两种带血运骨瓣移植术治疗股骨头坏死的早期疗效分析  

Early Efficacy Analysis of Two Types of Bone Flap Transplantation with Blood Supply for Osteonecrosis of the Femoral Head

作　　者：张绍炳 许莹 丁文星 戴传强 钟晓 张德祥 葛建华 ZHANG Shaobing;XU Ying;DING Wenxing;DAI Chuanqiang;ZHONG Xiao;ZHANG Dexiang;GE Jianhua(Ziyang Central Hospital,Ziyang 641300;Affiliated Hospital of Southwest Medical University,Luzhou 646000,Sichuan China)

机构地区：[1]资阳市中心医院,四川资阳641300 [2]西南医科大学附属医院

出　　处：《中国中医骨伤科杂志》2025年第3期31-37,42,共8页Chinese Journal of Traditional Medical Traumatology & Orthopedics

基　　金：2023年四川省医学会骨科(尚安通)专项科研课题(2023SAT21)。

摘　　要：目的:比较带血管游离腓骨瓣移植术与带股方肌蒂骨瓣移植术治疗成人非创伤性股骨头坏死的早期疗效。方法:回顾性分析2017年5月至2021年8月收治的26例(26髋)非创伤性股骨头坏死ARCO分期为Ⅱ/Ⅲ期的患者治疗效果。根据手术方式的不同将患者分为A、B两组:A组为带血管游离腓骨瓣移植术,B组为带股方肌蒂骨瓣移植术,每组13例。比较两组患者围手术期情况、末次随访临床效果及影像学评价。结果:两组患者术中出血量比较,差异无统计学意义(P>0.05);B组患者手术时间、切口总长度较A组更短,术中透视次数更少,差异有统计学意义(P<0.05)。术后随访24个月,末次随访时两组患者的VAS评分较术前下降,Harris评分较术前升高,差异有统计学意义(P<0.05);两组患者间术前与末次随访的VAS评分及Harris评分比较,差异无统计学意义(P>0.05)。两组患者术后优良率及术后完全负重活动时间比较,差异无统计学意义(P>0.05)。末次随访时A组股骨头坏死面积率小于B组,差异有统计学意义(P<0.05)。结论:带血管游离腓骨瓣移植和带股方肌蒂骨瓣移植治疗早中期非创伤性股骨头坏死的早期疗效确切,可根据具体情况选择手术方式。Objective:To compare the early efficacy of anastomotic vascular free fibular grafting and quadratus femoris muscle-pedicle bone graft transplantation in treating non-traumatic femoral head necrosis in adults with ARCO stages Ⅱ/Ⅲ.Methods:The outcome of 26 patients(26 hips) admitted from May 2017 to August 2021 with non-traumatic femoral head necrosis ARCO stage Ⅱ and Ⅲ were retrospectively analyzed.Based on the various surgical techniques,the patients were split into two groups,A and B,with 13 cases each.Free vascularized fibular grafting was used to treat group A,while quadratus femoris muscle-pedicle bone graft transplantation was used to treat group B.Between the two groups,the perioperative and clinical outcomes of the most recent follow-up parameters(including imaging data) were compared.Results:Between the two groups,there was no statistically significant difference in terms of intraoperative blood loss or duration of hospital stay(P>0.05).Group B experienced shorter operating times(P<0.05),shorter total incision lengths(P<0.05),and shorter intraoperative fluoroscopy periods(P<0.05).The two groups were followed up for 24 months.The VAS values in both groups were lower at the last follow-up visit than they were before the procedure(P<0.05).In comparison to the pre-operation,the Harris score rose(P<0.05).Preoperative and final follow-up VAS and Harris ratings did not significantly differ between the two groups(P>0.05).There was no significant difference in postoperative excellent rate and complete weight activity time in the two groups(P>0.05).The necrotic area of the femoral head in group A was less than that in group B at the last follow-up visit(P<0.05).Conclusion:The early efficacy of quadratus femoris muscle-pedicle bone graft and free vascularized fibular grafting in treating early to mid-stage nontraumatic femoral head necrosis is certain,and the surgical approach can be chosen based on the particular circumstance.

关 键 词：股骨头坏死 带血管腓骨移植 股方肌蒂骨瓣 

分 类 号：R681.8[医药卫生—骨科学]