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

Liu, Yu-Peng; Zhao, Dewei; Wang, W.M.; Wang, B.J.; Zhang, Y.; Li, Z.G.

doi:10.3233/thc-161173

Cited by 4 publications

(4 citation statements)

References 22 publications

(18 reference statements)

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“…Several methods, such as angiography [16,28,29], digital subtraction angiography (DSA) [43,44], single-photonemission computed tomography (CT) [24] and SPECT/CT [45], had been reported to evaluate the blood supply of vascular pedicle graft both before and after operation. Babhulkar S et al [16] advocated that preoperative angiography should be routinely performed on each patient to assess the presence of the transplanted blood vessel and to avoid vascular mutations.…”

Section: Discussionmentioning

confidence: 99%

“…Babhulkar S et al [16] advocated that preoperative angiography should be routinely performed on each patient to assess the presence of the transplanted blood vessel and to avoid vascular mutations. Liu Y et al [43] performed DSA on 48 patients before and 6 months after the operation to evaluate hemodynamic changes in ONFH with iliac bone flaps from the ALCA. They found that the position of the ALCA was relatively constant prior to operation, and also found that 44 of the 48 patients had a good blood supply to the femoral head 6 months after the operation, while the remaining 4 patients eventually underwent TKA due to poor blood flow of the femoral head.…”

Section: Discussionmentioning

confidence: 99%

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How long does a hip-preserving surgery with vascularized pedicle iliac bone grafts for femur head necrosis last? A systematic review and meta-analysis of case series with an average more than 5-year follow-up

Zhu

Zhang

Sun

et al. 2020

Preprint

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Background: Hip-preserving surgeries with vascularized pedicle iliac bone grafts (VPIBG) are effective for osteonecrosis of the femoral head (ONFH). However, few studies exist about the long-term efficacy of this procedure. The aim of this meta analysis was to investigate how long does this hip-preserving surgery last. Methods: A comprehensive search was carried out through PubMed, Embase and Cochrane Collaboration Library for all relevant studies up to November 2019. The literature search strategy contained Medical Subject Headings and terms relating to ONFH and bone transplantation. All included studies were articles on VBIPG for ONFH, with an average follow-up of more than 5 years. Interesting outcomes included clinical success rates, complications, and conversion rates of THA. The data from eligible studies were then extracted and synthesized. The pooled effect size (ES) and 95% confidence intervals (CIs) were calculated. Results: Ten studies were finally selected. Eight studies including 3413 hips were pooled into the meta-analysis of success rates, the overall ES was 0.89 (95% CI, 0.86–0.92). In subgroup analysis, the ES was 0.88 (95% CI, 0.78–0.98) and 0.90 (95% CI, 0.87–0.92) at an average 5-10 years and 10-15 years follow-up, respectively. Pooled analysis of THA conversion rates derived from 7 studies (3389 hips) showed the overall ES of 0.10 (95% CI, 0.09–0.11). Seven studies (3396 hips) were included in a meta-analysis of complication rates, and the overall ES was 0.12 (95% CI, 0.08–0.18). The most common complications were secondary wound healing (37.6%), numbness or paresthesia of the lateral thigh (22.4%), and deep vein thrombosis (19.6%). Conclusions: The hip-preserving surgery with VPIBG is a safe and effective treatment for early-stage ONFH, but it should be used with caution in the treatment of advanced femoral head necrosis. The pooled data from this study suggested that 90% of the hips in patients with ONFH lasted 10 years after this surgery. However, most of the included studies are case series, and these conclusions will need the support of high-quality research in the future.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

How long does a hip-preserving surgery with vascularized pedicle iliac bone grafts for femur head necrosis last? A systematic review and meta-analysis of case series with an average more than 5-year follow-up

Zhu

Zhang

Sun

et al. 2020

Preprint

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“…As the blood vessels of the femoral head are minute with a large distribution angle and slow blood flow, they are susceptible to insults such as trauma and hormone-induced intravascular changes [ 28 – 30 ]. Although a number of studies have attempted to resolve the mechanism by which these insults trigger ONFH, effective medical treatment for this condition is still lacking [ 31 , 32 ]. In traditional Chinese medicine theory, ONFH is considered as a type of bone erosion and bone atrophy, and the pathogenesis of which is Qi stagnation and blood stasis, meridians stasis, and marrow death.…”

Section: Discussionmentioning

confidence: 99%

Bone-strengthening pill (BSP) promotes bone cell and chondrocyte repair, and the clinical and experimental study of BSP in the treatment of osteonecrosis of the femoral head

Wang

Jin

et al. 2017

Oncotarget

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About 1 in 3 people suffer from bone and joint disease, which is a disease of bone and cartilage cells. Osteonecrosis of the femoral head (ONFH) is a typical example of bone and joint disease involving bone cell necrosis. Osteonecrosis of the femoral head leads to the occurrence of premature osteoarthritis of the hip and collapse of the cartilage cells, and there is currently no effective drug treatment available. In order to study the effects of “bone-strengthening pill” (BSP) on the repair of bone and cartilage cells, we investigated the potential effects of the herbal mixture BSP in an animal model of avascular necrosis of the femoral head and in patients. Results showed that 90% of rats injected with prednisone developed ONFH, whereas BSP administration prevented ONFH development in 70% of prednisone-injected rats. We evaluated the constituents of BSP by HPLC fingerprinting. We also evaluated the clinical efficacy of BSP in a double-blind, randomized, controlled trial of 300 patients with ONFH. The response rate was found to be higher in the treatment group than in the control group, with a response rate of 82% in the treatment group. Treatment with BSP also significantly reduced pain, improved hip function, reduced lameness, and improved pathology by X-ray and MRI analysis, compared with patients who did not receive BSP. These results suggest that BSP treatment inhibits and reverses necrosis of the femoral head bone cells and cartilage cells to repair the femoral head, promote the repair of bone and cartilage diseases.

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“…It was demonstrated that skeletal angiogenesis and vascularity were interrupted in necrotic tissue, no matter if it is steroid-induced or alcohol-induced one [3]. Femoral head blood flow was greatly reduced once osteonecrosis occurred, and vasoconstriction was usually found on lateral epiphyseal arteries of the femoral head [4]. Currently, the hip preservation surgery is used to provide biomechanical support and, more importantly, induce revascularization or transposition of the necrotic area [5].…”

Section: Introductionmentioning

confidence: 99%

Huo Xue Tong Luo capsule, a vasoactive herbal formula prevents progression of asymptomatic osteonecrosis of femoral head: A prospective study

Wei

Hong

Yuan

et al. 2019

Journal of Orthopaedic Translation

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Background/objective A prospective cohort study aimed to evaluate the clinical efficacy of a specific vasoactive herbal formula, Huo Xue Tong Luo capsule (HXTL capsule), for the treatment of patients with asymptomatic osteonecrosis of femoral head (ONFH). Methods We evaluated a clinical trial of 55 patients (59 hips) with asymptomatic ONFH (no joint collapse) evaluated by Steinberg staging system and necrosis range classification criteria. Then, they were given HXTL capsule under specific protocol. Among them, 39 males and 16 females with an average age of 36.4 ± 10.1 years were followed up for an average of 4.38 years during treatment. The aggravation of clinical and imaging results was assessed by initial pain and joint collapse. The clinical and imaging outcomes of these patients were compared with those of a historical control group from the literature under critical inclusion criteria. Results At the latest follow-up, initial pain occurred in five of 59 (8.5%) hips of patients taking HXTL capsule compared with 31 of 81 (38.3%) controls ( p < 0.001), and joint collapse occurred in 13 of 59 (22.0%) hips of patients taking HXTL capsule compared with 26 of 81 (32.1%) controls ( p < 0.001). There was no association between joint collapse and multiple key factors of ONFH. Only the location of type C2 necrotic lesions (hazard ratio, 4.12; 95% confidence interval, 2.64–18.91) and the extent of large necrotic lesions (hazard ratio, 3.39; 95% confidence interval, 1.43–16.21) predicted joint collapse. Conclusion As an agent formulated by vasoactive herbals, HXTL capsule with specific protocol is an effective medicine for relieving hip pain and preventing joint collapse in patients with asymptomatic ONFH. The translational potential of this article The translation potential of this prospective cohort study is that the initially officially approved clinical indication for HXTL capsule for treatment of ONFH is due to its possible effect of revascularization on angiogenesis of necrosis. It is has been now proven to be effective for a new clinical application.

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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

Cited by 4 publications

References 22 publications

How long does a hip-preserving surgery with vascularized pedicle iliac bone grafts for femur head necrosis last? A systematic review and meta-analysis of case series with an average more than 5-year follow-up

How long does a hip-preserving surgery with vascularized pedicle iliac bone grafts for femur head necrosis last? A systematic review and meta-analysis of case series with an average more than 5-year follow-up

Bone-strengthening pill (BSP) promotes bone cell and chondrocyte repair, and the clinical and experimental study of BSP in the treatment of osteonecrosis of the femoral head

Huo Xue Tong Luo capsule, a vasoactive herbal formula prevents progression of asymptomatic osteonecrosis of femoral head: A prospective study

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