带血管蒂髂骨移植治疗青少年镰状细胞病股骨头缺血性坏死:短中期结果随访

Short and mid-term results of vacularized iliac crest graft for femoral head necrosis with sickle cell disease in juvenile patients

背景:镰状细胞病是造成非洲青少年股骨头缺血性坏死的主要原因,带血管的髂骨移植用于股骨头缺血性坏死的报告已经很多,它也适用与镰状细胞病股骨头缺血性坏死的患者,可以使坏死区再血管化提高和阻止进行性发展。目的:探讨带血管蒂髂骨移植治疗青少年镰状细胞性股骨头缺血性坏死的早期和中期疗效。方法:纳入尼日尔马腊迪省治疗中心的青少年镰状细胞病并股骨头缺血性坏死的患者12例,均采带旋髂深血管髂骨瓣移植治疗,术后随访24～30个月(平均27个月),观察移植后患者是否髋痛,功能活动和X射线骨盆平片结果。结果与结论:移植后疼痛消失,无感染等并发症,无重复手术,近中期疗效满意,Harris评分平均从术前75分提高到术后90分,而X射线平片表现并不令人满意。对于FicatⅢ、IV期的镰状细胞性骨股头缺血性坏死青少年患者,采用带血管蒂髂骨移植治疗,可以解除疼痛,恢复髋关节功能。

BACKGROUND：Sickle cell disease is the main reason for the ischemic necrosis of the femoral head in African juvenile patients.There are more reports concerning vascularized iliac graft for femoral head necrosis.It is also effective for the treatment of femoral head necrosis with sickle cell disease.OBJECTIVE：To investigate the short and mid-term results of the vacularized iliac graft for ischemic necrosis of the femoral head in young patients with sickle cell disease.METHODS：Totally 12 patients suffered from ischemic necrosis of the femoral head with sickle cell disease were treated with vascularized iliac graft in Maradi Province Hospital of Niger.The patients were followed up 24-30 months after operation （mean 27 months）.The effects were evaluated on the basis of the Harris hip score and radiological examination.RESULTS AND CONCLUSION：The clinical results were satisfactory though the radiological was not satisfied.The mean Harris hip score increased from 75 points to 90 points.Pain relief and hip function improvement were achieved in all patients.No patients needed revision during short and mid-term follow up.This method is recommendation for treatment of ischemic necrosis of the femoral head in the Ficat Stages Ⅲ-Ⅳ in juvenile patients with sickle cell disease for pain relief and restoration of hip joint function.