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华西医学  2015 

腓骨移植治疗不同股骨头坏死面积患者的随访研究

DOI: 10.7507/1002-0179.20150412, PP. 1430-1434

Keywords: 股骨头缺血坏死,同种异体腓骨移植,坏死面积

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Abstract:

目的?回顾性分析钻孔减压结合同种异体腓骨移植术治疗塌陷前期股骨头缺血性坏死的前中期临床效果,重点对比不同股骨头塌陷面积患者的预后。方法?收集2010年1月-2011年12月诊断为股骨头缺血坏死FicatⅡ期,并接受了股骨头髓芯钻孔减压、不吻合血管的同种异体腓骨移植术的住院患者59例(59髋),其中54例(54髋)得到随访,失访5例。其中男47例,女7例,年龄28~53岁。根据2001年股骨头坏死诊断、分型及分期修正标准,对患者股骨头坏死面积进行评估并分为3组A型6髋,B型37髋,C型11髋。术前及术后均对患者行X线检查、Harris功能评分、患髋活动度测量及视觉模拟疼痛评分。平均随访时间40.1个月。结果?术后X线检查结果显示54髋同种异体腓骨位置均良好,腓骨顶端均位于股骨头负重区,无腓骨脱出、骨折或感染,腓骨周围有骨质长入。6例患者股骨头发生塌陷,均为术前坏死面积C型患者,A型及B型患者未见股骨头塌陷。3组患髋术后Harris评分与术前相比均有改善,差异有统计学意义(P<0.05),但C组术后Harris评分明显低于A、B两组(P<0.01)。发生股骨头塌陷的患者,Harris评分与术前均低,差异无统计学意义(P>0.05)。A、B型患髋术后活动度同术前相似,疼痛均有明显缓解;C型患髋术后活动度较术前有所下降,疼痛程度反而加重。结论?股骨头髓芯钻孔减压结合同种异体腓骨移植术前中期治疗效果总体良好,但在C型患者中股骨头塌陷风险较A、B两型明显升高,治疗效果欠佳。因此此类手术更适用于股骨头坏死面积分型为A、B型的患者。

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