早期股骨头坏死患者应用带旋股外侧升支血管蒂髂骨瓣移植术的疗效评价  

Evaluation of Efficacy of Pedicled Iliac Bone Flap Transplantation with Ascending Branch of Lateral Femoral Circumflex Artery on Patients with Early Osteonecrosis of Femoral Head

作　　者：康昭河 罗树林[2] 刘术樟 周宇 姚磊 郭超 尹峰[2] KANG Zhaohe;LUO Shulin;LIU Shuzhang;ZHOU Yu;YAO Lei;GUO Chao;YIN Feng(Ji’an Hospital of Shanghai Oriental Hospital,Ji’an 343000,China;不详)

机构地区：[1]上海市东方医院吉安医院,江西吉安343000 [2]上海市东方医院 [3]江西省吉安市中心人民医院

出　　处：《中国医学创新》2022年第26期30-34,共5页Medical Innovation of China

基　　金：江西省卫健委课题(20187309,20204856)。

摘　　要：目的:探讨带旋股外侧升支血管蒂髂骨瓣移植术治疗早期股骨头坏死患者的效果。方法:选择2015年1月-2019年1月上海市东方医院吉安医院骨科收治的早期股骨头坏死患者,随访时间18个月,随机数字表法分为骨瓣移植组(n=32)和髓芯减压组(n=26),比较两组术前、术后1、2、3个月的肢体功能(Harris评分)、疼痛情况[视觉模拟评分法(VAS)],围手术期指标(手术时间、术中出血量、住院时间),术前、术后3、6、12、18个月的髋关节正位片影像学评分。结果:纳入64例,完成随访58例,骨瓣移植组(n=32)和髓芯减压组(n=26)。骨瓣移植组术后1、2、3个月Harris评分均高于髓芯减压组,术后2、3个月VAS得分均低于髓芯减压组,术后3、6、12、18个月影像学评分均低于髓芯减压组,差异均有统计学意义(P<0.05);两组术后1个月VAS得分、手术时间、术中出血量、住院时间比较,差异均无统计学意义(P>0.05)。结论:带旋股外侧升支血管蒂髂骨瓣移植治疗早期股骨头坏死有助于改善患者关节功能,减轻患者术后疼痛,获得较好治疗效果。Objective:To explore the effects of pedicled iliac bone flap transplantation with ascending branch of lateral femoral circumflex artery in the treatment of patients with early osteonecrosis of femoral head.Method:The patients with early osteonecrosis of femoral head who were treated in Department of Orthopedics of Ji’an Hospital of Shanghai Oriental Hospital were selected from January 2015 to January 2019 and were followed up for 18 months.The patients were divided into bone flap transplantation group (n=32) and medullary core decompression group (n=26) by means of the random number table method.The limb function (Harris score) and pain[visual analogue scale (VAS)]before surgery and 1,2 and 3 months after surgery,perioperative indicators (surgical time,intraoperative blood loss,hospital stay) and imaging score of hip anteroposterior radiograph before surgery and at 3,6,12 and 18 months after surgery were compared between the two groups.Result:Among 64 enrolled cases,58 cases completed the followed up,including 32 cases in bone flap transplantation group and 26 cases in medullary core decompression group.The Harris scores in bone flap transplantation group at 1,2,and 3 months after surgery were higher than those in medullary core decompression group,and the VAS scores at 2 and 3 months after surgery were lower than those in medullary core decompression group,and the imaging scores were lower compared with those in medullary core decompression group at 3,6,12,and 18 months after surgery (P<0.05).There were no statistical differences in VAS score,surgical time,intraoperative blood loss and hospital stay between the two groups at 1 month after surgery (P>0.05).Conclusion:Pedicled iliac bone flap transplantation with ascending branch of lateral femoral circumflex artery for early osteonecrosis of femoral head can help to improve the joint function,relieve the postoperative pain and obtain good therapeutic effect.

关 键 词：旋股外侧升支血管 带血管蒂髂骨瓣 髓芯减压 早期股骨头坏死 

分 类 号：R687.3[医药卫生—骨科学]