[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.

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.

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

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 provide an effective and convenient microsurgical method for ischemic necrosis of femoral head in children (Perthes disease) Method Basing on anatomic study, two periosteal flap pedicled with anterior superior iliac and anterior inferior iliac branches of lateral femoral circumflex vessel transposition was designed for the treatement of Perthes disease Result Eleven patients were performed with this method, and the average period of follow up was 2 1 years (range 1～3 5 years) The good and excellent rate was 82 percent Conclusion The operative method can not only provide with plenty of blood supply,but also increase osteogenic ability of the femoral head So, it is an effective method for the treatment of Perthes disease

Objective To compare open reduction and cannulated screws combined with ascending branch of lateral femoral circumflex artery iliac bone flap with closed reduction and cannulated screw fixation for the treatment of displaced femoral neck fracture in young adults.Methods From January 1992 to January 2007,totally 204 cases of displaced femoral neck fracture were treated.Group A:one hundred and three cases were treated with open reduction and 2 cannulated screw fixation,covered by the vascular pedicled iliac bone flap with ascending branch of lateral femoral circumflex artery.Garden classification:type Ⅲ.68 cases,type Ⅳ:35 cases.Group B:one hundred and one cases,treated with closed reduction and three cannulated screw fixation.Garden classification:type Ⅲ in 62 cases and type Ⅳ in 39 cases.Results Two groups were followed up for 5-15 years.The healing time of group A was (73 ±21.2) days,including 4 cases of nonunion fracture (3.9％) and 5 cases of femoral head avascular necrosis occurred (4.9％) ; The healing time of group B was (89 ± 12.5) days,including 12 cases of nonunion fracture (11.9％) and 18 cases of femoral head avascular necrosis occurred (17.8％).The healing time,the rate of nonunion of fracture and the rate of femoral head necrosis were significantly different of these 2 groups.Conclusion The treatment of open reduction and 2 cannulated screw fixation,covered by the vascular pedicled iliac bone flap with ascending branch in young adults can effectively prevent nonunion of fractures and osteonecrosis of the femoral head.