双支撑骨柱移植术治疗股骨头坏死的远期疗效分析

Analysis of long-term effects of the double strut bone graft for the treatment of osteonecrosis of femoral head

目的分析双支撑骨柱移植术治疗股骨头坏死的远期疗效。方法从1988年3月以来，采用双支撑骨柱移植术治疗成人股骨头坏死366例466髋，获5年以上随访者186例206髋，平均年龄32．2（20-60）岁。按病因分类：激素性者60例68髋，酒精性者86例96髋，激素加酒精者30例32髋，外伤性者10例10髋。ARCOⅡB、ⅡC、ⅢA、ⅢB、ⅢC、Ⅳ期患者分别为36、30、40、40、32、28髋。参照百分法进行疗效评价。结果术后所有患者的髋关节疼痛均获得明显缓解或消失，股骨头高度有不同程度增加，关节活动度有改善。平均随访时间10．5（5～16）年，手术前与随访时临床评价（疼痛、功能、关节活动度）、X线评价、总分数比较，差异均有统计学意义（P〈0．01）。结果显示ⅡB～Ⅳ期优良率分别为83．3％、80．0％、75．0％、65．0％、40．6％、28．6％，总优良率为63．6％。Ⅱ期效果好（81．8％），Ⅲ期早期（ⅢA、ⅢB）效果较好（70％），ⅢC、Ⅳ期者效果差（35％）。期别间疗效依次降低，差异有统计学意义（P=0．0001）。30岁以内患者术后股骨头内植骨愈合较快，平均为3．2（2．9-3．5）个月。50～60岁患者植骨愈合需时较长，平均为5．5（4．4～6．4）个月。结论该术式治疗股骨头坏死的远期疗效良好，治疗效果与股骨头坏死期别有关，尤其适用于股骨头坏死Ⅱ期和Ⅲ期的早期病例。

Objective To analyze the long-term effect of the double strut bone graft for the treatment of osteonecrosis of femoral head （ONFH）. Methods The 366 adult patients with 466 hips suffered from the osteonecrosis of femoral head underwent by the surgery of the double strut bone graft from Mar 1988. The mean age is 32.2 years （20-60）. According to classifying from etiological factors, the steroid- induced ONFH was in 68 hips, alcohol-induced ONFH was in 96 hips, steroid and alcohol-induced ONFH was in 32 hips, and the traumatic ONFH was in 10 hips. According to Association Research Circulation Osseous （ ARCO ） classifying, 36, 30, 40, 40, 32 and 28 hips were in stage Ⅱ B, Ⅱ C, Ⅲ A, Ⅲ B, Ⅲ C and Ⅳ respectively. Results The pain of the hip area in all patients disappeared or mostly relieved after the operation. The height of the femoral head increased in different level, and the motion of hip joint become better. 118 patients （206 hips） follow up average 10.5 years （5～16 years）. Comparing to pre-operation, the scores of clinical manifestation, X-ray evaluation and total scores in patients were significantly increased. The rate of excellent and good results was 83.3%, 80.0%, 75.0%, 65.0%, 40.6% and 28.6% in stage Ⅱ B, Ⅱ C, Ⅲ A, Ⅲ B, Ⅲ C and Ⅳ respectively. The rate of excellent and good in total was 63.6%. Among them, the results were good in group Ⅱ with 81.8%, were better in early stage Ⅲ （ⅢA, ⅢB） with 70%, and were poor in stage Ⅲ C and Ⅳ with 35%. In the patients younger than 30 years, the mean healing time of the grafting bone in the femoral head was 3.2 （2.9-3.5） months. The healing time was longer in the patients in age ranging from 50 to 60, the mean healing time of the grafting bone in the femoral head was 5.5 （4.4-6.4） months. Conclusion The long-term effect of the double strut bone graft for the osteonecrosis of femoral head was good, and was relative to the stages of the osteonecrosis. It is better to the younger patients with the osteonecrosis of femoral head in stage Ⅱ B, ⅡC ,and ⅢA, ⅢB according to ARCO classifying.