钽棒植入与骨瓣移植治疗成年人早期股骨头坏死的近期疗效对比
| 作者: |
1高俊峰
1 衡水市第四人民医院手足外科，河北 衡水 053000 |
| 通讯: |
高俊峰
Email: gaojunfengjf@sina.com |
| DOI: | 10.3978/j.issn.2095-6959.2017.01.004 |
| 基金: | 衡水市科技局科技术与发展指导计划课题, 13031Z |
摘要
目的：比较髓芯减压联合金属钽棒植入术与带血管蒂髂骨瓣转移术治疗成年早期股骨头坏死(osteonecrosis of the femoral head，ONFH)的近期临床疗效。方法：回顾性收集本院2012年1月至2015年2月间收治的83例(97髋)非创伤性ONFH患者病历资料，A组43例52髋行髓芯减压并钽棒植入术，B组40例47髋，行自身带血管蒂髂骨瓣转移术，术后随访1年，比较两组手术参数指标、术后1年Harris髋关节功能评分及手术疗效。结果：A组手术时间(40.7±10.3) min、术中失血量(88.0±27.1) mL、术后镇痛泵应用时间(1.68±0.32) d、拆线天数(12.8±1.5) d均显著低于B组[(82.5±17.2) min，(239.4±45.2) mL，(2.15±0.48) d，(14.2±1.9) d；P<0.05]。两组术后12个月Harris总评分及各项目评分均较术前显著提高(P<0.05)，A组术后Harris总评分(88.4±5.9)及关节功能评分(41.5±4.8)均显著高于B组[(83.6±5.3)，(37.5±6.1)；P<0.05]。两组术后12个月髋关节功能优良率均较术前显著提高(P<0.05)，A组术后12个月优良率(92.3%)显著高于B组(76.6%，P<0.05)。B组有1例出现髓塌陷，A组无髓塌陷病例。结论：髓芯减压联合金属钽棒植入术较带血管蒂髂骨瓣转移术治疗早期ONFH手术操作相对简单，近期疗效更为明显。
关键词：
股骨头坏死
钽棒植入术
带血管蒂髂骨瓣转移术
Harris髋关节评分
股骨头塌陷
Comparison of the short-term efficacy between tantalum rod implantation and bone flap transplantation in the treatment of early osteonecrosis of the femoral head
CorrespondingAuthor: GAO Junfeng Email: gaojunfengjf@sina.com
DOI: 10.3978/j.issn.2095-6959.2017.01.004
Abstract
Objective: To compare the short-term clinical efficacy between the medullary core decompression combined with tantalum rod implantation and vascular pedicled iliac bone flap transplantation in the treatment of early stage of osteonecrosis of the femoral head (ONFH) of the young and middle-aged patients. Methods: Eighty-three cases (97 hips) with non-traumatic ONFH patients of January 2012 to February 2015 in our hospital were collected retrospectively, of which 43 cases (52 hip) were conducted with medullary core decompression and tantalum rod implantation, classified as group A, 40 patients (47 hips) with vascular pedicled iliac bone flap transplantation, and classified as group B, 1-year follow-up was conducted after operation; operation parameters, postoperative 1-year Harris hip joint score and surgical efficacy of the two groups were compared. Results: Operation time (40.7±10.3) min, intraoperative blood loss (88.0±27.1) mL, postoperative analgesia pump application time (1.68±0.32) d, stitches removal time (12.8±1.5) d in group A were all significantly lower than those in group B [(82.5±17.2) min, (239.4±45.2) mL, (2.15±0.48) d, (14.2±1.9) d; P<0.05]. Total Harris hip joint score and each item score of the two groups at 12-month postoperation increased significantly compared with the preoperation scores (P<0.05), group A whose postoperative Harris hip score (88.4±5.9) and sub index joint function score (41.5±4.8) were significantly higher than those of group B (83.6±5.3, 37.5±6.1; P<0.05). The excellent and good ratio of hip function of the two groups at 12-month post-operation were significantly higher than those in the pre-operation (P<0.05). The excellent and good ratio in group A (92.3%) at 12-month postoperation was significantly higher than those in group B (76.6%, P<0.05). In group B, there was 1 case with femoral head collapse, and there was no such case in group A. Conclusion: Compared with vascular pedicled iliac bone flap transplantation, medullary core decompression combined with tantalum rod implantation for treatment of early ONFH has the advantages of simple operation and far superior short-term efficacy.