Chen Chun-Chieh, Lin Chun-Li, Chen Wei-Chih, Shih Hsin-Nung, Ueng Steve W N, Lee Mel S
Department of Orthopaedic Surgery, Chang Gung Memorial Hospital, 5, Fu-Hsin Street, Kweishan, Taoyuan, Taiwan 333, Republic of China.
J Bone Joint Surg Am. 2009 Oct;91(10):2390-4. doi: 10.2106/JBJS.H.01814.
Vascularized iliac bone-grafting has been reported to be successful for patients with osteonecrosis of the femoral head. However, its benefit in patients with segmental collapse of the femoral head has not been determined. The purpose of this study was to analyze the results of vascularized iliac grafting in osteonecrotic femoral heads with segmental collapse.
We retrospectively analyzed thirty-three hips in thirty-two patients in whom an osteonecrotic femoral head with segmental collapse (Association Research Circulation Osseous [ARCO] stage IIIA [<2-mm collapse] or stage IIIB [2 to 4-mm collapse]) had been treated with vascularized iliac bone-grafting between 1994 and 1999. The average age of the patients at the time of surgery was thirty-seven years. Twenty-six patients (twenty-seven hips) overused alcohol, five patients (five hips) had no known risk factor, and one patient (one hip) used corticosteroids for refractory bronchial asthma. Clinical outcomes were evaluated with the Harris hip score. We defined clinical failure as conversion to total hip replacement for any reason and radiographic failure as progressive femoral head collapse or secondary osteoarthritis of the involved hip.
At the conclusion of the study, only eight (24%) of the thirty-three hips were preserved. The mean survival time for the series as a whole was seventy-four months (95% confidence interval, fifty-four to ninety-five months) after the surgery. Eighteen of the twenty-six ARCO stage-IIIA hips were converted to a total hip replacement, and the mean survival time for the stage-IIIA hips was eighty-five months (95% confidence interval, sixty-one to 108 months). All of the seven ARCO stage-IIIB hips were converted to a total hip replacement, and the mean survival time for the stage-IIIB hips was thirty-five months (95% confidence interval, eleven to fifty-eight months). The mean Harris hip score for the eight hips that still survived at the time of follow-up had improved from 62 points to 80 points. However, all of them had progressive collapse of the femoral head-i.e., radiographic failure-at the time of final follow-up.
Vascularized iliac bone-grafting with use of the technique described in this study is not indicated for the treatment of osteonecrotic femoral heads with segmental collapse.
据报道，带血管蒂髂骨移植术对股骨头坏死患者治疗成功。然而，其对股骨头节段性塌陷患者的益处尚未确定。本研究的目的是分析带血管蒂髂骨移植术治疗股骨头节段性塌陷坏死的结果。
我们回顾性分析了1994年至1999年间32例患者的33髋，这些患者均为股骨头节段性塌陷坏死（骨循环研究协会[ARCO]分期IIIA期[塌陷<2mm]或IIIB期[塌陷2至4mm]）并接受了带血管蒂髂骨移植术。手术时患者的平均年龄为37岁。26例患者（27髋）过度饮酒，5例患者（5髋）无已知危险因素，1例患者（1髋）因难治性支气管哮喘使用皮质类固醇。临床疗效采用Harris髋关节评分进行评估。我们将因任何原因行全髋关节置换术定义为临床失败，将股骨头进行性塌陷或患髋继发性骨关节炎定义为影像学失败。
在研究结束时，33髋中仅8髋（24%）得以保留。整个系列手术后的平均生存时间为74个月（95%可信区间，54至95个月）。26例ARCO IIIA期髋中的18髋接受了全髋关节置换术，IIIA期髋的平均生存时间为85个月（95%可信区间，61至108个月）。7例ARCO IIIB期髋均接受了全髋关节置换术，IIIB期髋的平均生存时间为35个月（95%可信区间，11至58个月）。随访时仍存活的8髋的Harris髋关节评分平均从62分提高到了80分。然而，在最后随访时，所有这些髋均出现了股骨头进行性塌陷，即影像学失败。
采用本研究中描述的技术进行带血管蒂髂骨移植术并不适用于治疗股骨头节段性塌陷坏死。
