带血管蒂肌骨瓣转移与髓芯钻孔减压植骨治疗股骨头缺血坏死的疗效比较

目的:比较髓芯钻孔减压植骨术和股骨颈开窗减压带血管蒂的肌骨瓣转移术治疗早期股骨头缺血性坏死(ANFH)的手术时间和失血量差异,评估手术创伤并通过随访比较两种手术治疗股骨头坏死的中期疗效.方法:通过对34名早期股骨头坏死的患者采用上述两种方法进行治疗的病例进行分析、随访,病例入选的标准:年龄20～55岁的非创伤性ANFH早期患者(ARCO分期均为Ⅱ期).比较两手术相关数据(术中出血量和手术时间),分别评估两手术术前、术后Harris评分,影像学随访观察股骨头无塌陷生存率.结果:通过比较分析髓芯钻孔减压植骨组的术中失血量和手术时间都明显少于带血管蒂的肌骨瓣转移组(P＜0.01).髓芯钻孔减压植骨组术后平均随访3.2(2.1～5.4)年,带血管蒂的肌骨瓣转移组术后平均随访3.0(2.1～5.0)年,两手术组术前Harris评分平均分别为54.9和53.56,统计学分析无明显差异(P=0.436).带血管蒂肌骨瓣转移组术后Harris评分(平均86.8)优于髓芯钻孔减压植骨组(平均76.2)(p=0.000).通过影像学评价,以股骨头坏死进展发生股骨头塌陷为结果的生存分析显示,带血管蒂的肌骨瓣转移组在平均3.0年的随访中观察到2髋塌陷,生存率为92%,髓芯减压组在平均3.2年的随访中观察到8髋塌陷,生存率为60%,带血管蒂的肌骨瓣转移组的远期股骨头无塌陷的生存率优于髓芯钻孔减压植骨组.结论:与开窗减压带血管蒂的肌骨瓣移植术比较,虽然髓芯钻孔减压植骨术治疗早期股骨头坏死(ARCOⅡ期)具有手术创伤小,术后恢复快,短期疗效较好的特点,但其远期髋关节功能以及股骨头无塌陷生存率均不如前者.

Comparison of the Curative Effects of Vascular Pedicled Muscle Flap Transfers and Intramedullary Decompression with Bone Graft in Treatment of Femoral Head Avascular Necrosis

Objective:To compare the operative time and blood loss of intramedullary decompression with bone graft method and vascular pedicled muscle flap transfers method in the treatment of early avascular necrosis of femoral head(ANFH,) to assess their surgical trauma and compare their long-term efficacy for treatment of ANFH through follow-up.Methods:34 cases of early ANFH who treated with the two treatment methods were analyzed and followed-up.The case selection criteria:aged 20 to 55 years,early non-trauma ANFH ...