Scully S P, Aaron R K, Urbaniak J R
Duke University Medical Center, Durham, North Carolina 27710, USA.
J Bone Joint Surg Am. 1998 Sep;80(9):1270-5. doi: 10.2106/00004623-199809000-00004.
Avascular necrosis of the femoral head is a multifaceted process that leads to articular incongruity and subsequent osteoarthrosis of the joint. Clinicians concur that primary treatment should focus on preservation of the natural surface of the joint; however, there has not been a consensus on how best to accomplish this. While a number of therapeutic interventions have been reported, the efficacy has varied markedly and there have been few statistical comparisons. The purpose of the current study was to use statistical analysis to compare the results of two widely used procedures, vascularized fibular grafting (614 hips; 480 patients) and core decompression (ninety-eight hips; seventy-two patients), for the treatment of avascular necrosis. The patients were stratified according to age and the stage of disease, and a survival analysis was performed with total hip arthroplasty as the end point for failure. None of the eleven hips that had Ficat stage-I disease needed a total joint replacement after being treated with either regimen. Analysis of the hips that had stage-II disease revealed rates of survival, at fifty months, of 65 per cent (twenty-eight of forty-three hips) after core decompression and 89 per cent (ninety-nine of 111 hips) after vascularized fibular grafting. For the hips that had Ficat stage-III disease, the rates of survival at fifty months were 21 per cent (ten of forty-seven hips) after core decompression and 81 per cent (405 of 500 hips) after vascularized fibular grafting. Among the hips that had Ficat stage-II or III disease, the rate of eventual total joint arthroplasty after vascularized fibular grafting was significantly lower than that after core decompression (p < 0.0001). The results indicate that the increased morbidity associated with vascularized fibular grafting is justified by the associated delay in or prevention of articular collapse in hips that have stage-II or III disease.
股骨头缺血性坏死是一个多方面的过程，会导致关节面不协调以及随后的关节骨关节炎。临床医生一致认为，主要治疗应侧重于保留关节的自然表面；然而，对于如何最好地实现这一点尚未达成共识。虽然已经报道了多种治疗干预措施，但其疗效差异显著，且很少有统计学比较。本研究的目的是使用统计分析来比较两种广泛使用的手术方法，即带血管蒂腓骨移植术（614髋；480例患者）和髓芯减压术（98髋；72例患者）治疗股骨头缺血性坏死的结果。患者根据年龄和疾病阶段进行分层，并以全髋关节置换术作为失败的终点进行生存分析。接受任何一种治疗方案后，11例处于Ficat I期疾病的髋关节均无需进行全关节置换。对处于II期疾病的髋关节分析显示，髓芯减压术后50个月的生存率为65%（43髋中的28髋），带血管蒂腓骨移植术后为89%（111髋中的99髋）。对于处于Ficat III期疾病的髋关节，髓芯减压术后50个月的生存率为21%（47髋中的10髋），带血管蒂腓骨移植术后为81%（500髋中的405髋）。在处于Ficat II期或III期疾病的髋关节中，带血管蒂腓骨移植术后最终进行全关节置换的比例显著低于髓芯减压术后（p < 0.0001）。结果表明，对于处于II期或III期疾病的髋关节，带血管蒂腓骨移植术相关的发病率增加是合理的，因为它可以延迟或预防关节塌陷。
