Mahmut KÖMÜRCÜ, Kaan ERLER, Serkan ÖZDEMİR, DOĞAN BEK, Mehmet ALTINMAKAS

Femur başı avasküler nekrozu tedavisinde vaskülarize fibula grefti uygulaması: Üç olgu sunumu

Yaşları 21, 21 ve 24 olan üç erkek hastaya femur başı avasküler nekrozu tanısıyla vaskülarize fibula grefti uygulandı. Hastalık iki olguda idyopatik bulunurken, bir olgu steroid kullanmaktaydı. Ameliyat öncesinde Pennsylvania Üniversitesi radyolojik evrelendirme sistemine göre üç hasta sırasıyla evre 2a, 2b ve 2c şeklinde değerlendirildi. Olgular ameliyattan sonra ortalama 31 ay (dağılım 30-32 ay) izlendi. Evre 2a ve 2b olan olgularda ilerleme görülmezken, evre 2c olan hasta 3b olarak değerlendirildi. Harris kalça skoru ameliyat öncesi ortalama 54 (dağılım 52-58) iken son kontrollerde ortalama 93.3 (dağılım 86-100) bulundu. Vaskülarize fibula grefti uygulaması, subkondral çökme gelişmesini engellemesi, kalça protezi uygulamasını geciktirmesi ve yüksek başarı oranı nedeniyle, erken evreli özellikle genç hastalarda tercih eğilebilecek bir tedavi yöntemidir.

Anahtar Kelimeler:

Nakil, otolog, Steroidler, Femur başı nekrozu, Kemik nakli

The treatment of avascular necrosis of the femoral head with vascularized fibular grafting: a report of three cases

Three male patients aged 21, 21, and 24 years were treated with vascularized fibula grafting for avascular necrosis of the femoral head. The disease was found idiopathic in two cases, while one patient was on steroid therapy. According to the Pennsylvania University Staging System, preoperative radiologic stages were 2a, 2b, and 2c. At the end of a mean follow-up period of 31 months (range 30 to 32 months), there was no progression in two patients, whereas the patient with stage 2c disease was found as stage 3b. The mean Harris hip score increased from preoperative 54 (range 52 to 58) to postoperative 93.3 (range 86 to 100). Vascularized fibula grafting may be an alternative method for early stages of avascular necrosis of the femoral head especially in young patients, because it prevents subchondral collapse, delays total hip arthroplasty, and offers a high success rate.

Keywords:

Transplantation, Autologous, Steroids, Femur Head Necrosis, Bone Transplantation,

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