手术治疗股骨头缺血性坏死210例临床分析

cOperative treatments for osteonecrosis of the femoral head： A report of 210 cases

目的探讨如何根据不同年龄和分期为股骨头缺血性坏死患者选择最合适的外科治疗方法。方法股骨头缺血性坏死患者共210例（252髋）。根据不同手术方法分为三组：带血管蒂骨膜瓣移位组，带血管蒂骨瓣移位组及髋关节置换组。采用Stulberg分类标准、Harris评分标准、VAS评分法进行评价。结果210例（252髋）得到随访，术后随访1～10年，平均6．3年。三组优良率分别为87．2％、88．7％、85．7％；带血管蒂骨瓣移位组和髋关节置换组，术后Harris评分明显提高（P〈0．05）、VAS显著降低（P〈0．05）。结论带旋股内侧动脉深支大转子骨膜瓣移位术为主的综合术式较适用于儿童股骨头缺血性坏死患者；带旋股内侧动脉深支大转子骨瓣或带旋股外侧动脉升支髂骨瓣移位术较适用于中青年FicatⅡ～Ⅲ期股骨头缺血性坏死患者；髋关节置换术适用于中青年晚期、老年以及其他方法失败的股骨头缺血性坏死患者。

Objective To examine the optimal operative methods for the patients with osteo- necrosis of the femoral head in terms of age and staging. Methods A total of 210 patients （252 hips ） with osteonecrosis of the femoral head who were treated from 1998 to 2008 in our hospital were enrolled in the study. Follow - up averaged 6.3 years （ range ： 1 - l0 years ）. The mean age of the patients was 35.3 years （range ：4- 81 years）. The patients received vascularized periosteal flap transfer, vaseularized bone flap transfer and hip replacement （3 groups）respectively according to different ages and Fieat or Catterall staging. All patients were evaluated clinically and radiographieally. Results The postoperative excellent and good rate was 87.2% ,88.8% and 85.7% in the three groups, respectively. The mean Hariss score was significantly iucreased（P 〈 0.05）and the mean VAS score decreased（ P 〈 0.05 ）in the groups in which patients were subjected to vascularized bone flap transfer or hip prosthesis replacement. Conclu- sion The vascularized periosteal flap transfer is suitable to children with osteoneerosis of the femoral head. For the young and middle - aged patients at Ficat Ⅱ - Ⅲ stage, vascularized bone flap transfer may be adopted; the young and middle -aged patients at FicatⅣ stage, or the elder or patients in whom other treatments fail may be treated by arthroplasty.