改良与传统股方肌骨瓣治疗青壮年股骨头坏死的临床疗效比较

Comparison of clinical efficacy of modified quadrat femoral bone flap and traditional quadrat femoral bone flap in the treatment of osteonecrosis of the femoral head in young adults

目的回顾性分析比较改良股方肌骨瓣与传统股方肌骨瓣治疗青壮年股骨头坏死的临床疗效。方法按照纳入及排除标准收集联勤保障部队第九二〇医院2019年1月至2020年7月因股骨头坏死接受保髋手术治疗的78例患者资料,分为改良股方肌骨瓣组和传统股方肌骨瓣组,各组38例,对比分析两组手术时间,切口长度,Hb下降量,术后36个月VAS评分,髋关节Harris评,及髋关节活动度及并发症情况,股骨头生存率等指标,评价两种手术方式的临床效果。结果所有患者均顺利完成手术并获得随访,随访时间为(39.5±3.2)月,无伤口感染及深静脉血栓等并发症发生。改良组切口平均长度(10.7±0.9)cm,血红蛋白(hemoglobin,Hb)下降量(10.6±1.1)g/L,较传统组(13.5±0.7)cm,(12.1±1.1)g/L均减小,P<0.05,差异有统计学意义;术后36个月改良组髋关节Harris评分(86.7±4.5)、ROM(311.5±15.0)较传统组(82.7±5.4)、(294.4±20.8)改善明显,P<0.05,差异有统计学意义,两组患者在手术时间及VAS评分方面无显著差异,改良组优良率94.7%与传统组优良率89.5%无显著性差异,改良组股骨头生存率高于传统组。结论改良股方肌骨瓣可有效保留股骨头后上支持带动脉,治疗青壮年股骨头坏死的临床疗效较传统股方肌骨瓣效果好,是保留髋关节手术的一种选择。

Objective To investigate the clinical effect of the modified quadrat femoral bone flap and the traditional quadrat femoral bone flap.Methods According to the inclusion and exclusion criteria,data of 78 patients who received hip preservation surgery for femoral head necrosis from 920th Hospital of Joint Logistics Support Force of Chinese People's Liberation Army from January 2019 to July 2020 were col-lected and divided into the improved quadrate femoral bone flap group and the traditional quadrate femoral bone flap group,with 38 cases in each group,operation time,incision length,Hb reduction,VAS score 36 months after operation,Harris score of hip joint,hip joint motion and complications,and survival rate of fem-oral head were compared between the two groups.To evaluate the clinical effect of the two surgical methods.Results All patients successfully completed the operation and were followed up for(39.5±3.2)months.No complications such as wound infection and deep vein thrombosis occurred.The average incision length and Hb decline of the improved group were(10.7±0.9)cm and(10.6±1.1)g/L,which were both decreased com-pared with the traditional group(13.5±0.7)cm and(12.1±1.1)g/L,P<0.05,and the difference was statistical-ly significant.The Harris score(86.7±4.5)and ROM(311.5±15.0)in the improved group were significantly improved than those in the traditional group(82.7±5.4)and 294.4±20.8)36 months after surgery(P<0.05),and the difference was statistically significant.There were no significant differences in operation time and VAS scores between the two groups.The superior rate of the improved group was 94.7%and 89.5%,and the survival rate of the improved group was higher than the traditional group.Conclusion The modified quad-rate femoral bone flap can effectively preserve the posterior superior supporting band artery of the femoral head.The clinical effect of the modified quadrate femoral bone flap is better than that of the traditional quad-rate femoral bone flap in the treatment of femoral head necrosis in young adults.