Zhao De-wei, Wang Wei-ming, Wang Ben-jie, Wang Tie-nan, Lu Jian-min, Guo Lin, Cui Xu, Yu Xiao-guang
Department of Orthopaedic, Zhongshan Hospital of Dalian University, Dalian 116001, China.
Zhonghua Wai Ke Za Zhi. 2005 Aug 15;43(16):1054-7.
To research on the conservative methods used to preserve the femoral head of patients with osteonecrosis of the femoral head.
In these series surgical procedures the osteonecrotic lesion was removed and various vascularized bone blocks or periosteal flaps with its nutrient vessels were transferred to regain sphericity of the femoral head and reinforce the sequestrum. The current study assessed 1005 patients (1226 hips) operated on from 1989 to 2002 with an average follow-up of 5.1 years (range, 1.5-15 years). The mean age of the patients was 37.4 years (range, 17-65 years).
Sixty-one hips (57 patients) had conversion surgery to a total hip arthroplasty because of progressive collapse or severe pain, or both. In the patients without failure, postoperative Harris hip score improved significantly. Of the 1174 reconstructions that were in situ, 1041 (89.4%) were clinically successful, and 878 (75.4%) were radiologically successful. In relation to the stage of necrosis according to the classification system of Ficat and Alert, good results were achieved in 95.3% of the patients with stages II disease, 87.9% with stages III and 60.8% with stages IV.
Conservative methods of vascularized bone block or periosteal flap transfer should be considered in active symptomatic patients to preserve the femoral head. In addition, the earlier the stages of the disease the better outcome could be obtained.
研究用于保留股骨头坏死患者股骨头的保守方法。
在这些系列手术中，切除骨坏死病灶，并转移各种带血管的骨块或带有滋养血管的骨膜瓣，以恢复股骨头的球形并加固死骨。本研究评估了1989年至2002年接受手术的1005例患者（1226髋），平均随访5.1年（范围1.5 - 15年）。患者的平均年龄为37.4岁（范围17 - 65岁）。
61髋（57例患者）因病情逐渐塌陷或剧痛或两者兼有而改行全髋关节置换术。在未出现失败的患者中，术后Harris髋关节评分显著改善。在1174例原位重建中，1041例（89.4%）临床成功，878例（75.4%）影像学成功。根据Ficat和Alert分类系统，就坏死分期而言，II期疾病患者95.3%取得良好结果，III期患者87.9%，IV期患者60.8%。
对于有症状的活跃期患者，应考虑采用带血管骨块或骨膜瓣转移的保守方法来保留股骨头。此外，疾病分期越早，预后越好。
