Baksi D P
Department of Orthopaedic Surgery, Medical College and Hospitals, Calcutta, India.
J Bone Joint Surg Br. 1991 Mar;73(2):241-5. doi: 10.1302/0301-620X.73B2.2005147.
Sixty-one patients with 68 osteonecrotic femoral heads, at different stages of development, were treated surgically; their average age was 36 years. Necrosis followed a fracture in 43 hips and traumatic dislocation in three. It was idiopathic in 14, cortisone-induced in seven and associated with gout in one. The operation of multiple drilling, curettage of the necrotic bone and muscle pedicle bone grafting was performed in all. Cheilectomy of the superolateral part of the femoral head and adductor tenotomy were added in cases of advanced necrosis. Of the several types of muscle pedicle used, tensor fasciae latae anteriorly and quadratus femoris posteriorly were preferred. Full weight-bearing was not permitted for five to six months. The follow-up period varied from three to 12 years. Hip pain was regularly relieved and abduction and rotation of the joints were improved. Those with post-traumatic or idiopathic necrosis did better than those with cortisone-induced necrosis.
61例患有68个股骨头坏死的患者，处于不同的发展阶段，接受了手术治疗；他们的平均年龄为36岁。43个股骨头坏死继发于骨折，3个股骨头坏死继发于创伤性脱位。14个股骨头坏死为特发性，7个股骨头坏死由皮质激素引起，1个股骨头坏死与痛风相关。所有患者均接受了多处钻孔、坏死骨刮除及带肌蒂骨移植手术。对于晚期坏死患者，加做股骨头外上部分的唇状切除术及内收肌切断术。在使用的几种肌蒂类型中，优先选择阔筋膜张肌作为前侧肌蒂，股方肌作为后侧肌蒂。术后五到六个月内不允许完全负重。随访期为3至12年。髋部疼痛经常得到缓解，关节的外展和旋转功能得到改善。创伤后或特发性坏死患者的治疗效果优于皮质激素引起的坏死患者。
