Objective To evaluate the mid-term outcome of impacting bone graft and strut graft in treating osteonecrosis of the femoral head (ONFH) and to compare the effects of fibular autograft and allograft for strut graft. Methods From August 2004 to December 2004, 40 cases (58 hips) of ONFH were treated with impacting bone graft and nonvascular fibular autograft (autograft group) or allograft (allograft group). In the autograft group, 20 cases (27 hips) included 17 males (23 hips) and 3 females (4 hips) with an average age of 41 years (22-53 years); 22 hips were at stage II and 5 hips at stageIII according to the classification system of Association Research Circulation Osseous (ARCO). In the allograft group, 20 cases (31 hips) included 17 males (25 hips) and 3 cases females (6 hips) with an average age of 40 years (18-55 years); 23 hips were at stage II and 8 hips at stage III according to the classification system of ARCO. The outcome was evaluated both cl inically by Harris hip score (HHS) and radiologically by X-rays. The related compl ications were recorded. The end-point of observation was determined when further salvage operation or total hip arthroplasty was needed. Results All cases were followed up for 36-40 months (mean 37.5 months), 25 hips (92.6%) preserved femoral heads in autograft group and 28 hips (90.3%) in allograft group. Harris score in autograft and allograft groups was increased significantly from 70.82 ± 8.26 and 69.94 ± 9.59 before operation to 86.36 ± 6.27 and 87.45 ± 7.03 at the last follow-up, respectively, indicating a significant difference between before and after operation in two groups (P lt; 0.05), but no significant difference between two groups (Pgt;0.05). The radiological results showed that 17 hips (63.0%) in autograft group and 21 hips (67.8%) in allograft group improved or had no further collapse; and 20 hips (74.1%) in autograft group and 22 hips (71.0%) in allograft group were in good repair, indicating no significant difference between two groups (P gt; 0.05). The postoperative compl ication occurred after weight-bearing walk in the autograft group and during wound heal ing stage in the allograft group. Conclusion For selected cases of femur head necrosis, the treatment with modified impacting bone graft and strut graft has a satisfactory mid-term outcome. The results of fibular autograft and fibular allograft had no significant difference.
【Abstract】 Objective To explore the correlation between pain grading, stage of necrosis and bone marrow edema(BME) in nontraumatic osteonecrosis of femoral head (NONFH) so as to strengthen understandings about cl inical significance of BME in NONFH. Methods From October 2004 to October 2006, 97 patients (149 hips) with NONFH were treated. There were 68 males and 29 femals with an average age of 38.8 years (19-62 years). The disease course was from 20 days to 4 years. BME was identified grade 0 to grade 2 according to MRI. Based on grading scale of pain, pain grading were divided into no pain (grade 0), mild pain (grade 1) and moderate or severe pain (grade 2). According to Association Research Circulation Osseous staging system, NONFH were divided into I-IV stages. The incidence rate of BME in each pain grading and stages of necrosis was analyzed respectively. Contingency table analyses and rank sum tests were used to compare the difference of pain grading and stages of necrosis among these groups. Results The total incidence rate of BME was 73.15% (109/149), the incidence rateswere 84.38% in pain groups (108 /128) and 94.12% in the grade 2 (32/34). Pain grading correlated with BME rating (P lt; 0.001).The results of rank sum tests for several independent samples showed significant difference in BME among pain groups(P lt; 0.001). With the advance of pain scale, the mean rank of BME increased gradually(28.19 for grade 0, 78.94 for grade 1 and 96.12 for grade 2). BME was more commonly and clearly seen in stage Ⅱ（77.05%）and stage Ⅲ（82.81%）of NONFH. Stage I-III of NONFH correlated with BME rating (P lt; 0.001). The results of rank sum tests showed significant difference in BME rating among three stages (P lt; 0.001). With the advance of disease, the rank of BME rating increased gradually (39.07 for grade 0, 60.16 for grade 1 and 86.15 for grade 2 ). Conclusion BME is a sign that is accompanied with NONFH. The probabil ity and extent of BME correlated well with the pain and stage of NONFH．The condition of BME can be used as a index for the appraisal of advancement of disease and the judgment of treatment result.