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01.12.2015 | Research article | Ausgabe 1/2015 Open Access

BMC Musculoskeletal Disorders 1/2015

Should thorough Debridement be used in Fibular Allograft with impaction bone grafting to treat Femoral Head Necrosis: a biomechanical evaluation

Zeitschrift:
BMC Musculoskeletal Disorders > Ausgabe 1/2015
Autoren:
Guangquan Zhou, Ying Zhang, Linghong Zeng, Wei He, Zhihui Pang, Xiumin Chen, Yujing Xu, Liao Shaoyi Stephen, LeiLei Chen
Wichtige Hinweise
Wei He, Zhihui Pang and Xiumin Chen contributed equally to this work.

Competing interests

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Authors’ contributions

ZGQ, HW, PZH and CXM have contributed to develop protocol of the study. ZGQ, ZY and ZLH have carried out data collection. ZGQ and ZY performed the experiments. ZGQ and ZLH have conducted data analysis. ZGQ and ZY wrote the paper. ZGQ, ZLH, XYJ, LSS and CLL translated the paper. ZGQ, HW, PZH and CXM have contributed to results interpretation and have read and approved the final manuscript.

Authors’ Information

Guangquan Zhou, Ying Zhang, Linghong Zeng: co-first authors.

Abstract

Background

Fibular allograft with impaction bone grafting (FAIBG) is an effective hip-preservation method for avoiding total hip arthroplasty in the early stage of femoral head necrosis. However, whether thorough debridement should be used with FAIBG is controversial. This study compared the mechanical performance between FAIBG with and without thorough debridement, which provides a biomechanical basis for selecting the proper treatment in clinical settings.

Methods

Eighteen computational models were constructed and used to simulate two subtypes of femoral head collapse with seven debridement radii. The initial model was validated using the bony density distribution from X-ray images and a photograph of the cadaver bone cross-section. The stress of the anterolateral column and the debridement efficiency were computed and analyzed.

Results

(1) The peak stress of the anterolateral column in all conditions could return to the physiological level, and in two cases, the decrement/increment of stress was almost less than 0.1 % when the debridement radius increased. (2) The load share ratio (LSR) of the cortical and cancellous bone was markedly decreased in the untreated condition and increases with an increase in the debridement radius. (3) A debridement radius greater than 1/2r yields a LSR value larger than that obtained in the normal condition.

Conclusions

The simulation results provide specific biomechanical evidence to support the finding that FAIBG with a debridement region of 3/8 -1/2 appears to be a better choice for resisting femoral head collapse (FHC). Furthermore, FAIBG without thorough debridement, which requires relatively simple surgical devices and reduces artificial damage, appears to be a better method for resisting FHC than FAIBG with thorough debridement.
Literatur
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