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Context: Osteonecrosis of femoral head (ONFH) was gradually concerned as a global disease for its progression to collapse of femoral head, ultimately causing the arthritic change.Due to the high incidence of this disease in young people, arthroplasty tend to be suspected for its uncertain long-term efficiency.The hip-preserving surgery, an alternative treatment could delay progression of ONFH, comes into public vision extensively.Vascularized pedicle iliac bone grafts (VPIBG) was regarded as a effective option in hip-preserving protocol since 1970s.Nevertheless, there exist no unified standards widely agreed as the optimal operative programme since the lack and diversity of related studies.Thus we execute this systematic review to synthesis and analysis existing studies, and further suggest a direction of future researches.Methods: Data were collected by searching electronic database (Pubmed, Embase and Cochrane Library), and including the eligible studies of all types of clinical researches except case report.Through our extraction and synthesis of included study results in respect of clinical evaluation (rating scales), radiographic evaluation, Joint survival rate, viability of implanted flap and complications by transform varied assessment method into a unified standard, we qualitative analyze and discuss the efficacy of VPIBG according the heterogeneity across the included studies and quality of individual study.Results: Our systematic review includes 1 RCT, 2 case control studies and 13 case series studies, resulting in a significant improve of postoperative scores compared with preoperative.Minority of hips progressed for joint replacement.Some researches suggested a high collapse rate in femoral head collapsed already before operation.Compared with some other hip-preserving surgery, the complications of VPIBG are relatively slight and barely affect clinical efficiency.Conclusion: a better clinic response of VPIBG was gotten in femoral head before the appearance of crescent sign.And the short-term efficiency suggest better compared with a long-term follow-up, but there exist no obvious difference on clinic efficiency within 3 to 5 years.The fixation of the implanted iliac bone flap increase the clinical effect.the majority of complications were slight, and rarely affected clinical efficacy.