两种保髋手术治疗成人股骨头坏死初步结果比较

Comparison of preliminary clinical outcomes of two hip-preserving surgeries for femoral head necrosis in adult

[目的]比较带血管腓骨移植术(free vascularized fibular transplantation,FVFG)与钽棒置入术(tantalum rod implanta⁃tion,TRI)治疗成人股骨头坏死(osteonecrosis of the femoral head,ONFH)的初步临床结果。[方法]2015年2月—2019年8月,本院关节外科保髋治疗ONFH患者60例,其中,32例患者接受FVFG,28例患者接受TRI。比较两组患者的围手术期、随访和影像资料。[结果]两组均顺利完成手术,无严重并发症。FVFG组在手术时间、切口总长度、术中失血量、住院时间方面均显著大于TRI组(P<0.05)。FVFG组恢复完全负重时间显著早于TRI组。与术前相比,末次随访时两组患者VAS评分均显著下降(P<0.05),而Harris评分显著增加(P<0.05)。术前两组间VAS评分和Harris评分的差异均无统计学意义(P>0.05),但是,末次随访时,FVFG组VAS评分[(1.64±0.98)vs(3.87±1.60),P<0.05],Harris评分[(87.27±4.04)vs(77.64±4.92),P<0.05]均显著优于TRI组。影像方面,末次随访时,FVFG组ARCO总体分期与TRI组差异无统计学意义(P>0.05),但是,FVFG组股骨头坏死面积显著小于TRI组(P<0.05)。[结论]对成人ONFH,虽然FVFG手术操作复杂,但FVFG的初步临床效果优于TRI。

[Objective]To compare the preliminary clinical outcomes of free vascularized fibular grafting(FVFG)versus tantalum rod implantation(TRI)for osteonecrosis of the femoral head(ONFH)in the adult.[Methods]A retrospective study was done on 60 patients who received hip-preserving surgical treatments in our hospital from February 2015 to March 2018.Of them,32 patients received FVFG,while the remaining 28 patients had TRI performed.The perioperative,follow-up and imaging data were compared between the two groups.[Re⁃sults]All patients in both groups had operations completed successfully with no serious complications.The FVFG group proved significant⁃ly inferior to the TRI group regarding to operation time,total incision length,intraoperative blood loss,and hospital stay(P<0.05).The FVFG group spent significantly shorter time to recover full-weight bearing than the TRI group(P<0.05).The VAS scores significantly de⁃ceased,whereas the Harris scores significantly increased at the latest follow-up compared with those preoperatively in both groups(P<0.05).Although there were no significant differences in VAS and Harris scores between the two groups before surgery(P>0.05),the FVFG group was significantly superior to the TRI group in VAS score[(1.64±0.98)vs(3.87±1.60),P<0.05],Harris score[(87.27±4.04)vs(77.64±4.92),P<0.05]at the latest follow up.In terms of imaging evaluation,the overall ARCO classification of the FVFG group was not statistically different from that of the TRI group(P>0.05),but the area of femoral head necrosis in the FVFG group was significantly small⁃er than that of the TRI group at the latest follow up(P<0.05).[Conclusion]Although the FVFG is more complicated,the preliminary clini⁃cal outcome of FVFG is better than that of TRI for ONFH in the adult.