两种不同方法治疗早期股骨头坏死临床疗效比较

Comparison of Clinical Results for Two Different Methods for Treatment of Early Osteonecrosis of the Femoral Head

目的用多孔钽金属棒植入和带血管蒂的大转子骨瓣移植两种不同方法治疗早期股骨头坏死,比较其临床疗效差异。方法2007年2月至2008年5月治疗成人早期股骨头坏死（FicatⅠ-Ⅱ期）43例（48髋）,A组：在股骨头坏死行髓芯减压后植入多孔钽金属棒;B组：用带血管蒂的大转子骨瓣移植修复股骨头坏死。A组24例（29髋）,B组19例（19髋）,分别观察两组病例的手术时间、术中出血量、Harris髋关节评分、X线影像学进展情况及并发症的发生率。结果两组所有患者均获得随访,随访18-32个月,平均随访26个月,以最后一次随访资料作为最终评价依据。两组在手术时间、术中出血量、输血量、X线影像学进展情况方面均有显著性差异（P〈0.05）,两组术后的Harris评分均较术前明显提高,差异有显著性。结论钽棒微创植入治疗早期股骨头坏死,相比带血管蒂的大转子骨瓣移植创伤小、出血少、手术时间短、并发症少,早期临床效果优良,对预防股骨头进一步塌陷具有更好的效果,值得推广使用。

Objective To compare the clinical results of the treatment of early osteonecrosis of the femoral head with implantation of porous tantalum and transplantation of greater trochanteric bone flap pedicled with blood vessel.Methods We treated 43 patients（48 hips）with early osteonecrosis of the femoral head,from February 2007 to May 2008.Patients with Ficat-Ⅰ,Ⅱ osteoneerosis were randomly assigned to be treated with implantation of porous tantalum（group A） and transplantation of greater trochanteric bone flap pedicled with blood vessel（group B）.The group A consisted of twenty-four patients（twenty-nine hips）,and the group B consisted of nineteen patients（nineteen hips）.The patients in these two groups had similar demographic characteristics,duration and stage of disease,and duration of follow-up.The evaluation parameters included the operative time,the volume of blood loss,Harris hip scores,radiographic assessment and the incidence of complication.Results All the patients were followed up for a mean of 26 months（range,18～32 months）.The final valuation was based on the documents of the last fellow up.The two groups had significant differences on surgical time,blood loss,transfusions and development of X-ray picture（P〈0.05）.The Harris Hip Score were improved significantly in two groups.Conclusion Compared to transplantation of greater trochanteric bone flap pedicledwith blood vessel,mini-invasive treatment of early osteonecrosis of the femoral head with implantation of porous tantalum have the merit of simplicity,minimally invasive,shorter surgical time,little hemorrhage and no transfusion.It had better clinical effect.It is one of the better alternatives that can prevent the necrosis femoral head from progressing to collapse.