保留股骨头手术治疗股骨头缺血性坏死1005例临床分析  

Conservative methods for osteonecrosis of the femoral head:the review of 1005 cases

作　　者：赵德伟[1] 王卫明[1] 王本杰[1] 王铁男[1] 芦健民[1] 郭林[1] 崔旭[1] 于晓光[1] 

机构地区：[1]大连大学附属中山医院骨科,116001

出　　处：《中华外科杂志》2005年第16期1054-1057,共4页Chinese Journal of Surgery

摘　　要：目的探讨股骨头缺血性坏死保留股骨头的外科治疗方法.方法对采用带旋股外侧血管升支髂骨瓣、带旋股外侧血管横支大转子骨瓣、带旋股外侧血管降支骨膜支骨膜瓣及旋髂深血管蒂髂骨瓣及联合骨瓣方法治疗并获得临床随访的1005例患者(1226髋)进行回顾分析.其中男性579例(695髋),女性426例(531髋);年龄17～65岁,平均年龄37.4岁;Ficat Ⅱ期485髋,Ⅲ期473髋,Ⅳ期268髋;Harris髋关节功能评分平均56.2分;术后随访1.5～15年,平均随访5.1年.根据Harris髋关节功能评分标准进行临床评价,根据手术前后Ficat分期改变进行影像学评价.结果 57例61髋于术后1～6年改行人工全髋关节置换术.股骨头得到重建的病例,术后Harris髋关节功能评分提高至平均85.8分,其中临床成功率为89.4%(1041髋),影像学成功率为75.4%(878髋).Ficat Ⅱ期优良率为95.3%,Ⅲ期为87.9%,Ⅳ期为60.8%.结论应用显微外科技术,针对不同程度的股骨头缺血性坏死采用单纯或联合带血管蒂骨(膜)瓣转移,是青壮年股骨头缺血性坏死患者保留股骨头的有效治疗方法.Objective To research on the conservative methods used to preserve the femoral head of patients with osteonecrosis of the femoral head. Methods In these series surgical procedures the osteonecrotic lesion was removed and various vascularized bone blocks or periosteal flaps with its nutrient vessels were transferred to regain sphericity of the femoral head and reinforce the sequestrum. The current study assessed 1005 patients （ 1226 hips） operated on from 1989 to 2002 with an average follow-up of 5.1 years （range, 1.5-15 years）. The mean age of the patients was 37.4 years （range, 17- 65 years）.Results Sixty-one hips （57 patients） had conversion surgery to a total hip arthroplasty because of progressive collapse or severe pain, or both. In the patients without failure, postoperative Harris hip score improved significantly. Of the 1174 reconstructions that were in situ, 1041 （89.4% ） were clinically successful, and 878 （75.4%） were radiologically successful. In relation to the stage of necrosis according to the classification system of Ficat and Alert, good results were achieved in 95.3% of the patients with stages Ⅱ disease, 87. 9% with stages Ⅲ and 60. 8% with stages Ⅳ. Conclusions Conservative methods of vascularized bone block or periosteal flap transfer should be considered in active symptomatic patients to preserve the femoral head. In addition, the earlier the stages of the disease the better outcome could be obtained.

关 键 词：股骨头坏死 组织移植瓣 随访研究 青壮年股骨头缺血性坏死 保留股骨头 临床分析 手术治疗 带旋股外侧血管升支髂骨瓣 髋关节功能评分 带旋股外侧血管横支 

分 类 号：R687.3[医药卫生—骨科学]