游离髂骨瓣联合带血管蒂大转子骨瓣移植对中青年ARCOⅢ期股骨头坏死患者的保髋作用

Effect of free iliac flap combined with vascularised greater trochanter bone grafting on preserving hip in young and middle-aged patients with ARCO Ⅲ necrosis of the femoral head

背景:临床上经常采用单纯游离髂骨瓣移植伴或者不伴带血管大转子骨瓣移植治疗中青年ARCOⅢ期非创伤性股骨头坏死患者,但以上2项术式的疗效优势尚不十分明确。目的:比较游离髂骨瓣与其联合带血管蒂大转子骨瓣移植治疗中青年ARCOⅢ期股骨头坏死患者的临床疗效。方法:选择2009年1月至2013年11月于广州中医药大学第一附属医院行髂骨瓣联合带血管蒂大转子骨瓣移植(A组)与游离髂骨瓣移植(B组)的ARCOⅢ期股骨头坏死患者,年龄18-45岁。2组患者对治疗方案均知情同意,且得到医院伦理委员会批准。记录2组患者术口长度、住院时间、手术时间及出血量,比较组间ARCOⅢ期各亚型术前及末次随访Harris评分及疼痛目测类比评分,并统计髋关节优良率及保髋率。结果与结论:(1)共纳入71例患者(A组37例42髋,B组34例38髋),随访3.5-7年;(2)A组手术时间和术中出血量均大于B组,差异有显著性意义(P <0.05);(3)组内比较,2组术后末次随访ARCOⅢ期各亚型Harris评分及目测类比评分均较术前明显改善;组间比较,A组ARCOⅢb、c型患者术后髋关节Harris评分及目测类比评分均优于B组,差异均有显著性意义(P <0.05);2组ARCOⅢa期患者间Harris评分及目测类比评分差异无显著性意义(P> 0.05);(4)A、B组保髋率分别为91%和74%,差异有显著性意义(Z=3.9,P <0.05);据Harris评分结果,A、B组髋关节优良率分别为82%和75%;(5)2组患者术后均未出现严重并发症;(6)结果表明,游离髂骨瓣伴或不伴带血管蒂大转子骨瓣移植均为治疗中青年ARCOⅢ期股骨头坏死患者的有效方法,能明显改善髋关节功能并缓解疼痛,但前者治疗ARCOⅢ期b、c型股骨头坏死更具优势。

BACKGROUND: Free iliac flap combined with or without vascularised greater trochanter bone grafting is adopted in the treatment of young and middle-aged patients with non-traumatic ARCO III necrosis of the femoral head. However, the efficacy of these two operation treatments is still unclear.OBJECTIVE: To compare the clinical outcomes of free iliac flap combined with or without vascularised greater trochanter bone graft in young and middle-aged patients with ARCO III necrosis of the femoral head.METHODS: Those ARCO III necrosis of the femoral head patients aged 18-45 years who were treated with free iliac flap combined with vascularised greater trochanter bone graft(group A) or with free iliac flap(group B) from January 2009 to November 2013 at the First Affiliated Hospital of Guangzhou University of Chinese Medicine were included in this study. All patients signed the informed consents and the study was approved by the ethics committee of the hospital. The incision length, hospitalization time, operation time and blood loss were recorded.The Harris scores and Visual Analogue Scale scores at baseline and end of follow-up in ARCO III subtypes were compared. The good and excellent rate of hip joint and hip preserving rate were calculated.RESULTS AND CONCLUSION:(1) A total of 71 patients(group A 37 patients with 42 hips;group B 34 patients with 38 hips) were included.The follow-up time was 3.5-7 years.(2) The operation time and intraoperative blood loss in the group A were significantly higher than those in the group B(P < 0.05).(3) The Harris scores and Visual Analogue Scale scores were improved significantly after surgery in ARCO III subtypes of two groups. The Harris scores and Visual Analogue Scale scores in the group A were significantly superior to group B in necrosis of the femoral head patients with ARCO III b and c(P < 0.05). The Harris scores and Visual Analogue Scale scores had no significant difference between two groups in necrosis of the femoral head patients with ARCO III a(P > 0.05).(4) The hip preserving rate in the groups A and B was 91% and 74%(Z=3.9, P < 0.05), respectively. According to the result of Harris scores, the good and excellent rate of hip joint in the groups A and B was 82% and 75%, respectively.(5) There were no serious complications after surgery.(6) These results imply that free iliac flap combined with or without vascularised greater trochanter bone grafting is an effective treatment method for young and middle-aged patients with ARCO III necrosis of the femoral head. They can effectively improve the hip joint function and release joint pain. However, free iliac flap combined with vascularised greater trochanter bone grafting can achieve good clinical outcomes in young and middle-aged patients with ARCO III b and c necrosis of the femoral head.