Surgical methods
Debrided sclerosing, necrotic, necrosis
CAVITY, GROUP B, NECROTIC, NECROSIS
Operations were performed by the same surgeon (JRS) who has been engaged in hip preservation for more than three decades. After general anesthesia, the patients were placed in the supine position, and the affected hip elevated 30°. The operation position was selected on the connecting line between the anterior superior iliac spine (ASIS) and the outer edge of the patella, along the iliac bone to 3 cm below the ASIS to the outside of the greater trochanter, and then turned back to the connecting line to form a "S" double curve incision, about 8–12 cm in length. Cut the skin and subcutaneous tissue in turn to protect the lateral femoral cutaneous nerve. One retractor pulled the sartorius muscle and rectus femoris inward, and the other retractor pulled the tensor fascia lata outward to expose the Huter space. Separated from the lower end of the Huter space layer by layer, identified the ascending branch of the lateral circumflex femoral vessels (ALCFVs) and protected it which supplies blood to the separated iliac bone flap with tensor fascia latae). A portion of the tensor fascia latae was dissected from the lateral circumflex femoral artery from its branch near the origin of the lateral circumflex femoral artery until the tensor fascia latae was near the origin of the anterior superior iliac spine. Next, a portion of the ASIS with the origin of the tensor fascia latae (along with the dissociated tensor fascia lata and the ascending branch of the lateral femoral circumflex artery) was harvested. The size of the iliac bone graft was approximately 3*3*1 cm. At the same time, excavate the cancellous bone for iliac. Cut part of the capsule of hip to expose the anterior of the femoral head and neck, chiseled the cartilage which is near to the necrotic area with a grinding drill, then exposed the necrosis bone. Debrided sclerosing bone with a high-speed abrasive drill and debrided necrosis bone with a curet. The necrotic area was filled with the cancellous bone taken out from the iliac bone, and the collapsed femoral head was pressed and enriched with a bone grafting rod. The cancellous bone side of the muscle-bone flap with blood supply was further filled with the necrotic area towards the femoral head, the anterolateral column was rebuilt, and the iliac bone graft was transferred to it. Group A: lifted the collapsed femoral head, measure with a depth meter, selected biodegradable magnesium screws with appropriate diameter and length, drilled it with an electric drill, then drilled out the screw canal with the corresponding tap, finally screwed the biodegradable magnesium screw (35 or 40 mm diameter, Dongguan Eontec.Co., Ltd) to fix the bone graft. Group B: Fixation of the bone graft with a hollow titanium screw (35 or 40 mm diameter, AO Co., Ltd) (as in Group A, without the need to drill a screw channel with a screw tap). Group C: The bone graft was directly embedded without screws. After confirming that the bone graft is firmly fixed, irrigate with normal saline, and close the surgical incision with absorbable line layer by layer, obliterating cavity by stitching tightly. Be careful not to ensnare the lateral femoral cutaneous nerve.