改良的髂嵴前方合页式开窗取骨植骨治疗早期股骨头缺血性坏死

Application of iliac bone autografting via a modified leaflet anterior approach for early avascular necrosis of femoral head

背景:髓芯减压联合自体骨植骨是治疗早期股骨头缺血性坏死的有效手段。如何改进髂骨取骨方式,减少供骨区的并发症,提高患者的生活质量是临床医师关注的重要问题。目的:评价改良的髂嵴前方合页式开窗取骨植骨治疗股骨头缺血性坏死的临床应用价值。方法:回顾性分析2007年1月至2011年12月收治的59例应用改良的髂嵴前方合页式开窗取骨植骨加髓芯钻孔减压术治疗的早期股骨头缺血性坏死患者,共70髋。其中男46例,女13例,年龄21~63岁,平均年龄(39.5±10.1)岁;FicatⅠ期54髋,Ⅱ期16髋。比较患者术前及末次随访时Harris髋关节评分、髋关节活动度、疼痛视觉模拟评分(VAS)。结果:59例患者随访6~10年,平均(8.3±2.1)年,髂骨取骨时间(20±5)min,术中出血量(62±21)ml。与术前比较,患者末次随访时Harris评分升高[(87.8±1.4)分vs(8.6±1.2)分],髋关节活动度增大[(119.2±13.3)°vs(98.2±19.8)°],疼痛VAS评分降低[(16.2±6.7)分vs(79.2±12.3)分],且差异均有统计学意义(t=-19.882、-20.518、7.813,P均<0.05)。仅2例患者进展为股骨头塌陷而行全髋关节置换。术后急慢性并发症各1例,并发症总发生率3.4%(2/59)。患者对髂嵴供骨区外观满意度达96.6%(57/59)。结论:改良的髂嵴前方合页式开窗取骨具有并发症少、出血量小、患者满意度高及同一部位反复多次取骨等优势,为一种实用、简便、安全有效的自体髂骨取骨方法,在治疗早期股骨头缺血性坏死中具有较好的临床应用价值。

Background: It is an effective treatment for early-stage avascular necrosis of femoral head by core decompression combined with autologous bone grafting. How to improve iliac bone grafting, reduce the complications of donor site and improve the quality of life of patients were paid more attention to clinicians. Objective: To evaluate the application of modified leaflet anterior approach to harvest iliac bone for the treatment of avascular necrosis of femoral head. Methods: From January 2007 to December 2011, 59 patients(70 hips) with early-stage avascular necrosis of femoral head underwent core decompression combined with iliac crest bone grafting through leaflet anterior approach. There were 46 males and 13 females with a mean age of(39.5±10.1) years(range, 21-63 years). According to Ficat classification, there were 54 hips at stage I disease and 16 hips at stage Ⅱ. Based on the Ficat Grading scale, the operative time and intraoperative blood loss were observed. Harris hip score, range of motion of the hip, and VAS score were recorded before and after surgery. Results: Eventually, 59 patients were followed up for an average of(8.3±2.1) years(range, 6-10 years). It took(20±5) min in iliac bone harvesting. Intraoperative blood loss was(62±21) ml on average. Compared with preoperative ones, postoperative Harris Hip score and range of motion significantly increased, while VAS score decreased greatly(87.8±1.4 vs 8.6±1.2, 119.2°±13.3° vs 98.2°±19.8°, 16.2±6.7 vs 79.2±12.3;t=-19.882,-20.518 and 7.813, P<0.05). Two patients had to undergo total hip arthroplasty due to the collapse of femoral head. The incidence of postoperative complications was 3.4%(2/59, one acute and one chronic complication). The degree of the appearance satisfaction was 96.6%(57/59). Conclusions: The anterior leaflet iliac crest autografting has many advantages, such as less complications, less perioperative blood loss, and higher patients’ satisfaction, repeated harvesting in the autografts. It is a practical, simple, and safe method for the treatment of early-stage avascular necrosis of femoral head.