髓芯减压植骨术与缝匠肌肌骨瓣移植术治疗Ficat Ⅲ期股骨头缺血性坏死的远期疗效比较  

Comparison of Intramedullary Decompression with Bone Graft Bone and Flap Muscle Sartorious Transfers in Treatment of Ficat-Ⅲ Femoral Head Avascular Necrosis

作　　者：刘德淮[1] 庄小强[1] 白宇[1] 陆生林[1] 

机构地区：[1]广西医科大学附属民族医院骨科,广西南宁530001

出　　处：《实用骨科杂志》2014年第6期495-499,共5页Journal of Practical Orthopaedics

摘　　要：目的：研究比较髓芯减压植骨术与缝匠肌肌骨瓣移植术治疗成人FicatⅢ期股骨头缺血性坏死的远期临床疗效。方法回顾性分析2003年1月至2008年12月，采用髓芯减压植骨术和缝匠肌肌骨瓣移植术治疗的38例（43髋）Ficat Ⅲ期股骨头缺血性坏死病例，比较两组病例的一般资料、术中失血量、手术时间和住院时间，根据两组手术前后Harris评分变化和Ficat分期改变进行临床和影像学评价，以改行人工关节置换术为终点，对其生存率进行Kaplan-Meier生存分析。结果所有病例均获得60～123个月随访，平均93个月。两组病例的年龄、随访时间及术前Harris评分比较无统计学意义（ P﹥0.05）。两组病例术后Harris评分较术前均有明显提高（ P﹤0.05），但缝匠肌肌骨瓣移植术组术后Harris评分优于髓芯减压植骨术组（ P﹤0.05）。髓芯减压植骨术组术中失血量、手术时间和住院时间均明显少于缝匠肌肌骨瓣移植术组（P﹤0.01）。两组术后影像学成功率比较无统计学意义（P﹥0.05），Kaplan-Meier生存分析显示髓芯减压植骨术组远期生存率为64％（16/25），缝匠肌肌骨瓣移植术组的远期生存率为77.8％（14/18），两组的远期生存率比较无统计学意义（ P﹥0.05）。结论髓芯减压植骨术与缝匠肌肌骨瓣移植术治疗Ficat Ⅲ期股骨头缺血性坏死均取得一定的远期临床疗效，虽然缝匠肌肌骨瓣移植术组的远期影像学成功率和生存率与前者比较无统计学差异，但其临床疗效更佳。Objective To compare the long-term follow-up results of intramedullary decompression with bone graft bone and flap muscle sartorious transfers in treatment of Ficat-Ⅲfemoral head avascular necrosis. Methods we retrospectively ananlyzed 38 cases（43 hips）of Ficat-Ⅲ femoral head avascular necrosis treated with intramedullary decompression with bone graft bone and flap muscle sartorious transfers between January 2003 and December 2008. The related data,intraoperative blood loss,surgical time and hospital days were compared. The outcomes were assessed clinically according to changes in the Harris hip score. The hip survival analysis were conducted with the Kaplan-Meier method. Results All cases were followed up 60 to 123 months. There was no significant difference between the two groups according to their age,duration of follow-up and preoperative Harris hip scores（P ﹥0. 05）. The Harriss core of both groups was obviously increased postoperatively（P ﹤0. 05）. The blood loss,surgical time and hospital days of intramedullary decompression with bone graft group were significantly less than flap muscle sartorious transfers group（ P ﹤0. 01）. The postoperative Harris scorees of intramedullary decompression group were higher than intramedullary decompression with bone graft group（P ﹤0. 05）. There was no significant radiological difference in the results of both surgical techniques（ P ﹥ 0. 05）. Kaplan-Meier survivorship curves showed that the survival rate in the two groups were 64%（16/25）and 77. 8%（14/18）respectively. There was no significant difference between the two groups according to the long-term survival rate（P ﹥0. 05）. Conclusion There is certain clinical curative effect in the two groups treated by intramedullary decompression with bone graft bone and flap muscle sartorious transfers. Although there was no significant radiological and survival difference in the long-term results of both surgical techniques,the clinical results of flap muscle sartorious transfers were

关 键 词：股骨头缺性坏死 髓芯减压术 缝匠肌肌骨瓣移植术 Ficat Ⅲ期 远期疗效 

分 类 号：R681.8[医药卫生—骨科学]