钻孔减压植骨和股方肌骨瓣植入治疗早期成人股骨头坏死的疗效比较

Comparison of effect of drilling core decompression and quadratus femoris muscle pedicle bone implantation in treatment of early adult osteonecrosis of femoral head

目的比较钻孔减压植骨术和病灶刮除股方肌骨瓣植入术治疗早期成人股骨头坏死(ONFH)的疗效,为临床治疗方案的选择提供参考。方法 54例(61髋)ONFH分别采用病灶刮除股方肌骨瓣植入术(骨瓣植入组,25髋)和钻孔减压植骨术(减压植骨组,36髋)治疗,比较2组手术一般情况、髋关节功能Harris评分、术后临床效果及手术失败率。结果减压植骨组术中出血量更少,切口长度、住院时间、更短,差异有统计学意义(P<0.05)。2组术后12个月及末次随访时髋关节功能Harris评分较术前明显提高,差异有统计学意义(P<0.05);但2组术后6个月、12个月、末次随访时髋关节功能Harris评分差异无统计学意义(P>0.05)。骨瓣植入组临床改善率为69.6%(16/23),减压植骨组临床改善率为66.7%(24/36),2组比较差异无统计学意义(χ2=0.054,P=0.816)。结论采用钻孔减压植骨和病灶刮除股方肌骨瓣植入术治疗早期ONFH的早期随访效果确切,但钻孔减压植骨术创伤更小,住时院时间更短。

Objective To compare the effect of treatment on the early adult osteonecrosis of femoral head （ONFH） by drilhng core decompression with bone grafting and by quadrate femoral muscular pedicled bony flap implantation and provide the reference for the clinical treatment choice. Methods A retrospective analysis for 54 cases（61 hips） with avascular necrosis of the femoral head in our hospital was performed. The patients were divided into the drilling decompression group （36 hips） and quadrate femoral muscular pedicled bony flap implantation group （25 hips）, followed up for 24-52 months. The patient＇s general condition, the postoperative Harris score, clinical results and the rate of treatment failure were recorded and compared between two groups. Results The patient＇s blood loss, the length of incision and hospital stay were significantly less in drilling decompression group than those in quadrate femoral muscular pedicled bony flap implantation group（P 〈0.05）. In each group, the Harris scores at 12 months after operation and final follow-up were higher than those before operation （P 〈0.05）. There was no significant difference in Harris scores between two groups at 6 months, 12 months and final follow-up （P 〉0.05）. Clinical improvement rate of two groups was 66.7% and 69.6% respectively, there was no significant difference between two groups （x2=0.054, P =0.816）. Conclusion Both drilling decompression with bone grafting and quadrate femoral muscular pedicled bony flap implantation can provide definitive effect for early adult avascular necrosis of the femoral head. Drilling decompression has the advantages of less injury, shorter hospital stay during treatment.