带股方肌蒂的骨瓣移植术治疗成人股骨头缺血性坏死的疗效

摘要

目的 观察采用带股方肌蒂的骨瓣移植术治疗成人股骨头缺血性坏死的临床效果. 方法 回顾性分析郑州大学第一附属医院骨科自2006年8月至2013年6月住院的355例因股骨头坏死行带股方肌蒂的骨瓣移植术患者的手术相关资料,按照世界骨循环研究学会(ARCO)分期,Ⅰ-C期41例、Ⅱ-A期126例、Ⅱ-B期115例、Ⅱ-C期62例、Ⅲ-A期6例、Ⅲ-B期5例,参照百分法评价该术式的疗效. 结果 术后所有患者获得门诊随访,随访1 ～ 8(4.3±1.8)年.与手术前相比,术后关节疼痛、关节功能、关节活动度及X线表现较术前均有显著改善.各年龄段患者愈合时间总体比较差异有统计学意义(P＜0.05),随年龄的增长,愈合时间逐渐延长.与手术前相比,各期别患者术后评分均明显上升(P＜0.05).Ⅰ-C期、Ⅱ-A期、Ⅱ-B期、Ⅱ-C期、Ⅲ-A期、Ⅲ-B期的优良率分别为98.5％、98.0％、92.3％、89.7％、83.5％、81.3％,总体优良率为93.8％.结论 带股方肌蒂的骨瓣移植术是治疗成人股骨头坏死的一种有效手术方法,效果肯定.%Objective To analyze the clinical effect of the bone grafting pedicled with femoral quadratus for the osteonecrosis of femoral head.Methods The clinical operation data were analyzed from 355 patients with osteonecrosis of femoral head underwent by the surgery of the bone grafting pedicled with femoral quadrates in the First Affiliated Hospital of Zhengzhou University from August,2006 to June,2013.According to association research circulation osseous (ARCO) classifying,41,126,115,62,6 and 5 patients were in stage Ⅰ-C,Ⅱ-A,Ⅱ-B,Ⅱ-C,Ⅲ-A,and Ⅲ-B.The results were evaluated by the hundred forked method.Results All the patients obtained the outpatient followed-up after operation,the follow-up time was 1-8 (4.3 ± 1.8) years.The pain of the hip,the function of the joint,the motion of hip joint,and the X ray evaluation became better than preoperations.There were statistically significant differences in the healing time among all the age patients (P ＜ 0.05),along with the age growth,the healing time gradually extended.Compared with that before operation,the scores of all the stage patients after operation were higher (P ＜ 0.05).The rate of excellent and good results were 98.5％,98.0％,92.3％,89.7％,83.5％,81.3％ in stage Ⅰ-C,Ⅱ-A,Ⅱ-B,Ⅱ-C,Ⅲ-A,and Ⅲ-B,the excellent and good rate was 93.8％ of all the 355 patients.Conclusion Bone grafting pedicled with femoral quadratus is effective surgical method for the osteonecrosis of femoral head.