: comparison of clinical results for vascularized iliac and fibula bone grafting. J Reconstr Microsurg, 2006, 22(1): 21-24.
42.	Tetik C, Başar H, Bezer M, et al. Comparison of early results of vascularized and non-vascularized fibular grafting in the treatment of osteonecrosis of the femoral head. Acta Orthop Traumatol Turc, 2011, 45(5): 326-334.
43.	Korompilias AV, Beris AE, Lykissas MG, et al. Femoral head osteonecrosis: why choose free vascularized fibula grafting. Microsurgery, 2011, 31(3): 223-228.
44.	Fang T, Zhang EW, Sailes FC, et al. Vascularized fibular grafts in patients with avascular necrosis of femoral head: a systematic review and meta-analysis. Arch Orthop Trauma Surg, 2013, 133(1): 1-10.
45.	Feng W, Chen J, Wu K, et al. A comparative study of cortico-cancellous iliac bone graft with or without the combination of vascularized greater trochanter flap for the management of femoral head osteonecrosis: a minimum 6 years follow-up. BMC Musculoskelet Disord, 2019, 20(1): 298.
46.	Dewei Z, Xiaobing Y. A retrospective analysis of the use of cannulated compression screws and a vascularised iliac bone graft in the treatment of displaced fracture of the femoral neck in patients aged < 50 years. Bone Joint J, 2014, 96-B(8): 1024-1028.
47.	Judet H, Gilbert A. Long-term results of free vascularized fibular grafting for femoral head necrosis. Clin Orthop Relat Res, 2001, (386): 114-119.
48.	Louie BE, McKee MD, Richards RR, et al. Treatment of osteonecrosis of the femoral head by free vascularized fibular grafting: an analysis of surgical outcome and patient health status. Can J Surg, 1999, 42(4): 274-283.
49.	Eward WC, Rineer CA, Urbaniak JR, et al. The vascularized fibular graft in precollapse osteonecrosis: is long-term hip preservation possible? Clin Orthop Relat Res, 2012, 470(10): 2819-2826.
50.	Korompilias AV, Lykissas MG, Beris AE, et al. Vascularised fibular graft in the management of femoral head osteonecrosis: twenty years later. J Bone Joint Surg (Br), 2009, 91(3): 287-293.
51.	陈圣宝, 张长青, 金东旭, 等. 影响吻合血管腓骨移植治疗股骨头坏死疗效的相关因素分析. 中华显微外科杂志, 2009, 32(4): 266-270.
52.	Petek D, Hannouche D, Suva D. Osteonecrosis of the femoral head: pathophysiology and current concepts of treatment. EFORT Open Rev, 2019, 4(3): 85-97.
53.	Plakseychuk AY, Kim SY, Park BC, et al. Vascularized compared with nonvascularized fibular grafting for the treatment of osteonecrosis of the femoral head. J Bone Joint Surg (Am), 2003, 85(4): 589-596.
54.	Kawate K, Yajima H, Sugimoto K, et al. Indications for free vascularized fibular grafting for the treatment of osteonecrosis of the femoral head. BMC Musculoskelet Disord, 2007, 8: 78.
55.	Millikan PD, Karas V, Wellman SS. Treatment of osteonecrosis of the femoral head with vascularized bone grafting. Curr Rev Musculoskelet Med, 2015, 8(3): 252-259.
56.	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.
57.	Roush TF, Olson SA, Pietrobon R, et al. Influence of acetabular coverage on hip survival after free vascularized fibular grafting for femoral head osteonecrosis. J Bone Joint Surg (Am), 2006, 88(10): 2152-2158.
58.	Yang F, Wei Q, Chen X, et al. Vascularized pedicle iliac bone grafts as a hip-preserving surgery for femur head necrosis: a systematic review. J Orthop Surg Res, 2019, 14(1): 270.
59.	Gaskill TR, Urbaniak JR, Aldridge JM. Free vascularized fibular transfer for femoral head osteonecrosis: donor and graft site morbidity. J Bone Joint Surg (Am), 2009, 91(8): 1861-1867.

1. Wang A, Ren M, Wang J. The pathogenesis of steroid-induced osteonecrosis of the femoral head: A systematic review of the literature. Gene, 2018, 671: 103-109.
2. Zhang CF, Fang XY, Huang ZD, et al. Addition of bone marrow stem cells therapy achieves better clinical outcomes and lower rates of disease progression compared with core decompression alone for early stage osteonecrosis of the femoral head: a systematic review and meta-analysis. J Am Acad Orthop Surg, 2020. doi: 10.5435/JAAOS-D-19-00816.
3. Aurégan JC, Villain B, Bégué T. What is the rate of patients undergoing a total hip arthroplasty after core decompression and insertion of a tantalum rod in osteonecrosis of the femoral head: a systematic review. Int Orthop, 2018, 42(7): 1631-1638.
4. Kobayashi S, Kubo T, Iwamoto Y, et al. Nationwide multicenter follow-up cohort study of hip arthroplasties performed for osteonecrosis of the femoral head. Int Orthop, 2018, 42(7): 1661-1668.
5. Gadinsky NE, Klinger CE, Sculco PK, et al. Femoral head vascularity: implications following trauma and surgery about the hip. Orthopedics, 2019, 42(5): 250-257.
6. Atilla B, Bakırcıoğlu S, Shope AJ, et al. Joint-preserving procedures for osteonecrosis of the femoral head. EFORT Open Rev, 2020, 4(12): 647-658.
7. Zuo W, Ma JH, Cui W, et al. Comparison of total hip arthroplasty after two types of failed hip preserving procedures with primary total hip arthroplasty. Orthop Surg, 2020, 12(1): 162-169.
8. Tomaru Y, Yoshioka T, Sugaya H, et al. Ten-year results of concentrated autologous bone marrow aspirate transplantation for osteonecrosis of the femoral head: a retrospective study. BMC Musculoskelet Disord, 2019, 20(1): 410.
9. Pang Y, Zheng X, Pei F, et al. A retrospective study to compare the efficacy and postoperative outcome of total hip arthroplasty with internal screw fixation in patients with avascular necrosis of the femoral head. Med Sci Monit, 2019, 25: 3655-3661.
10. Min BW, Cho CH, Son ES, et al. Highly cross-linked polyethylene in total hip arthroplasty in patients younger than 50 years with osteonecrosis of the femoral head: a minimum of 10 years of follow-up. J Arthroplasty, 2020, 35(3): 805-810.
11. Agarwala S, Vijayvargiya M. Bisphosphonate combination therapy for non-femoral avascular necrosis. J Orthop Surg Res, 2019, 14(1): 112.
12. Nazal MR, Parsa A, Martin SD. Mid-term outcomes of arthroscopic-assisted core decompression of precollapse osteonecrosis of femoral head-minimum of 5 year follow-up. BMC Musculoskelet Disord, 2019, 20(1): 448.
13. Zalavras CG, Lieberman JR. Osteonecrosis of the femoral head: evaluation and treatment. J Am Acad Orthop Surg, 2014, 22(7): 455-464.
14. 顾长源, 杜斌, 孙光权, 等. 股骨头坏死保髋治疗常用术式的利与弊. 中国组织工程研究, 2020, 24(21): 3379-3386.
15. Asmus A, Vogel K, Vogel A, et al. Pedicled vascularized iliac bone graft for treatment of osteonecrosis of the femoral head. Oper Orthop Traumatol, 2020, 32(2): 127-138.
16. Tomaru Y, Yoshioka T, Sugaya H, et al. Hip preserving surgery with concentrated autologous bone marrow aspirate transplantation for the treatment of asymptomatic osteonecrosis of the femoral head: retrospective review of clinical and radiological outcomes at 6 years postoperatively. BMC Musculoskelet Disord, 2017, 18(1): 292.
17. Zhang L, Fan Y, Zhang Y, et al. 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 Orthop Traumatol Turc, 2019, 53(4): 255-259.
18. 夏远军, 章莹, 谢会斌, 等. 腓骨瓣移植治疗股骨头坏死的研究进展. 中国骨科临床与基础研究杂志, 2015, 7(4): 230-235.
19. 赵德伟, 王本杰, 王卫明, 等. 股骨头修复与重建术后血运重建的数字减影血管造影评价. 中华医学杂志, 2006, 86(7): 438-441.
20. Zhao D, Xiaobing Y, Wang T, et al. Digital subtraction angiography in selection of the vascularized greater trochanter bone grafting for treatment of osteonecrosis of femoral head. Microsurgery, 2013, 33(8): 656-659.
21. Fontecha CG, Roca I, Barber I, et al. Femoral head bone viability after free vascularized fibular grafting for osteonecrosis: SPECT/CT study. Microsurgery, 2016, 36(7): 573-577.
22. Meyers MH. The treatment of osteonecrosis of the hip with fresh osteochondral allografts and with the muscle pedicle graft technique. Clin Orthop Relat Res, 1978, (130): 202-209.
23. Cui G, Wei R, Hou C, et al. Transplantation of iliac bone flaps pedicled with sartorius muscular fascia around superficial circumflex iliac vessels in the treatment of osteonecrosis of the femoral head. Exp Ther Med, 2016, 11(6): 2201-2208.
24. Liu Y, Zhao D, Wang WM, et al. Hemodynamic changes in osteonecrosis treatment of the femoral head with iliac bone flaps pedicled with the lateral femoral circumflex artery ascending branch: A 10-year report. Technol Health Care, 2016, 24 Suppl 2: S493-498.
25. 吴敏, 官建中, 肖玉周, 等. 带旋髂深血管蒂髂骨瓣植入治疗 FicatⅡ期及Ⅲ期股骨头缺血性坏死的远期疗效. 中国修复重建外科杂志, 2016, 30(11): 1326-1330.
26. Zhao D, Xie H, Xu Y, et al. Management of osteonecrosis of the femoral head with pedicled iliac bone flap transfer: A multicenter study of 2190 patients. Microsurgery, 2017, 37(8): 896-901.
27. Zhao DW, Liu BY, Wang BJ. Vascularized greater trochanter bone flap transfer for treatment of ARCO stage-ⅡB to ⅢB osteonecrosis of the femoral head. JBJS Essent Surg Tech, 2019, 9(2): 1-7.
28. Zhao DW, Wang BJ, Guo L, et al. Will a vascularized greater trochanter graft preserve the necrotic femoral head? Clin Orthop Relat Res, 2010, 468(5): 1316-1324.
29. Fan D, Liu B, Tian S. Clinical follow-up study of the reconstruction of the femoral head with transferred vascularized greater trochanter bone graft for association research circulation osseous Ⅲ-Ⅳ osteonecrosis of the femoral head. Ann Plast Surg, 2020, 84(5S Suppl 3): S215-S221.
30. Zeng YR, He S, Feng WJ, et al. Vascularised greater trochanter bone graft, combined free iliac flap and impaction bone grafting for osteonecrosis of the femoral head. Int Orthop, 2013, 37(3): 391-398.
31. 张天一, 董巍, 米盼盼, 等. 三维有限元分析大转子骨瓣转移治疗股骨头缺血坏死应力分布变化. 中国组织工程研究, 2018, 22(7): 1090-1095.
32. Aldridge JM, Urbaniak JR. Avascular necrosis of the femoral head: role of vascularized bone grafts. Orthop Clin North Am, 2007, 38(1): 13-22.
33. Pederson WC, Person DW. Long bone reconstruction with vascularized bone grafts. Orthop Clin North Am, 2007, 38(1): 23-35.
34. Wood MB. Free vascularized fibular grafting-25 years’ experience: tips, techniques, and pearls. Orthop Clin North Am, 2007, 38(1): 1-12.
35. Ünal MB, Cansu E, Parmaksızoğlu F, et al. Treatment of osteonecrosis of the femoral head with free vascularized fibular grafting: Results of 7. 6-year follow-up. Acta Orthop Traumatol Turc, 2016, 50(5): 501-506.
36. Cao L, Guo C, Chen J, et al. Free vascularized fibular grafting improves vascularity compared with core decompression in femoral head osteonecrosis: a randomized clinical trial. Clin Orthop Relat Res, 2017, 475(9): 2230-2240.
37. 董帅, 蔡喜雨, 朱征威. 吻合血管游离腓骨移植治疗股骨头缺血性坏死技术总结及手术器械改进. 中国修复重建外科杂志, 2017, 31(2): 129-133.
38. Gao YS, Chen SB, Jin DX, et al. Modified surgical techniques of free vascularized fibular grafting for treatment of the osteonecrosis of femoral head: results from a series of 407 cases. Microsurgery, 2013, 33(8): 646-651.
39. 胡剑秋, 程栋, 杨胜相, 等. 单切口游离腓骨移植治疗Ⅱ期股骨头缺血性坏死28例. 中华显微外科杂志, 2019, 42(6): 599-602.
40. 张少成, 胡万坤, 朱红伟. 不同种带血管骨移植治疗股骨头坏死的远期效果对比. 中华临床医师杂志 (电子版), 2009, 3(8): 1379-1383.
41. Yen CY, Tu YK, Ma CH, et al. Osteonecrosis of the femoral head: comparison of clinical results for vascularized iliac and fibula bone grafting. J Reconstr Microsurg, 2006, 22(1): 21-24.
42. Tetik C, Başar H, Bezer M, et al. Comparison of early results of vascularized and non-vascularized fibular grafting in the treatment of osteonecrosis of the femoral head. Acta Orthop Traumatol Turc, 2011, 45(5): 326-334.
43. Korompilias AV, Beris AE, Lykissas MG, et al. Femoral head osteonecrosis: why choose free vascularized fibula grafting. Microsurgery, 2011, 31(3): 223-228.
44. Fang T, Zhang EW, Sailes FC, et al. Vascularized fibular grafts in patients with avascular necrosis of femoral head: a systematic review and meta-analysis. Arch Orthop Trauma Surg, 2013, 133(1): 1-10.
45. Feng W, Chen J, Wu K, et al. A comparative study of cortico-cancellous iliac bone graft with or without the combination of vascularized greater trochanter flap for the management of femoral head osteonecrosis: a minimum 6 years follow-up. BMC Musculoskelet Disord, 2019, 20(1): 298.
46. Dewei Z, Xiaobing Y. A retrospective analysis of the use of cannulated compression screws and a vascularised iliac bone graft in the treatment of displaced fracture of the femoral neck in patients aged < 50 years. Bone Joint J, 2014, 96-B(8): 1024-1028.
47. Judet H, Gilbert A. Long-term results of free vascularized fibular grafting for femoral head necrosis. Clin Orthop Relat Res, 2001, (386): 114-119.
48. Louie BE, McKee MD, Richards RR, et al. Treatment of osteonecrosis of the femoral head by free vascularized fibular grafting: an analysis of surgical outcome and patient health status. Can J Surg, 1999, 42(4): 274-283.
49. Eward WC, Rineer CA, Urbaniak JR, et al. The vascularized fibular graft in precollapse osteonecrosis: is long-term hip preservation possible? Clin Orthop Relat Res, 2012, 470(10): 2819-2826.
50. Korompilias AV, Lykissas MG, Beris AE, et al. Vascularised fibular graft in the management of femoral head osteonecrosis: twenty years later. J Bone Joint Surg (Br), 2009, 91(3): 287-293.
51. 陈圣宝, 张长青, 金东旭, 等. 影响吻合血管腓骨移植治疗股骨头坏死疗效的相关因素分析. 中华显微外科杂志, 2009, 32(4): 266-270.
52. Petek D, Hannouche D, Suva D. Osteonecrosis of the femoral head: pathophysiology and current concepts of treatment. EFORT Open Rev, 2019, 4(3): 85-97.
53. Plakseychuk AY, Kim SY, Park BC, et al. Vascularized compared with nonvascularized fibular grafting for the treatment of osteonecrosis of the femoral head. J Bone Joint Surg (Am), 2003, 85(4): 589-596.
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Treatment of osteonecrosis of the femoral head with vascularized bone grafting

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