股骨头缺血性坏死修复与再造的长期随访观察

Long-term follow-up of osteonecrosis of the femoral head with repair and reconstruction

[目的]对成人股骨头缺血性坏死修复与再造术进行远期随访,评估该治疗方法的有效性。[方法]对1986年11月到1997年3月接受股骨头缺血性坏死修复与再造术治疗的313例(382侧)患者进行随访,平均年龄36.4岁(18～65岁),根据Ficat分期标准,Ⅱ期151侧,Ⅲ期142侧,IV期89侧,术后平均随访12.1年(10～20年),根据Harris髋关节功能评分标准进行临床评价,根据手术前后Ficat分期改变进行影像学评价。Kaplan.Meier生存曲线以关节置换为终结点,对股骨头修复与再造的生存率进行分析。[结果]术后19髋(19/382,5%)改行人工全髋关节置换术。术后Harris髋关节功能评分明显提高(术前平均56.2,术后平均85.8),临床生存率为85.6%(341髋),影像学生存率为75.4%。Kaplan-Meier生存曲线提示FicatlV期,激素性和酒精性以及55岁以上的患者远期生存率较低。[结论]针对不同程度、不同年龄以及不同病因的股骨头缺血性坏死采用单纯或联合带血管蒂骨(膜)瓣转移修复与再造术,远期疗效是满意的,是青壮年股骨头缺血性坏死患者保留股骨头的有效治疗方法。

[ Objective] To evaluated the clinical results of treatment of osteoneerosis of the femoral head （ONFH） with repair and reconstruction through long-term follow-up. [ Methods ] A total of 313 patients （382 hips） operated on from November 1986-March 1997 who had a mean age of 36.4 years （range, 18 -65 years） were reviewed retrospectively. The hips were 151 Ficat and Arlet stage Ⅱ, 142 stage Ⅲ, 89 stage Ⅳ. All patients were followed up for a mean of 12. lyrs （range, 10 -20 yrs） and were assessed clinically and radiologicaUy according to Harris scoring and variation of Ficat stage respectively. The patients were analyzed by the Kaplan-Meier method with replacement for any reason as the end-point. [ Results] Ninteen hips underwent total hip replacement postoperatively. Preoperative and postoperative Harris score were 56. 2 and 85.8. Clinical success rate was 85.6% and radiological success rate was 75.4%. Kaplan-Meier survivorship curves showed there was a lower long-term survival on stage-Ⅳ, abuse of hormone alcolutic indulger and above 55 years old patients. [ Conclusion] The long-term efficacy is satisfactory to be confirmed by repair and reconstruction in treatment of osteonecrosis of the femoral head. This procedure will improve the curative effect of preserving head treatment of ONFH and early-middle clinical results being satisfied.