带血管腓骨移植治疗ARCOⅡ期与Ⅲ期股骨头坏死的步态功能分析  

Gait analysis of ARCO stageⅡ and Ⅲ femoral head necrosis treated with vascularized fibular graft

作　　者：苏来提.肖合热提 盛加根[1] 殷文靖[1] 徐明剑 向富州 李春晓[1] 朱振中[1] 

机构地区：[1]上海交通大学附属第六人民医院骨科,200233

出　　处：《国际骨科学杂志》2017年第3期183-187,共5页International Journal of Orthopaedics

摘　　要：目的探讨带血管腓骨移植对国际骨科循环学会(ARCO)Ⅱ、Ⅲ期股骨头坏死步态功能的影响。方法选择2011年2月至2012年2月于我院行带血管腓骨移植治疗并符合纳入标准的ARCOⅡ、Ⅲ期股骨头坏死病例89例(97髋)为研究对象,其中Ⅱ期42例(49髋),Ⅲ期47例(48髋);男73例,女16例,平均年龄39.5岁。手术前后采用Harris髋关节评分量表进行评分,对手术前后及不同分期之间的疼痛和步态功能进行分析比较。结果 Harris髋关节功能量表疼痛、步态功能评分信度均极好,疼痛、步态功能评分差值的相关性均较强。ARCOⅡ、Ⅲ期股骨头坏死患者术后疼痛评分均高于术前(P<0.05);ARCOⅡ期与Ⅲ期股骨头坏死患者术前疼痛评分及手术前后疼痛评分差值均有显著性差异(P<0.05),而两者术后疼痛评分则无显著性差异(P>0.05)。ARCOⅢ期股骨头坏死患者术后步态功能评分明显高于术前(P<0.05),而ARCOⅡ期股骨头坏死患者手术前后步态功能差异无显著性差异(P>0.05);ARCOⅡ期与Ⅲ期股骨头坏死患者术前、术后步态功能及手术前后步态功能差值均无显著性差异(P>0.05)。结论带血管腓骨移植可有效缓解ARCOⅡ、Ⅲ期股骨头坏死疼痛症状,并显著改善ARCOⅢ期股骨头坏死步态功能,是治疗ARCOⅡ、Ⅲ期股骨头坏死的有效方法。Objective To explore the gait changes before and after the vascularized fibular graft treatment of patients with femoral headnecrosis at Association Research Circulation Osseous （ARCO） stage Ⅱand Ⅲ. Methods According lo lhe inclusion criteria, a total of 89 patients （97 hips） with femoral head necrosis, including 42 cases （49 hips） at ARCO stage n and 47 cases （48 hips） at stage Ⅲ,were treated with vascularized fibular gratt from February 2011 to February 2012. The average age of 89 patients, including 73 39. 5 years. Harris hip score scale was used to evaluate the patients before and after the surgery; pain andgait function were compared and analyzed between pre-surgery and post-surgery and between stage Ⅱ and stage Ⅲ. Results The reliability of both pain subscores and gait function subscores in the Harris hip score scale were extremely good; the changes in pain subscores had a fair good association with the changes in gait function subscores. The postoperative pain subscores in osteonecrosis patients at ARCO stage Ⅱ and ARCO stageⅢ were higher than those preoperatively （P〈0. 05） ; there was statistically significant diference between the preoperative pain subscores and subscores either in patients at stage Ⅱ （P〈0. 05） or in patients at stageⅢ （P〈0. 05） ？ and between the preoperative pain subscores in patientsat stage Ⅱ and those in patientsat stage Ⅲ （P〈0. 05） ; but no significant difference was found between the postoperative pain ubcorpatients at stage n and those in patients at stage Ⅲ （P〉0. 05）. The postoperative gait function subscoresin osteonecrosis patients at Astage Ⅲ were significantly higher than those preoperatively （P〈 0. 05）, while there was no statistically significant diference between the preoperative gait subscores and the postoperative gait subscores in patients at stage Ⅱ （P〉0. 05）. Conclusion The vascularized fibular gratt can significantly improve the pain rn the osteonecros

关 键 词：带血管腓骨移植 早中期股骨头坏死 步态功能 信度 

分 类 号：R687.3[医药卫生—骨科学]