带肌蒂骨瓣移植术治疗股骨头坏死

Treatment osteonecrosis of femoral head with the bone grafting pedicled with muscle

目的探讨带股方肌蒂骨瓣移植术治疗股骨头坏死的临床疗效。方法应用双支撑骨柱移植术治疗ONFH获5年以上随访者186例206髋,ARCO分期为ⅡB、ⅡC、ⅢA、ⅢB、ⅢC、Ⅳ期者分别为36、30、40、40、32、28髋。单纯股方肌蒂骨瓣移植术治疗ONFH获得3年以上随访者82例94髋,ARCO分期6ⅡB、ⅡC、ⅢA分别为36、30、28髋。参照百分法评价疗效。结果患者术后的髋关节疼痛明显缓解或消失,股骨头高度有不同程度的增加,关节活动度改善。双支撑骨柱移植术组平均随访时间10.5年(5～16年),术前术后的临床评价、X线评价、总分数比较,两者间的差异均有统计学意义(P<0.01)。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%。期别间疗效依次降低,差异有统计学意义(P<0.01)。单纯股方肌蒂骨瓣移植术组平均随访时间3.2年(0.5～5.5年),ⅡB、ⅡC、ⅢA期的优良率分别为94.4%、93.3%、89.3%,总优良率为92.6%。结论两种带股方肌蒂骨瓣移植术治疗股骨头坏死的疗效良好,远期效果与坏死期别有关,适用于Ⅱ期和Ⅲ早期的年轻患者。

Objective To analyze the clinical effect of the bone grafting pedicled with muscle for the osteonecrosis of femoral head （ONFH）. Methods The clinical results were analyzed from 186 patients with 206 hips suffered from the osteonecrosis of femoral head underwent by the surgery of the double strut bone grafting from1988, and were followed up at least five years. According to Association Research Circulation Osseous （ARCO） classifying, 36,30,40,40,32 and 28 hips were in stage ⅡB、ⅡC、ⅢA,Ⅲ B, ⅢC and Ⅳ respectively. 82 patients with 94 hips suffered from ONFH underwent by the surgery of one strut bone grafting pedicled with femoral quadratus muscle, and were followed up at least three years. 36, 30 and 28 hips were in the stage ARCO ⅡB、ⅡC、 and Ⅲ A respectively. The results were evaluated by the hundred forked method. Results The pain of the hip area in all patients disappeared or mostly relieved after the operation. The height of the femoral head after the operations was increased in different level, and the motion of hip joint became better than preoperations. The follow-up time were from 5 - 16 years with an average of 10.5 years in the group of the double strut bone grafting. Comparing to pre-operation, the scores of clinical manifestation included pain, function, motion of hip, X-ray evaluation and total scores in patients were significantly increased when follow-up after operation, P 〈 0. 01. The rate of excellent and good results was 83.3% ,80.0% ,75, 0% ,65.0% ,40.6% and 28.6% in stage ⅡB、ⅡC、ⅢA, ⅢB, ⅢC and Ⅳ respectively. The rate of excellent and good in total was 63.6%. The effect among the stages was de- creased gradually, and the difference of them were significantly（ P 〈0. 01 ）. The follow-up time were from 0. 5 - 5.5 years with an average of 3.2 years in the group of the one strut bone grafting pedicled with femoral quadratus muscle. The rate of excellent and good results was 94.4% ,93.3% , 89. 3% in stage ⅡB、ⅡC、 and ⅢA respectively. The rate of excellent and good in total was 92.6%. Conclusion The outcome of the two surgeries, the double strut bone grafting and one strut bone grafting pedicled with femoral quadratus muscle, was good. The long-term effect of the double strut bone graft for the osteonecrosis of femoral head was relative to the stages of the osteonecrosis. This treatment was suitable to the younger patients with the os- teonecrosis of femoral head in stage ⅡB、ⅡC and ⅢA , ⅢB according to ARCO classifying.