带血管蒂髂骨瓣转移联合多孔钽金属棒植入治疗股骨头缺血性坏死

Vascularized iliac grafting combined with tantalum rod implantation for osteonecrosis of the femoral head

目的 探讨运用带血管蒂髂骨瓣转移联合多孔钽金属棒植入治疗股骨头缺血性坏死的临床疗效. 方法 2010年1月至2011年1月间28例（36髋）非创伤性股骨头缺血性坏死患者,男15例,女13例;年龄18 ～53岁,平均40岁.按ARCO分期：Ⅱa期8髋、Ⅱb期10髋、Ⅲa期9髋、Ⅲb期9髋.采用带血管蒂髂骨瓣转移提供股骨头血运支持,多孔钽棒植入腾起恢复股骨头外形.采用Harris评分和VAS评分评价临床效果及对比测量患者术前10 d内、术后6个月、12个月的三维步态值进行比较,观察及分析患者术后步态改变的情况. 结果 临床28例（36髋）患者均随访6～ 20个月,平均12个月.术后6个月及12个月随访时髋关节Harris评分、VAS评分均显著优于术前（P＜0.01）；术后6个月与12个月随访时比较除Harris评分差异有统计学意义（P＜0.05）,而VAS评分差异无统计学意义（P＞0.05）；术后12个月随访髋关节结果优13髋,较好15髋,良4髋,差4髋,优良率89.65％.通过三维步态结果分析表明,随着时间的延长及变化,患者的步态逐渐趋于正常. 结论 带血管蒂髂骨瓣转移联合多孔钽棒植入临床功能评价成功率高,是治疗早、中期股骨头缺血性坏死的有效方法.

Objective To explore the clinical outcome of vascularized iliac bone flap combined with tantalum rod implantation for the treatment of osteonecrosis of the femoral head （ONFH）.Methods Totally 28 cases （36 hips） of non traumatic avascular necrosis of the femoral head patients from January 2010 to January 2011,which were 15 males and 13 females; a mean age of 40 years （ranged,18-53years）,according to ARCO stages：eight hips of stage Ⅱ a,ten hips of stage Ⅱ b,nine hips of stage Ⅲ a,nine hips of stage Ⅲ b,adopt to vascularized iliac grafting combined with tantalum rod Implantation for osteonecrosis of the femoral head.The Harris hip score and VAS score of pre-and post-operation was recorded to evaluate the clinical outcome,and to compare observe and analyze the change of postoperative of patients by used three-dimensional gait.Results All 28 cases （36 hips） were followed up 6 ～20 months,averaged 12 months.The results of Harris hip score and VAS score of the 6 months postoperatively and last follow-up were significantly higher than preoperative ones （P 〈0.05）.And the Harris hip score of the last follow-up was also significantly higher than the one of 6 months postoperatively （P 〈 0.05）.However,there was no significant different in that of VAS score （P 〉0.05）.There were 13 cases in excellent,fourteen in good and 4 in fair with an excellent and good rate of 89.8%,which shows that the extension of time and changes in patients gait tends to normal by three-dimensional gait analysis.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 to reduce the progress of femoral head collapse.