改良Urbaniakrbaniak术式治疗股骨头缺血性坏死疗效观察

EFFECTIVENESS OF MODIFIED Urbaniak OPERATION TO TREAT AVASCULAR NECROSIS OF THE FEMORAL HEAD

目的探讨改良Urbaniak术式治疗股骨头缺血性坏死的临床疗效。方法回顾分析2010年2月-2012年10月采用在股骨大粗隆切口基础上增加股前外侧切口,保留原有腓骨瓣经粗隆外皮质钻孔减压填充方式,选择旋股外侧动脉降支作为供血血管的改良Urbaniak术式,治疗38例（41髋）股骨头缺血性坏死患者。其中男25例（28髋）,女13例（13髋）;年龄16~52岁,平均34岁。酒精性19例（21髋）,创伤性9例（9髋）,激素性5例（6髋）,特发性5例（5髋）。病程10个月~6年,平均3.7年。按Ficat分期标准：Ⅱ期24髋,Ⅲ期17髋。术前Ⅱ、Ⅲ期髋关节Harris评分分别为（80.63±5.02）分和（77.06±6.77）分。术后记录相关并发症,根据患髋术后X线片表现分为改善、稳定、恶化、失败4个等级,评价为改善或稳定即为影像学成功;采用Harris评分评定患髋功能,≥80分为临床成功。结果术后切口均Ⅰ期愈合。术后3例出现股前外侧皮肤麻木和感觉减退,1例出现足背感觉异常,均对日常生活无影响。38例（41髋）均获随访,随访时间1年~3年3个月,平均2年3个月。随访期间无髋关节僵硬、髋部或腹股沟区持续性疼痛、髋关节感染、踝关节不稳等并发症发生。末次随访时X线片示23髋（56.1%）改善、17髋（41.5%）稳定、1髋（2.4%）恶化,影像学成功40髋;患髋Harris评分获优17髋、良20髋、可3髋、差1髋,优良率为90.2%,临床成功37髋。末次随访时Ⅱ、Ⅲ期髋关节Harris评分分别为（89.92±4.12）分和（86.53±5.70）分,均较术前提高,差异有统计学意义（t=7.011,P=0.000;t=4.412,P=0.000）。结论改良Urbaniak术式具有操作简便、并发症少、安全性较高及术后患髋功能恢复良好等优点,是治疗股骨头缺血性坏死的有效方法。

Objective To investigate the effectiveness of the modified Urbaniak operation to treat avascular necrosis of the femoral head（ANFH）. Methods A retrospective analysis was made on the clinical data of 38 patients（41 hips） with ANFH treated between February 2010 and October 2012 with the modified Urbaniak operation（to add lateral femoral incision based on femoral greater trochanter incision, to preserve the original fibula flap drilling, decompression and filling through trochanteric outer cortex, and to select the descending branch of lateral circumflex femoral artery as the supply vessel）. Of 38 cases, 25 were male（28 hips）, 13 were female（13 hips）, aged 16-52 years（mean, 34 years）; there were 19 cases（21 hips） of alcoholic ANFH, 9 cases（9 hips） of traumatic ANFH, 5 cases（6 hips） of hormone ANFH, and 5 cases（5 hips） of idiopathic ANFH. The disease duration ranged from 10 months to 6 years（mean, 3.7 years）. According to Ficat staging criteria, 24 hips were rated as stages II and 17 hips as stage III. The preoperative Harris hip scores were 80.63±5.02 and 77.06±6.77 in patients at stage II and III respectively. The related complications were recorded after operation. According to the findings of postoperative X-ray films, 4 grades were improvement, stabilization, deterioration, and failure; improvement or stabilization was determined to radiological success. According to the Harris score to evaluate the function of hips, more than 80 was determined to clinical success. Results Healing by first intention was achieved in all patients after operation. Three cases had numbness and hypoaesthesia of the lateral femoral skin, 1 case had abnormal sensation of the dorsal foot, which had no effect on daily life. Thirty-eight cases（41 hips） were followed up 1 year to 3 years and 3 months（mean, 2 years and 3 months）. There was no complication such as hip joint stiffness, hip or groin persistent pain, hip joint infection, or ankle instability. At last follow-up, the X-ray films showed improvement in 23 hips（56.1%）, stabilization in 17 hips（41.5%）, and deterioration in 1 hip（2.4%）; 40 hips obtained the radiological success. According to the Harris score, the results were excellent in 17 hips, good in 20 hips, fair in 3 hips, and poor in 1 hip with an excellent and good rate of 90.2%; 37 hips achieved the clinical success. The Harris scores were 89.92±4.12 and 86.53±5.70 in patients at stage II and III respectively at last follow-up, showing significant differences when compared with preoperative ones（t=7.011, P=0.000;t=4.412, P=0.000）. Conclusion The modified Urbaniak operation has the advantages of more convenient operation, less complications, higher safety, and better hip functional recovery. It is an effective method to treat ANFH.