扩大髓芯减压植骨术和肌骨瓣植入术治疗股骨头坏死的疗效比较

Comparison of the effects of expanded core decompression bone grafting and musculoskeletal flap implantation in the treatment of the femoral head necrosis

目的比较扩大髓芯减压植骨术和肌骨瓣植入术治疗股骨头坏死的临床疗效。方法将27例股骨头坏死患者按照手术方式不同分为扩大髓芯减压植骨组(10例)和肌骨瓣植入组(17例)。记录两组手术情况,采用疼痛VAS评分评价患者疼痛缓解情况,采用Harris评分评价髋关节功能恢复情况。结果患者均获得随访,时间12~48个月。手术时间、术中出血量、切口长度、住院时间扩大髓芯减压植骨组均短(少)于肌骨瓣植入组(P<0.01)。两组术后1、3、12个月疼痛VAS评分均低于术前(P<0.05),术后各时间点两组比较差异均无统计学意义(P>0.05)。两组术后1、3、12个月Harris评分均高于术前(P<0.05),术后各时间点两组比较差异均无统计学意义(P>0.05)。末次随访时,两组X线片均未见股骨头坏死区域进展;患者均能正常行走,除肌骨瓣植入组2例轻度跛行步态外,其余患者均为正常步态。结论扩大髓芯减压植骨术和肌骨瓣植入术治疗股骨头坏死均能获得满意的临床效果,扩大髓芯减压植骨术的手术创伤更小,出血更少,患者恢复更快。

Objective To compare the clinical efficacy of expanded core decompression bone grafting and musculoskeletal flap implantation in the treatment of femoral head necrosis.Methods The 27 patients with femoral head necroses were divided into expanded core decompression bone grafting group(10 cases)and musculoskeletal flap implantation group(17 cases),according to different surgical methods.The operation conditions of the two groups were recorded.The pain relief of patients was evaluated by pain VAS,and the functional recovery of hip joint was evaluated by Harris score.Results All patients were followed up for 12~48 months.Operative time,intraoperative blood loss,incision length and hospitalization time were shorter(less)in the expanded core decompression bone grafting group than those in the musculobone flap implantation group(P<0.01).Pain VAS:at 1,3 and 12 months after surgery,they were lower than those before surgery(P<0.05),and there were no statistical differences between the two groups at various time-point after surgery(P>0.05).Harris scores:at 1,3 and 12 months after surgery,they were higher than those before surgery,there were no statistical differences between the two groups at various time-point after surgery(P>0.05).At the last follow-up,X-ray films of both groups showed no progression in the necrotic area of the femoral head.All patients could walk normally,except for 2 cases with mild claudication in the musculoskeletal flap implantation group,the other patients could walk with normal gait.Conclusions Both expanded core decompression bone grafting and musculoskeletal flap grafting can achieve satisfactory clinical results in the treatment of femoral head necrosis.The surgery of expanded core decompression bone grafting is less trauma,less bleeding and faster recovery.