[Objective]To evaluated the clinical results of treatment of osteoneerosis of the femoral head(ONFH)with repair and reconstruction through long-term follow-up.[Methods]A total of 313 patients(382 hips)operated on from November 1986-March 1997 who had a mean age of 36.4 years(range,18～65 years)were reviewed retrospectively.The hips were 151 Ficat and Arlet stage Ⅱ,142 stage Ⅲ,89 stage Ⅳ.All patients were followed up for a mean of 12.1yrs(range,10～20 yrs) and were assessed clinically and radiologically according to Harris scoring and variation of Ficat stage respectively.The patients were analyzed by the Kaplan-Meier method with replacement for any reason as the end-point.[Results]Ninteen hips underwent total hip replacement postoperatively.Preoperative and postoperative Harris score were 56.2 and 85.8.Clinical success rate was 85.6%and radiological success rate was 75.4%.Kaplan-Meier survivorship curves showed there was a lower long-term survival on stage-IV、abuse of hormone alcolutic indulger and above 55 years old patients.[Conclusion]The long-term efficacy is satisfactory to be confirmed by repair and reconstruction in treatment of osteonecrosis of the femoral head.This procedure will improve the curative effect of preserving head treatment of ONFH and early-middle clinical results being satisfied.

As a common disease in orthopedics,osteonecrosis of the femoral head (ONFH) frequently occurs among young and middle-aged people.Hip joint preserving surgery has attracted more and more attention due to the fact that artificial joint prosthesis has a certain useful life and the rate of hip joint revision is high and the higher risk of many complications.There are a large number of operative methods for preserving hip joint in clinical practice without definitive curative effects.Core decompression and impaction bone grafting with simple operative methods can relieve internal pressure of femoral head and pain symptoms,but they cannot remove necrotic bone completely.Hence,they are only used for ONFH in the early stage.Vascularized bone transplantation can fill defects of the former,as it can not only completely remove necrotic bone,but also provide bone graft with nourishing vessels for femoral head,being beneficial to reconstruct the bone structure of femoral head.Subsequently,the application of tantalum rod can provide mechanical support for femoral head to prevent the collapse of femoral head.The emergence of stem cell transplantation has created a new approach to preserve hip joint for ONFH,which promotes the regeneration of bone cells and assists femoral head in repair,often combined with other operative methods and using characteristics of superior proliferation and differentiation of stem cells.Hip joint preserving surgery,in recent years,has been performed increasingly,and has obtained improvement in clinical effects.The multiple combination of a variety of its operative methods provides more effective treatments for ONFH.It is an essential notion that hip joint preserving surgery,however with any operative method,should as far as possible select a surgical plan with little trauma,simple methods and little injury to bone structure of hip joint based on ensuring the efficacy.

-mid stage ONFH. It provided good blood supply and enough mechanical support as to reduce the progress of femoral head collapse.

The occurrence of iliac vein compression syndrome(IVCS) has the anatomic factor.IVCS has no specific symptoms and signs.The diagnosis of IVCS is mainly made by venography, intravascular pressure measurement, intravascular ultrasound, Doppler ultrasound,magnetic resonance venography, and CT.Before the occurrence of acute iliofemoral thrombosis,the treatment of IVCS is conservative therapy.The purpose of surgical intervention is to resolve the obstruction and keep the blood flow. The surgery of occluded iliac veins secondary to IVCS is now to be replaced by endovascular reconstruction. IVCS can be treated correctly before the occurrence of iliofemoral thrombosis and its sequelae can be reduced greatly, if the diagnosis of IVCS can be made as early as possible,and the degree of the stenosis of the iliac vein,the characteristics of its hemorheology and hemodynamics can be understood in time.

Objective:For further exploring the feasibility,we have treated the middle and infe- rior femoral bone fracture nonunion by the transplantation of bone flap with ascending and transvers branch of the lateral femoral circumflex vessels.Method:The technique,on the basis of anatomical study have been designed to treat the femoral bone fracture nonunion by the transplantation of bone flap with ascending and transvers branch which pedicle was descendant branch of the lateral femoral circumflex vessel.Results:8 cases of middle and inferior femoral fracture nonunion had been treated by this method.At follow-up of 1 year 5 months to 4 years 6 months,the results have been satisfacto- ry.Conclusions:The method of the transplantation of the bone flap with ascending and transvers branch of the lateral femoral circumflex vessel for the treatment of middle and inferior femoral fracture nonunion has the adventages of simplicity,easiness,reliability.

Objective To explore the biomechanical influences of cystic degeneration in different locations on femoral head and guide the appropriated surgical treatment to preserve the femoral head. Methods First scanning a upper femur specimen with spinal CT, dealing the two-dimensional image with Efilm software, identifying the outline of the femoral head by range estimation, inputting coordinate value of the femur into the computer to build up three-dimensional finite element model of the upper femur by Ansys-5.7 software, then simulating necrosis and cystic degeneration of 1 cm diameter by analogue computer, at last putting three kinds of pressure on the femoral head respectively to analyse the stress distribution and the stress/strength ratio and predict the collapse of the femoral head. Results The tension concentration was obvious when the necrosis and cystic degeneration was beneath the loading area or medial or lateral to the loading area in the femoral head, the stress/strength ratio of the cancellous bone beneath the articular surface was high which tends to cause collapse of the femoral head. When the necrosis and cystic degeneration located in the inferior parts of the femoral head, the strain concentration was not obvious and the stress/strength ratio of the cancellous bone beneath the articular surface was normal and the femoral head had little danger of collapse. When the focus located in the anterior or posterior part of the femoral head, its upper edge displayed tension concentration but not obvious and the stress/strength ratio of the cancellous bone beneath the articular surface was lower than normal and the danger of collapse was little. Conclusion When the necrosis and cystic degeneration is beneath the loading area or medial or lateral to the loading area in the femoral head, the focus should be cleared thoroughly and the vascularised bone flap should be implanted ideally with abutment against the subchondral plate to prevent the collapse of the femoral head. If the necrotic range is large involved the loading area and its medial or lateral sides, the vascularised bone flap should be implanted beneath the loading area.

Objective To evaluate a new method of arthroplasty by transposing the greater trochanter together with a fascia flap pedicled by a branch of transverse lateral circumflex femoral artery. Methods On the basis of anatomical study, arthroplasty of the hip by transposition of the greater trochanter with fascia flap pedicled by a branch of transverse lateral circumflex femoral artery was performed in 17 patients (18hip). All the patients were followed up for six years and two months to eight years and two months. Results Pain vanished in 10 cases, slight pain remained in 1 patient, walking was nearly normal in 5 patients, and 2 patients were still limping with fast walk. Range of movement of the hip joint was as follows: flexion and extension 60?-120?, adduction 5?-15?, abduction 5?-10?, internal rotation 0?-5?, and external rotation 0?-5?. As shown by radiography, the joint space was obviously enlarged, the configuration of the femoral head was sharp, and the union between the greater trochanter and the femoral head was good. Conclusion Transposition of the greater trochanter with fascia flap pedicled by a branch of transverse lateral circurmflex artery to femoral head could result in a solid union with cartilagenous ossification and satisfactory recovery of function of the hip joint.

Objective To probe into the microsurgical method of using arthroscope in treating ischemic necrosis of femoral head(INFH) Method Twenty six cases (33 hips) with early stage of INFH were operated by vascularized greater trochanter bone flap graft through the lateral acetabulum approach under the surveillance of arthroscope Result The follow up ranged from 1 to 3 years Function evaluation was made according to pain,function,joint activity and radiographic criteria The clinical results were satisfactory Conclusion With this method, can accurately clean the sequestra and reconstruct the blood supplying system of femoral head At the same time, the injury of the peripheral muscle of hip joint and ligament can be further reduced and the function of hip joint can be recovered maximally So the method of applying arthroscope and microsurgical technique to treat early stage INFH is a simple, convenient and effective method

Objective To comparison anterior cervical decompression and plating techniques for CSM between under microscope and traditional method retrospectively, investigate clinical result of surgery under microscope. Methods Sixty-seven patients with CSM underwent surgery of anterior cervical decompression and plating techniques were evaluated retrospectively from January 2008 to June 2010. Thirty-three patients underwent operation under microscope; thirty-four patients underwent traditional operation. The operating time, bleeding volume during operating and poster operating, walking time post-operation and complication were observed. Clinical outcomes were assessed by Japanese Orthopaedic Association (JOA), Image of before and after operation. Results Microsurgery operation time averaged of 100 minutes. Bleeding volume during the operation averaged of 60 ml, and after operation averaged of 40 ml. The JOA scores were improved from 8.43 pre-operatively to 14.70. Six months post operation, the average rage of JOA improvement were 83.2%. Traditional operation time averaged of 115 minutes. Bleeding volume during operation averaged of 100 ml, and after operation averaged of 50 ml. The JOA scores were improved from 7.45 pre-operatively to 11.84. Six months post operation, the average rage of JOA improvement were 82.1%. There were difference between two groups(P ＞ 0.05) in the JOA scores. No statistical difference (P ＜ 0.05) in bleeding volume and operating time. Conclusion The operation under microscope is restored significantly than the traditional method in bleeding volume, the surgical field, safety of operation, time of recovery and so on.

BACKGROUND: A discussion is ongoing whether the elderly patients with femoral neck fractures should be treated with a non-cemented or a cemented hemiarthroplasty.OBJECTIVE: To evaluated the results of cemented hemiarthroplasty for femoral neck fractures in the patients older than 85 years with high-risk clinical problems and functional outcomes.METHODS: Thirty-two patients with femoral neck fractures were treated with cemented bipolar hemiarthroplasty. X-ray examination after operation was done at 1, 3 and 6 months and annually in all patients. The mean follow-up period was 2 to 5 years.RESULTS AND CONCLUSION: Medical complications occurred in five patients (16%) and four patients (25%) died within the follow-up period. Dislocation occurred in one patient (3%). None of the patients had heterotopic ossification. The mean Harris-hip score was 84. Cemented hemiarthroplasty can provide stability, security and good outcomes for the treatment of femoral neck fractures in elderly patients.