单纯带血管蒂骨瓣转移与联合钽棒植入治疗股骨头缺血性坏死的比较研究

A comparative study of treatment for necrosis of the femoral head by vascularized iliac bone flap combined with or without tantalum screw

目的报道应用带血管蒂髂骨瓣转移联合多孔钽金属棒植入与单纯带血管蒂髂骨瓣转移治疗股骨头缺血性坏死的早中期临床疗效。方法ARCO分期标准分为，Ⅱa期1例，Ⅱb期9例，Ⅱc期6例，HIa期7例，Ⅲb期5例，Ⅲc期8例。单纯带血管蒂髂骨瓣转移治疗20例，带血管蒂髂骨瓣转移联合钽金属棒植入治疗16例。结果随访7．20个月，两组术中失血量、术后24hVAS评分与术后3个月Harris评分比较差异无统计学意义。术后6个月Harris评分两组较术前均有明显提高．带血管蒂髂骨瓣转移联合钽棒治疗平均为82．94分（临床成功率为81．25％）与单纯带血管蒂髂骨瓣转移治疗（平均70．0分，临床成功率为65．0％）比较差异有统计学意义。结论带血管蒂髂骨瓣转移联合多孔钽金属棒植入可为坏死股骨头提供丰富的血运、力学支撑及诱导骨生成，植入股骨头负重区后可有效防止股骨头进一步塌陷，减少限制负重时问，早期临床功能评价成功率高，是治疗早中期年轻患者股骨头缺血性坏死的有效方法。

Objective To report the short-mid term clinical outcome of vascularized iliac Bone Flap combined with or without tantalum screw for the treatment of necrosis of the femoral head（ONFH）. Methods Thirty six ONFH patients （36 hips） were divided into two groups including one hip of stage Ⅱ a, 9 hips of stage Ⅱ b, 6 hips of stage Ⅱ c, 7 hips of stage Ⅲ a, 5 hips of stage m b, and 8 hips of stage Ⅲc according ARCO staging system. 20 hips were in vascularized iliac bone flap transplantation group and 16 hips in vascularized iliac bone flap transplantation combined with tantalum screw group. Preoperative evaluation showed that there was no statistical difference between two groups in Harris score, age and body mass index. Results All patients were followed up 7 to 20 months （average 15 months）, there was no statistical difference between two groups in intraoperative blood loss, 24h postoperative VAS score and Harris score of 3 months post-operation. The Harris score of both groups was obviously increased 6 months postoperatively. The average Harris score of vascularized iliac bone flap transplantation combined with tantalum screw group were 82.94 with a 81.25% clinical success rate, compared with the Harris score of group treated without tantalum screw （average ,70.0 ）with a 65.0% clinical success rate showed statistical difference. Conclusion Vascularized iliac bone flap transplantation combined with tantalum screw was an effective method with high clinical success rate for treatment of younger patients with early-mid stage ONFH. It provided good blood supply and enough mechanical support as to reduce the progress of femoral head collapse.