Feng C K, Yu J K, Chang M C, Chen T H, Lo W H
Department of Orthopedics and Traumatology, Veterans General Hospital-Taipei, Taiwan, ROC.
Zhonghua Yi Xue Za Zhi (Taipei). 1998 Aug;61(8):463-9.
Nontraumatic avascular necrosis of the femoral head (ANFH) is a common disorder causing disability of the hip joint. The means for optimally treating this disease are still controversial. In this study we evaluated the relatively new technique of vascularized iliac bone grafting for treating ANFH.
From March 1990 to March 1992, 17 hips (15 patients) with ANFH were treated using the vascularized iliac bone grafting technique in our hospital. The patients included 12 men and three women, with an average age of 38 years. Steinberg's classification was used to categorize the severity of hip disease. The clinical results were classified as excellent, good, fair and poor according to symptoms, hip function and roentgenographic changes after surgery. Life-table analysis was applied to assess graft survival and the log rank test was used to compare statistical differences between the steroid-related and nonsteroid-related groups.
Cumulatively, 16 hips (14 patients), excluding one patient (one hip) lost to follow-up, were clinically evaluated for an average of 68 months. Among 12 hips at Steinberg stage II, eight progressed to stage IV, three to stage III and only one remained at stage II. Although most hips at stage II showed mild to moderate disease progression on plain radiography, 58% of the hips (7/12) that progressed to less than IVb showed good to excellent results. In the three hips at stage III, one progressed to stage IVa and two to stage V. In the two hips at stage IV, one remained at stage IV at final follow-up and the other was lost to follow-up. The steroid-related and nonsteroid-related groups did not differ with respect to clinical results. Both groups had 63% (5/8) good to excellent results (p > 0.05, log rank test). Only four hips were converted to prosthetic arthroplasties at final follow-up. Overall, 63% (10/16) of the hips had good to excellent results, 12% had fair results and 25% had poor results. Graft survival after seven years of follow-up was 63%.
While treatment of ANFH still poses a challenge to orthopedic surgeons, the vascularized iliac bone grafting technique is a clinically acceptable option for treating the early stages of ANFH.
非创伤性股骨头缺血性坏死（ANFH）是导致髋关节残疾的常见病症。治疗该疾病的最佳方法仍存在争议。在本研究中，我们评估了带血管蒂髂骨移植治疗ANFH这种相对较新的技术。
1990年3月至1992年3月，我院采用带血管蒂髂骨移植技术治疗了17例（15名患者）ANFH患者。患者包括12名男性和3名女性，平均年龄38岁。采用斯坦伯格分类法对髋关节疾病的严重程度进行分类。根据术后症状、髋关节功能及X线变化，将临床结果分为优、良、中、差。应用寿命表分析评估移植骨的存活情况，并采用对数秩检验比较类固醇相关组和非类固醇相关组之间的统计学差异。
累计对16例患者（16髋）进行了临床评估，平均随访68个月，排除1例失访患者（1髋）。斯坦伯格II期的12髋中，8髋进展至IV期，3髋进展至III期，仅1髋仍处于II期。虽然II期的大多数髋关节在X线平片上显示轻度至中度疾病进展，但进展至IVb期以下的髋关节中，58%（7/12）的结果为良至优。III期的3髋中，1髋进展至IVa期，2髋进展至V期。IV期的2髋中，1髋在末次随访时仍处于IV期，另1髋失访。类固醇相关组和非类固醇相关组的临床结果无差异。两组的优良率均为63%（5/8）（p>0.05，对数秩检验）。末次随访时仅4髋改行人工关节置换术。总体而言，63%（10/16）的髋关节结果为良至优，12%为中，25%为差。随访7年后移植骨存活率为63%。
虽然ANFH的治疗对骨科医生来说仍然是一项挑战，但带血管蒂髂骨移植技术是治疗早期ANFH临床上可接受的选择。
