股骨头髓芯减压带旋髂深血管蒂髂骨骨瓣植骨治疗股骨头缺血性坏死

Vascularized iliac bone grafting for avascular necrosis of the femoral head

目的 探讨股骨头髓心减压带旋髂深血管蒂髂骨骨瓣植骨术治疗股骨头缺血坏死的疗效及手术适应证。 方法 1995年 10月～ 2 0 0 0年 8月共进行 18例 (2 6髋 )股骨头髓心减压带旋髂深血管蒂髂骨骨瓣植骨术。根据Harris髋关节评分系统进行关节功能评价 ,根据ARCO分期分型系统进行影像学评价。 结果 随访 16例 2 3髋 ,平均 3 1 5个月。Harris评分由术前平均 61 7改善为随访时 76 0分。 13髋 (5 6% )随访时Harris评分 >80 0分 (内侧型 8髋 ,中央型 3髋 ,外侧型 2髋 ) ,根据ARCO分期分型系统进行分类随访时优良率 ,内侧型 80 % ,中央型 60 % ,外侧型 2 5 %。 8髋分期发生进展。塌陷及失败率内侧型 2 0 % ,中央型 40 % ,外侧型 75 %。 结论 股骨头髓芯减压带旋髂深血管蒂髂骨骨瓣植骨术适用于ARCO分期分型系统中ⅠA中央型、ⅠB内侧型、ⅡA中央型、ⅡB内侧型股骨头缺血性坏死 ,并具有良好的近、中期疗效。对坏死范围较大的股骨头不能防止病程的进展 ,但可缓解症状 。

Objective To evaluate the indications for vascularized iliac bone grafting in the treatment of osteonecrosis of the femoral head and operative results. Methods From October 1993 to August 2000, Twenty six hips of 18 patients with osteonecrosis of the femoral head underwent vascularized iliac bone grafting. Clinical evaluation was made according to Harris Hip Score and ARCO staging system. Results Twenty three hips of 16 patients were followed up for 31 5 months (6 74 months) on average. The mean Harris hip score was 76 peints (mean 61 7). Thirteen hips (medial 8 hips, central 3 hips, lateral 2 hips) were graded >80 points by Harris hip score were. The incidence of radiographic collapse 20% was (medial), 40%(central) and 75% (lateral) respectively. Conclusions Vascularized iliac bone grafting is effective for the treatment of osteonecrosis of the femoral head in short and middle term. We recommend this procedure for the patients with ONFH in ARCO stage Ⅰ, stage ⅡA,ⅡB medial and central, and stage ⅡC medial.