股方肌蒂骨柱加钛网伞状支撑术治疗酒精性股骨头坏死5年随访研究

Five-year-follow up comparative study of bone grafting pedicled with the femoral quadratus augmented with a titanium mesh for alcohol-induced osteonecrosis of the femoral head

目的探讨股方肌骨柱加钛网伞状支撑术治疗酒精性股骨头坏死的中期随访效果，分析影响手术效果的相关技术因素。方法回顾性分析2008年1月至2009年9月采用股方肌蒂骨柱加钛网伞状支撑术治疗并获5年随访的AR—COⅡC、ⅢA期酒精性股骨头坏死患者20例（24髋，钛网组），以同期采用单纯股方肌蒂骨柱治疗的ARCOⅡC和ⅢA期酒精性股骨头坏死患者18例（20髋）作为对照（骨柱组）。疗效评价标准采用百分法。采用SPSS13．0（SPSS公司，美国）统计软件包进行统计学分析，相应资料的比较采用成组设计t检验和Mann—WhitneyU秩和检验。结果钛网组的失血量和手术时间明显高于骨柱组，差异有统计学意义。钛网组20例（24髋），除2例（3髋）失访和1例（1髋）行人工全髋关节置换外，余17例平均随访62．7个月（58～66个月）。骨柱组18例（20髋），除1例（1髋）失访和1例（1髋）行人工全髋关节置换外，余16例平均随访61．3个月（57～64个月）。末次随访时，钛网组优13髋、良5髋、可2髋、差1髋，优良率85．7％，股骨头五年存活率95．2％（20／21髋）；骨柱组优13髋、良3髋、可2髋、差1髋，优良率84．2％，股骨头五年存活率94．7％（18／19髋）。钛阿组和骨柱组手术前后的临床评分（包括疼痛、功能、关节活动度）和X线评分的差异均无统计学意义。两组术后均有股骨头轻度塌陷的病例，钛网组7髋（7／20）、骨柱组5髋（5／18）；骨柱组塌陷者临床恢复略逊色于钛网组塌陷者，钛网组支撑小者临床恢复逊色于面积大者。结论股方肌骨柱加钛网伞状支撑治疗ARCOⅡC、ⅢA期酒精性股骨头坏死中期临床疗效满意，钛网伞状支撑、位置、植骨技术是影响疗效的重要因素。

Objective To investigate the mid-term follow-up results of bone grafting pedicled with the femoral quadratus augmented with a titanium mesh for alcohol-induced osteonecrosis of the femoral head and to analyze the technical factors affecting the surgical outcome. Methods Twenty cases （24 hips） treated with bone grafting pedicled with the femoral quadratus augmented with a titanium mesh between January 2008 and September 2009 were retrospectively reviewed. Control group included 18 cases （20 hips） treated with bone grafting pedicled with the femoral quadratus alone in the same period. All the hips were alcohol-induced femoral head necrosis and were classified as ARCO Ⅱ C or ARCO IlIA stage. The one hundred points method was used for outcome evaluation. Statistical analysis was performed using SPSS statistical package 13.0（SPSS Inc., USA）. Results The titanium group has a longer operative time and more estimated blood loss than the bone-grafting group with statistical significance. For the twenty cases in the titanium group, two cases were lost to follow-up with another one case receiving total hip arthroplasty due to severe collapse, and the rest were followed for an average of 62.7 （58 to 66） months. For the eighteen cases in bonegrafting group, one case was lost to fallow-up with another one case receiving total hip arthroplasty due to severe collapse, and the rest were followed for an average of 61.3 （57 to 64） months. At the last follow-up, the titanium group had a successful rate of 85.7% （excellent in 13, good in 5 and fair in 2） with a five-year survival rate of 95.2% （20 out of 21 hips） and the bonerafting group had a successful rate of 84.2% （excellent in 13, good in 3 and fair in 2） with a five-year survival rate of 94.7% （18 out of 19 hips）. Clinical and radiographic outcomes were not statistically significant different between the two groups. Mild collapses were noted radiographically in both groups, with 7 out of 20 in titanium group and 5 out of 18 in the bone-grafting group. Among these mildly collapsed cases, the cases in titanium group had a relatively better clinical outcome than those in the control group and the cases with a larger mesh supporting area had an even better clinical outcome. Conclusion The mid-term follow-up results of bone grafting pedicled with the femoral quadratus augmented with a titanium mesh for alcohol-induced osteonecrosis of the femoral head were satisfactory. Factors affecting surgical outcomes included the placement of the titanium mesh, and the bone-grafting technique.