Objective:To explore the short-term clinical efficacy of arthroscopy-assisted surgical dislocation combined with autologous iliac bone graft for early and middle-stage femoral head necrosis in young and middle-aged patients.Methods:A retrospective study was conducted to analyze the clinical data of the 20 patients with early and middle-stage femoral head necrosis who had been treated by arthroscopy-assisted surgical dislocation combined with autologous iliac bone graft at Orthopaedic Medical Center, Haikou Hospital Affiliated to Xiangya School of Medicine, Central South University from January 2020 to December 2024. There were 12 males and 8 females, with an age of 31 (21, 46) years. The femoral head necrosis was due to hormones in 6 cases, to alcohol in 8 cases, to trauma in 3 cases, and to primary lesions in 3 cases. The International Bone Circulation Research Association staging: stage 2B in 2 cases, stage 2C in 5 cases, stage 3A in 7 cases, stage 3B in 3 cases, and stage 3C in 3 cases. The surgical time, intraoperative blood loss, and incidence of complications during follow-up were recorded in this cohort. The visual analogue scale (VAS) pain score, hip Harris score, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) in this cohort were compared between pre-surgery, 3 months after surgery, and the last follow-up.Results:In this cohort, the surgical time was 134 (120, 160) minutes, the intraoperative blood loss 275 (250, 300) mL, and the follow-up duration (28.7±8.2) months. At pre-surgery, 3 months after surgery, and the last follow-up, respectively, the VAS pain scores were 6.0 (5.0, 7.0) points, 2.0 (1.0, 3.0) points, and 0.5 (0.0, 1.0) points; the WOMAC scores 45.5 (40.3, 46.8) points, 12.5 (10.5, 14.0) points, and 9.5 (8.3, 10.0) points; the Harris hip scores (58.1±4.8) points, (78.4±4.7) points, and (85.0±6.7) points. There were statistically significant differences in the pairwise comparisons between the 3 time points ( P<0.05). At the last follow-up, the therapeutic effects were evaluated according to the Harris hip score as excellent in 7 cases, as good in 10 cases, and as poor in 3 cases, giving an excellent and good rate of 85.0% (17/20). Two patients developed lower limb intermuscular vein thrombosis after surgery, 2 patients had delayed healing of greater trochanter osteotomy after nail removal, heterotopic ossification occurred in 2 patients, and further collapse of the femoral head occurred in 7 patients. No patient developed complications such as wound infection or nerve injury during the follow-up period. Conclusion:The arthroscopy-assisted surgical dislocation combined with autologous iliac bone graft can lead to good short-term clinical efficacy in the treatment of early and middle-stage femoral head necrosis in young and middle-aged patients, but complications such as femoral head collapse, delayed healing of greater trochanter osteotomy, heterotopic ossification, and lower limb intermuscular vein thrombosis still exist.

Objective:To explore the short-term clinical efficacy of arthroscopy-assisted surgical dislocation combined with autologous iliac bone graft for early and middle-stage femoral head necrosis in young and middle-aged patients.Methods:A retrospective study was conducted to analyze the clinical data of the 20 patients with early and middle-stage femoral head necrosis who had been treated by arthroscopy-assisted surgical dislocation combined with autologous iliac bone graft at Orthopaedic Medical Center, Haikou Hospital Affiliated to Xiangya School of Medicine, Central South University from January 2020 to December 2024. There were 12 males and 8 females, with an age of 31 (21, 46) years. The femoral head necrosis was due to hormones in 6 cases, to alcohol in 8 cases, to trauma in 3 cases, and to primary lesions in 3 cases. The International Bone Circulation Research Association staging: stage 2B in 2 cases, stage 2C in 5 cases, stage 3A in 7 cases, stage 3B in 3 cases, and stage 3C in 3 cases. The surgical time, intraoperative blood loss, and incidence of complications during follow-up were recorded in this cohort. The visual analogue scale (VAS) pain score, hip Harris score, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) in this cohort were compared between pre-surgery, 3 months after surgery, and the last follow-up.Results:In this cohort, the surgical time was 134 (120, 160) minutes, the intraoperative blood loss 275 (250, 300) mL, and the follow-up duration (28.7±8.2) months. At pre-surgery, 3 months after surgery, and the last follow-up, respectively, the VAS pain scores were 6.0 (5.0, 7.0) points, 2.0 (1.0, 3.0) points, and 0.5 (0.0, 1.0) points; the WOMAC scores 45.5 (40.3, 46.8) points, 12.5 (10.5, 14.0) points, and 9.5 (8.3, 10.0) points; the Harris hip scores (58.1±4.8) points, (78.4±4.7) points, and (85.0±6.7) points. There were statistically significant differences in the pairwise comparisons between the 3 time points ( P<0.05). At the last follow-up, the therapeutic effects were evaluated according to the Harris hip score as excellent in 7 cases, as good in 10 cases, and as poor in 3 cases, giving an excellent and good rate of 85.0% (17/20). Two patients developed lower limb intermuscular vein thrombosis after surgery, 2 patients had delayed healing of greater trochanter osteotomy after nail removal, heterotopic ossification occurred in 2 patients, and further collapse of the femoral head occurred in 7 patients. No patient developed complications such as wound infection or nerve injury during the follow-up period. Conclusion:The arthroscopy-assisted surgical dislocation combined with autologous iliac bone graft can lead to good short-term clinical efficacy in the treatment of early and middle-stage femoral head necrosis in young and middle-aged patients, but complications such as femoral head collapse, delayed healing of greater trochanter osteotomy, heterotopic ossification, and lower limb intermuscular vein thrombosis still exist.

Objective:To investigate the short-term efficacy difference between femoral neck system and cannulated compression screw in the treatment of femoral neck fracture in young and middle-aged patients.Methods:Cochrane Library, PubMed, Web of Science, Embase, CNKI, Wanfang, VIP and CBM databases were searched. All literature on the treatment of femoral neck fractures using the femoral neck system (FNS) or cannulated compression screw (CCS). RevMan 5.4.1 software was used to analyze data.Results:Twelve high-quality cohort studies were included, including 787 patients treated surgically for femoral neck fractures, of whom 369 were treated with FNS and 418 with CCS. Results of meta-analysis showed that FNS had shorter operative time than CCS for femoral neck fracture [ WMD=-8.09, 95% CI (-14.12, -2.06), P=0.009]. FNS had less intraoperative blood loss [ WMD=6.63, 95% CI (1.42, 11.83), P=0.010], Partial weight-bearing time of FNS was earlier postoperative [ WMD=-2.11, 95% CI (-3.00, -1.22), P<0.001], while full weight-bearing time was also earlier postoperative [ WMD=1.01, 95% CI (1.59, 0.43), P<0.001), The postoperative fracture healing time of FNS was shorter [ SMD=0.67, 95% CI (1.04, 0.30), P<0.001]. The Harris score of FNS at the last follow-up was higher [ WMD=4.67, 95% CI (3.26, 6.08), P<0.001]. The number of fluoroscopy during FNS was less [ WMD=-9.05, 95% CI (-10.92, -7.18), P<0.001]. The rate of severe femoral neck shortening after FNS was lower [ RR=0.36, 95% CI (0.19, 0.70), P=0.002]. The incidence of postoperative complications after FNS, including urinary tract infection, venous thromboembolism, bone nonunion, screw loosening, femoral head avascular necrosis, was lower [ RR=0.38, 95% CI (0.27, 0.53), P<0.001]. There was no difference in postoperative hospital stay between FNS and CCS [ WMD=0.01, 95% CI (-0.36, 0.39), P=0.950]. There was no difference in fracture reduction quality (Garden I) [ RR=1.04, 95% CI (0.87, 1.24), P=0.660]. There was no difference in fracture reduction quality (Garden II) [ RR=0.91, 95% CI (0.59, 1.39), P=0.650]. There was no difference in postoperative moderate femoral neck shortening [ RR=0.85, 95% CI (0.58, 1.26), P=0.430]. Conclusion:Compared with cannulated compression screw, femoral neck system had shorter operation time, less intraoperative blood loss, earlier postoperative part load or full load time, shorter fracture healing time higher Harris score at the last follow-up, less number of intraoperative fluoroscopy, and lower rate of severe femoral neck shortening. Besides, FNS had a lower incidence of postoperative complications including urinary tract infection, venous thromboembolism, bone nonunion, screw loosening, and avascular necrosis of femoral head than CCS.