缝匠肌骨瓣和旋髂深骨瓣治疗青壮年早期非创伤性股骨头坏死的疗效对比

Treatment of early non-traumatic osteonecrosis of the femoral head in young adults: the comparison between sartorius bone flap and circumflex iliac deep bone flap transplantations

[目的]对不同方法治疗股骨头坏死的中期疗效进行对比分析,以探索优势保髋方法。[方法]回顾性分析2004年7月~2009年7月本院采用缝匠肌骨瓣和旋髂深骨瓣治疗的非创伤性股骨头坏死早期患者。比较两组患者年龄、随访时间、手术前后Harris评分、切口长度、手术时间、出血量、术后X线片结果。[结果]缝匠肌组平均随访（51.78±2.35）个月,旋髂深组平均随访（52.73±3.71）个月。其中旋髂深组拆线时间长,失血量大,手术时间长,切口长。Harris评分：两组术后各随访阶段比较差异均有统计学意义,旋髂深组比缝匠肌组恢复好且自12个月后两组评分逐渐下降。VAS评分：两组比较自24个月时始差异均有统计学意义,且评分自24个月时始到最终随访逐渐上升。X线片分析：两组术后随时间的推移坏死均有进展,且总髋数逐渐减少,置换数量增加。术前分期与好转率和保髋率之间差异有统计学意义,但两组好转率和保髋率组间对比差异无统计学意义。[结论]缝匠肌骨瓣移植与旋髂深骨瓣移植比较,均为治疗早期股骨头坏死（ARCOⅡ期）的有效方法,且缝匠肌骨瓣操作简单,便于掌握,是一种值得推广的可靠方法。

[Objective] To compare the medium- term treatment efficacy of early non- traumatic osteonecrosis of the femoral head in young adults with different bone flap transplantation methods,thus to expore possibilities for hip- preserving treatment. [Methods] A total of 175 patients（ 194 hips） of early non- traumatic osteonecrosis of the femoral head received surgical treatment from July 2004 to July 2009. According to the transplantation tissues,patients were divided into sartorius bone flap group（ 110 cases,121 hips） and circumflex iliac deep bone flap group（ 65 cases,73 hips）. The comparison between gorups included age,follow- up time,Harris score before and after surgery,length of incision,operative time,amount of bleeding,postoperative X- ray. [Results] The mean follow- up time was（ 51. 78 ± 2. 35） months in Sartorius bone flap group,（ 52. 73± 3. 71） months in circumflex iliac deep bone flap group. The stitche removal time,operation time,amount of bleeding,and length of incision were much more in circumflex iliac deep bone flap group than those in sartorius bone flap group. Comparison of Harris score between two groups showed a significant difference in any follow- up time point,and the scores in both groups decreased from postoperative 12 month. The postoperative recovery was better in circumflex iliac deep bone flap group according to Harris score. Comparison of VAS score between groups showed significant difference since postoperative 24 months and the scores in both groups increased from postoperative 24 moths to the last follow- up. X- ray analysis showed improvement of osteonecrosis in both two groups after surgery,and as time went on,the total hip amount decreased,the replacement amount increased.[Conclusion] Both the bone flap transplantions of sartorius and circumflex iliac deep bone flap are effective methods for treatment of early osteonecrosis of femoral head（ ARCOⅡ）,and the sartorius bone flap transplantion is a relatively simple technique and easy for matering,it is worth using widely.