全髋关节置换术和带血运骨瓣移位术治疗晚期股骨头缺血性坏死的比较研究  

COMPARISON OF TOTAL HIP REPLACEMENT AND TRANSPLANTATION OF VASCULARIZED BONE GRAFT IN TREATING LATE ISCHEMIC NECROSIS OF THE FEMORAL HEAD

作　　者：赵德伟[1] 张耀[1] 王卫明[1] 芦健民[1] 张克民[1] 于晓光[1] 孙强[1] 

机构地区：[1]大连大学附属中山医院,辽宁大连116001

出　　处：《中国修复重建外科杂志》2005年第9期700-702,共3页Chinese Journal of Reparative and Reconstructive Surgery

摘　　要：目的比较全髋关节置换术(total hip replacement,THR)和带血运骨瓣移位术治疗晚期股骨头缺血性坏死的疗效和适应证. 方法 1986年3月～1993年3月,共治疗晚期股骨头缺血性坏死患者81例.将其中59例单侧患者分为两组:一组26例行THR,术前髋关节Harris评分平均48.3分;另一组33例采用带血运骨瓣移位术,术前髋关节Harris评分平均48.7分.两组差异无统计学意义(P>0.05).对两组术后不同时间段和不同年龄段患者Harris评分的变化进行比较. 结果两组术后随访10年3个月～16年5个月,平均15年2个月.Harris评分变化术后初期差异有统计学意义(P<0.05),中远期无统计学意义(P>0.05).术后Harris评分变化THR组不同年龄段患者差异无统计学意义(P>0.05),而带血运骨瓣移位组不同年龄段患者差异有统计学意义(P<0.05). 结论两种手术方法治疗晚期股骨头缺血性坏死疗效均较满意,THR更适合治疗中老年患者,而青壮年患者选择带血运骨瓣移位术治疗更合适.Objective To compare the effects and indications of total hip replacement （THR） and transplantation of vascularized bone graft in treating late ischemic necrosis of the femoral head. Methods From March 1986 to March 1993, 81 patients with late ischemic necrosis underwent treatment. Of 81 patients, 59 patients who suffered in unilateral hip were divided into 2 groups： 26 underwent total hip replacement and 33 underwent transplantation of vascularized bone graft. There was no significant difference in the Harris-scores of the two groups before operations （P〉0.05）. The Harris hip scores were compared between different ages（〈30 years, 31-50 years, and 〉51 years） in two groups. Results The follow-up ranged from 10 years and 3 months to 16 years and 5 months （15 years and two months on average）. The changes of Harris-scores of the two groups after operations had significant difference in initial stage（P〈0.05）,but had no significant difference in the long term（P〉0.05）. The change of Harrisscores of patients who underwent total hip replacement had no significant difference between different ages （P〉0.05）, but that of patients who underwent transplantation of vascularized bone graft had significant difference between different ages （P〈0. 05）. Both groups had satisfactory effects in treating late ischemic necrosis of the femoral head. Conclusion Both methods are effective in treating late ischemic necrosis of the femoral head. Total hip replacement can be more effective in senior patients. Transplantation of vascularized bone can be more effective in young patients.

关 键 词：股骨头 缺血性坏死 全髋关节置换术 骨瓣移位术 比较研究 

分 类 号：R687.3[医药卫生—骨科学]