Zhang Leilei, Fan Yanan, Zhang Ying, Chen Xiantao, Liu Youwen
Luoyang Orthopedic Hospital of Henan Province, Orthopedics Hospital of Henan Province, Luoyang, PR China.
Luoyang Orthopedic Hospital of Henan Province, Orthopedics Hospital of Henan Province, Luoyang, PR China.
Acta Orthop Traumatol Turc. 2019 Jul;53(4):255-259. doi: 10.1016/j.aott.2019.04.005. Epub 2019 Apr 26.
The aim of this study was to retrospectively compare and evaluate the midterm curative effect of two different bone flap grafts in the treatment of early non-traumatic osteonecrosis of the femoral head (ONFH).
A total of 180 patients (199 hips) with early non-traumatic ONFH received surgical treatment by sartorius muscle-pedicle bone flap graft (SMBF) (104 patients, 64 males and 40 females; mean age 34.67 ± 3.24 years) or circumflex iliac deep bone flap graft (CIDBF) (76 patients, 44 males and 32 females; mean age: 35.54 ± 3.37 years) from July 2004 to July 2009. The comparison between the groups was made with Harris score before and after surgery, length of incision, operative time, amount of bleeding, postoperative X-ray. Association Research Circulation Osseous (ARCO) staging was performed.
The preoperative Harris hip score of two groups were 68.26 ± 1.26 and 69.35 ± 1.31, respectively. Patients' ARCO staging indicated 36 hips of stage IIa, 115 hips of stage IIb and 48 hips of stage IIc. The etiology of ONFH mainly including hormones (93 patients), alcohol (64 patients) and other (23 patients). The mean follow-up time of SMBF and CIDBF groups were (51.78 ± 2.35) and (52.73 ± 3.71) months, respectively. The time of removing sutures, operation time, amount of bleeding and length of incision in SMBF group were superior to those in the CIDBF group, and those differences between the SMBF and CIDBF groups were not significant (all p values > 0.28). The Harris score between the two groups was similar after operation and postoperative 12 month, and the difference was not statistically significant (p > 0.05), whereas the difference of the postoperative 24 and 48 months was statistically significant (p ˂ 0.05). X-ray analysis showed improvement of osteonecrosis in both two groups after surgery, and as time went on, the total hip amount decreased, the replacement amount increased.
Both bone flap grafts appear to be effective methods for treatment of early osteonecrosis of femoral head (ARCOⅡ), and the SMBF is a relatively simple technique and easy for mastering, and it is a reliable method for clinical application.
Level III, Therapeutic Study.
本研究旨在回顾性比较和评估两种不同骨瓣移植治疗早期非创伤性股骨头坏死（ONFH）的中期疗效。
2004年7月至2009年7月，共有180例（199髋）早期非创伤性ONFH患者接受了缝匠肌蒂骨瓣移植（SMBF）（104例，男64例，女40例；平均年龄34.67±3.24岁）或旋髂深骨瓣移植（CIDBF）（76例，男44例，女32例；平均年龄：35.54±3.37岁）手术治疗。通过手术前后的Harris评分、切口长度、手术时间、出血量、术后X线进行组间比较。进行了骨循环协会（ARCO）分期。
两组术前Harris髋关节评分为分别为68.26±1.26和69.35±1.31。患者的ARCO分期显示IIa期36髋，IIb期115髋，IIc期48髋。ONFH的病因主要包括激素（93例）、酒精（64例）和其他（23例）。SMBF组和CIDBF组的平均随访时间分别为（51.78±2.35）和（52.73±3.71）个月。SMBF组的拆线时间、手术时间、出血量和切口长度均优于CIDBF组，SMBF组和CIDBF组之间的差异无统计学意义（所有p值>0.28）。两组术后及术后12个月的Harris评分相似，差异无统计学意义（p>0.05），而术后24个月和48个月的差异有统计学意义（p<0.05）。X线分析显示两组术后骨坏死均有改善，且随着时间的推移，全髋量减少，置换量增加。
两种骨瓣移植似乎都是治疗早期股骨头坏死（ARCOⅡ）的有效方法，且SMBF技术相对简单，易于掌握，是一种可靠的临床应用方法。
三级，治疗性研究。
