Absorbable screws combined with quadratus femoris muscle pedicle bone flap transplantation in treatment of femur head necrosis

doi:10.3877/cma.j.issn.1674-134X.2026.03.003

Abstract

Abstract:

Objective

To investigate the clinical efficacy of absorbable screws combined with quadratus femoris muscle pedicle bone flap transplantation in the treatment of osteonecrosis of the femoral head (ONFH).

Methods

A retrospective analysis was performed on 54 patients with ONFH. The patients with ARCO stage Ⅱ or ⅢA, and aged from 16 to 55 years were included. The patients with surgery history at involved side hip, severe osteoporosis or infections were excluded. The treatment group (n=20) underwent absorbable screw fixation combined with quadratus femoris bone flap transplantation; the control group (n=34) received traditional bone flap implantation. Continuous variables were described as

x ¯

±s and compared using t test; categorical variables using chi square test.

Results

The treatment group presented longer operative time (1.42±0.21) h and more blood loss (95.70±10.20) ml than the control group (75.40±8.60) ml (t=13.251, 8.076, both P<0.001). Femoral head recovery rate was 80.0% in the treatment group which was higher than 52.9% in the control group (χ²=3.954, P<0.05). Necrosis rate was 5.0% in the treatment group which was lower than 29.4% in the control group (χ²=4.626, P<0.05). Harris excellent-good rate was 85.0% in the treatment group which was higher than 58.8% in the control group (χ²=4.105, P<0.05). Digital subtraction angiography showed higher microcirculation reconstruction rate in the treatment group than the control group (72.5% vs 43.9%) (χ²=4.378, P<0.05 ). The overall Harris hip function recovery rate was also higher in the treatment group (χ²=4.105, P<0.05).

Conclusion

This combined technique is effective for ONFH, yielding satisfactory improvement in femoral head blood supply and hip function.

Key words: Femoral head necrosis, Bone transplantation, Bone screws, Absorbable implants, Surgical flaps

Yaolin Zhang, Xingbo Cai, Teng Wang, Xi Yang, Chaobo Li, Liming Lyu, Yongqing Xu. Absorbable screws combined with quadratus femoris muscle pedicle bone flap transplantation in treatment of femur head necrosis[J]. Chinese Journal of Joint Surgery(Electronic Edition), 2026, 20(03): 275-282.

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URL: https://zhgjwkzz.cma-cmc.com.cn/EN/10.3877/cma.j.issn.1674-134X.2026.03.003

https://zhgjwkzz.cma-cmc.com.cn/EN/Y2026/V20/I03/275

Figures/Tables 7

Table 1 General data of the two groups before surgery

项目 Subjects	治疗组 Treatment group	对照组 Control group	统计值 Statistical values	P值
例数 Number of cases	20	34
年龄［岁，（ $x ¯$ ±s）］ Age（year）	37.50±6.50	33.60±5.90	t=1.427	＞0.05
性别（男/女） Gender（male/female）	13/7	23/11	χ²=0.076	＞0.05
病程［年，（ $x ¯$ ±s）］ Disease course（year）	1.81±0.73	1.84±0.69	t=0.152	＞0.05
ARCO分期（n） ARCO stage
Ⅱ期	12	20	χ²=0.032	＞0.05
Ⅲ期	8	14	χ²=0.032	＞0.05
术前Harris评分（ $x ¯$ ±s）Preoperative Harris score	58.30±8.70	60.10±9.20	t=0.724	＞0.05
骨密度［g/cm²，（ $x ¯$ ±s）］Bone density
腰椎L1-L4Lumbar vertebrae	0.87±0.08	0.88±0.08	t=0.621	＞0.05
股骨颈Femoral neck	0.71±0.07	0.73±0.07	t=0.656	＞0.05

Table 1 General data of the two groups before surgery

项目 Subjects	治疗组 Treatment group	对照组 Control group	统计值 Statistical values	P值
例数 Number of cases	20	34
年龄［岁，（ $x ¯$ ±s）］ Age（year）	37.50±6.50	33.60±5.90	t=1.427	＞0.05
性别（男/女） Gender（male/female）	13/7	23/11	χ²=0.076	＞0.05
病程［年，（ $x ¯$ ±s）］ Disease course（year）	1.81±0.73	1.84±0.69	t=0.152	＞0.05
ARCO分期（n） ARCO stage
Ⅱ期	12	20	χ²=0.032	＞0.05
Ⅲ期	8	14	χ²=0.032	＞0.05
术前Harris评分（ $x ¯$ ±s）Preoperative Harris score	58.30±8.70	60.10±9.20	t=0.724	＞0.05
骨密度［g/cm²，（ $x ¯$ ±s）］Bone density
腰椎L1-L4Lumbar vertebrae	0.87±0.08	0.88±0.08	t=0.621	＞0.05
股骨颈Femoral neck	0.71±0.07	0.73±0.07	t=0.656	＞0.05

Table 2 Comparison of intraoperative indicators between the two groups

组别 Groups	例数 Number of cases	手术时间（h） Operation duration	术中出血量（ml） Intra-operative blood loss
治疗组 Treatment group	20	1.42±0.21	95.70±10.20
对照组 Control group	34	0.81±0.15	75.40±8.60
t值		13.251	8.076
P值		P＜0.001	P＜0.001

Table 3 Comparison of postoperative femoral head recovery and necrosis rates

组别 Groups	例数 Number of cases	恢复率 Recovery rate	坏死率 Necrosis rate
治疗组 Treatment group	20	16（80.0）	1（5.0）
对照组 Control group	34	18（52.9）	10（29.4）
χ²值		3.954	4.626
P值		＜0.05	＜0.05

Table 4 Comparison of Harris hip scores between the two groups

组别 Groups	例数 Number of cases	优 Excellent	良 Good	中 Fair	差 Poor	优良率 Excellent-good rate
治疗组 Treatment group	20	13（65.0）	4（20.0）	2（10.0）	1（5.0）	17（85.0）
对照组 Control group	34	17（50.0）	3（8.8）	3（8.8）	11（32.3）	20（58.8）
χ²值						4.105
P值						＜0.05

Figure 1 Images of bilateral osteonecrosis of the femoral head before and after treatment with absorbable screw combined with quadratus femoris muscle pedicle bone flap transplantation. A is anteroposterior pelvic X-ray image before operation, showing bilateral femoral head necrosis; B is frog-leg lateral pelvic X-ray image before operation, showing density changes in bilateral femoral head necrotic areas; C is anteroposterior X-ray image of the left hip before operation, showing left femoral head necrosis; D is anteroposterior X-ray image of the right hip before operation, showing right femoral head necrosis; E is pelvic MRI image at axial view before operation, showing femoral head necrosis; F is pelvic MRI image at coronal view before operation, showing signal changes in femoral head necrotic areas; G is preoperative angiography image of left femoral head showing decreased blood supply to the femoral head; H and I are images showing placement of absorbable screws during surgery; J is anteroposterior pelvic X-ray image three months after operation, showing good screw position with bone flap in situ; K is frog-leg lateral pelvic X-ray image of the left hip three months after operation, showing satisfactory bone healing; L is angiography image of left femoral head six months after operation, showing intraosseous microcirculation reconstruction with increased neovascularization; M is angiography image of femoral head one after operation, showing further improvement in blood supply; N is picture of patient after operation showing significant pain relief

Figure 2 Changes in absorbable screw diameter over time in treatment group

Figure 3 Changes in BMD (bone mineral density) over time in two groups. A is change curve of lumbar spine L1-L4; B is change curve of femoral neck Note: *-the difference is statistically significant compared with preoperative baseline in the same group (P＜0.05)

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