Abstract
OBJECTIVE: To explore the application effects of core decompression, allograft fibula fixation, and pedicled fibula grafting in osteonecrosis of the femoral head (ONFH). METHODS: Forty patients with ONFH admitted to Ziyang Central Hospital from March 2017 to March 2022 were included in this study. According to the Association Research Circulation Osseous (ARCO) staging criteria, 20 patients at stage I underwent core decompression, 8 patients at stage II underwent core decompression combined with allogenic fibula fixation, and 12 patients at stage III underwent core decompression combined with pedicled fibula grafting. RESULTS: After 1 year of follow-up, changes in hip joint function (Harris score) and pain level (visual analogue scale (VAS)) were compared before and after surgery. Imaging examination results were recorded, and efficacy and ARCO stage progression were compared with preoperative findings. All 40 patients received follow-up for 1 year. The results showed that the Harris score at 1 year post-operation was higher than pre-operation, while the VAS score was lower (P<0.05). Hip joint function evaluation in the 20 patients at stage I showed excellent, good, and fair results in 12 (60.00%), 5 (25.00%), and 3 (15.00%) cases, respectively, with X-ray examination indicating complete stability and no progression in ARCO staging. Among the 8 patients at stage II, hip joint function evaluation showed excellent, good, fair, and poor results in 4 (50.00%), 2 (25.00%), 1 (12.50%), and 1 (12.50%) cases, respectively. X-ray examination revealed stability in 7 cases, while 1 case progressed to ARCO stage IV and ultimately required artificial hip arthroplasty. Among the 12 patients at stage III, hip joint function evaluation revealed excellent, good, fair, and poor results in 5 (41.67%), 3 (25.00%), 2 (16.67%), and 2 (16.67%) cases, respectively. X-ray examination indicated stability in 10 cases, while 2 cases progressed to ARCO stage IV and ultimately required artificial hip arthroplasty. CONCLUSION: Patients with stage I, II, and III ONFH achieved good short-term therapeutic outcomes using core decompression, core decompression with allogenic fibula fixation, and core decompression with pedicled fibula grafting. These methods effectively improved hip joint function and alleviated pain symptoms. Hence, it is crucial to select appropriate surgical methods based on the specific conditions of patients in clinical practice.