摘要
目的研究带股方肌蒂骨瓣移植联合打压植骨内固定术治疗激素型与酒精型股骨头坏死的临床疗效差异。方法对笔者医院2009年3月~2016年3月采用带股方肌蒂骨瓣移植联合打压植骨内固定术治疗早期股骨头坏死患者进行临床随访研究,包括128例154髋,其中5例8髋失访,余123例146髋:激素型43例52髋,男性19例22髋,女性24例30髋,年龄22~34岁,酒精型80例94髋,均为男性患者,患者年龄28~57岁。ARCO分期,ⅡB^C期125髋,ⅢA期21髋。分别从术前、术后2年、术后5年股骨头是否塌陷和髋关节Harris评分进行疗效对比分析和评价。结果对于股骨头是否塌陷,术后2年酒精组优良率89.4%,激素组优良率84.6%,两者之间比较差异无统计学意义(P>0.05);术后5年酒精组优良率87.7%,激素组优良率80.8%,两者之间的差异有统计学意义(P<0.05);对于髋关节功能Harris评分:酒精组与激素组患者术前髋关节Harris评分比较差异无统计学意义(P>0.05)。术后2年两组患者髋关节Harris评分较术前均有明显提高,酒精组为89.00±2.75,激素组为86.00±2.37,酒精组高于激素组髋关节Harris评分,差异有统计学意义(P<0.05)。术后5年两组患者髋关节Harris评分酒精组为86.00±3.29,激素组为81.00±3.35,较术前均有明显提高,但与术后2年髋关节Harris评分比较,术后5年髋关节Harris评分均有所降低。术后5年酒精组髋关节Harris评分高于激素组髋关节Harris评分,差异有统计学意义(P<0.05)。结论由于激素型与酒精型股骨头坏死发病机制不同,坏死组织病理结构成分不同,修复方式不同,对于ARCOⅡB^C期,ⅢA期早期股骨头坏死患者,带股方肌蒂骨瓣移植联合打压植骨内固定术保髋治疗效果酒精型股骨头坏死优于激素型股骨头坏死型。
Objective To explore the clinical efficacy difference of Muscle pedicle bone flap transplantation with a party in the treatment between steroid-induced and alcohol-induced femoral head necrosis.Methods The Clinical follow-up study was performed from March 2009 to July 2016. Patients were steroid-induced or alcoholic femoral head necrosis subjects who were treated by Muscle pedicle bone flap transplantation with a party.Totally 128 cases with 154 hips enrolled, 5 cases with 8 hips lost to follow-up, 123 cases with 146 hips completed this study. 43 cases with 52 hips were steroid-induced, including 19 males with 22 hips and 24 females with 30 hips, among these,females all aged between 22 to 34. Besides, 80 cases with 94 hips were enrolled in alcohol-induced group. All of whom were males aged between 28 and 57. While ⅡB-C 125 hips, ⅢA 21 hip, grouped by ARCO stages. The comparisons conducted by 2 index according to Harris scores of the hip joint and collapse of the femoral head in the X-ray film, respectively assessed at three points, pre-operation, 2 years later and 5 years after the operation.Results For the collapse index, all patients were followed up in 2 years later visit and the distinguished achiever rate was 89.4% in alcohol-induced group and 84.6% in the steroid-induced group, no significant difference between the two groups（P〉0.05）; For 5 years later visit, the distinguished achiever rate was 87.7% in alcohol-induced group and 80.8% in the steroid-induced group, significant difference between the two groups（P〈0.05）. For the Harris score index, no significant difference between the two groups preoperative（P〉0.05）. This index was significantly improved on both groups at 2 years later assessment. The alcohol-induced group was 89.00±2.75 and the steroid-induced group was 86.00±2.37, with significant difference between the two groups（P〈0.05）. On 5 years later assessment, The alcohol-induced group was 86.00±3.29 and the steroid-induced group was 81.00±3.35, with significant difference between the two groups（P〈0.05）. Accordingly, 5 years later Harris score is obviously improved compared with preoperative, while less than 2 years postoperative assessment.Conclusion For ARCO ⅡB-C and ARCO ⅢA patients, the treatment of Muscle pedicle bone flap transplantation with a party can has a better effect on the alcohol-induced necrosis than that of the steroid-induced patients. It may due to the differences of pathogenesis, the repairing methods and the structure of histopathology.
出处
《医学研究杂志》
2017年第12期165-169,共5页
Journal of Medical Research
关键词
股骨头坏死
骨瓣移植术
保髋治疗
随访研究
Femoral head necrosis
Bone flap transplantation
Hip-preservation treatment
Follow-up study
