股骨头坏死患者腓骨移植后长期服用激素:终点结局中8髋全髋关节置换

Patients with necrosis of the femoral head and taking hormone for a long time after fibular graft: eight hips receiving total hip replacement

背景:对于自身免疫性疾病患者,长期服用激素是导致股骨头坏死发病的因素,在经过带血管的游离腓骨移植后,由于治疗的需要,仍然要长期服用激素,而这一情况有可能导致手术疗效降低。至今很少有文献报道过上述病例的效果。目的:观察带血管的游离腓骨移植后长期服用激素股骨头坏死患者的中远期疗效。方法:回顾2003年9月至2013年12月进行带血管游离腓骨移植的激素性股骨头坏死患者,纳入的患者移植后至少继续服用激素6个月以上,共54例患者(96侧患髋)。对比分析患者移植前后Harris评分、生活质量评价量表SF-36评分及影像学资料(X射线片、MRI),随访时间1-10年。结果与结论:相对于移植前,末次随访时总体Harris评分平均值增加13.2(P<0.05),SF-36总体生理评分平均值提升11.0(P<0.05)、SF-36心理评分平均值提升9.4(P<0.05);X射线片显示61侧(63%)患髋影像学检查表现为改善,14侧(15%)患髋表现为稳定,21侧(22%)患髋表现为恶化,其中8侧(8%)患髋最终进行了全髋关节置换。对于需术后长期服用激素的股骨头坏死患者,带血管的游离腓骨移植能显著提高患肢功能及患者生活质量,是一种有效、可靠、稳定的保头治疗方式。

BACKGROUND： For patients with autoimmune diseases, long-term use of hormone is a factor for the onset of osteonecrosis. After free vascularized fibular graft, long-term use of hormone is required due to the need of treatment. This condition possibly caused a decrease in curative effect of operation. Few reports concerned the effects of above-mentioned cases. OBJECTIVE： To observe the mid-term and long-term results of free vascularized fibular graft in patients who still took hormone for a long time postoperatively. METHODS： A total of 54 patients （96 hips） with steroid-induced avascular necrosis of femoral head after free vascularized fibular graft from September 2003 to December 2013 were retrospectively analyzed. All subjects had taken hormone for more than 6 months. Harris Hip Score, 36-Item Short-Form Health Survey and imaging data （radiographs and magnetic resonance imaging） were compared and analyzed before and after transplantation. Follow-up was performed for 1-10 years. RESULTS AND CONCLUSION： Compared with before transplantation, mean Harris Hip Score increased 13.2 during final follow-up （P 〈 0.05）. Mean physiological score of 36-Item Short-Form Health Survey increased 11.0 （P 〈 0.05）. Mean psychological score of 36-Item Short-Form Health Survey increased 9.4 （P 〈 0.05）. Radiographs revealed that 61 affected hips （63%） were improved; 14 affected hips （15%） were stable; 21 affected hips （22%） worsened. Of them, 8 hips （8%） underwent total hip replacement. Free vascularized fibular graft can remarkably elevate the function of affected limbs and patient＇s quality of life in patients who have to take hormone for a long time. It is an effective, reliable and stable manner.