非创伤性股骨头坏死69例83髋：带血管蒂臀中肌骨瓣移植复合骨形态发生蛋白和自体松质骨的修复

背景：目前成人股骨头非创伤性坏死的治疗方法较多，但远期疗效大多不肯定。 目的：观察带血管蒂臀中肌骨瓣移植复合骨形态发生蛋白和自体松质骨治疗非创伤性股骨头坏死的临床效果。 方法：采用彻底刮除病灶死骨、骨形态发生蛋白混合自体松质骨加带血管蒂的臀中肌骨瓣移植治疗非创伤性股骨头坏死69例83髋。股骨颈部的缺损用取自大转子的臀中肌骨瓣嵌入，不作内固定。治疗后定期复查髋正位X射线片。 结果与结论：患者随访12~120个月，患者治疗后的髋关节疼痛明显缓解或消失，关节活动度改善。根据中华医学会推荐的100分评分法进行评价，优48髋(58%)，良27髋(33%)，可6髋(7%)，差2髋(2%)，优良率为90%。提示带血管蒂的臀中肌骨瓣移植复合骨形态发生蛋白和自体松质骨治疗非创伤性股骨头坏死创伤小，能促进坏死骨修复。但远期疗效尚待进一步观察。

Efficacy of gluteus medius bone grafting with vascular pedicle combined with bone morphogenetic protein and autogenous cancellous bone for non-traumatic osteonecrosis of the femoral head in 69 cases with 83 hips

BACKGROUND: Currently, there are many methods for treatment of adult non-invasive femoral head necrosis, but their long-term efficacy is not sure. OBJECTIVE: To evaluate the clinical efficacy of gluteus medius bone grafting with vascular pedicle combined with bone morphogenetic protein and autogenous cancellous bone for non-traumatic osteonecrosis of the femoral head. METHODS: Sixty-nine patients (83 hips) with non-traumatic osteonecrosis of the femoral head underwent thorough curettage and gluteus medius bone grafting with vascular pedicle combined with bone morphogenetic protein and autogenous cancellous bone. Defects in the femoral neck were implanted with gluteal muscle flap from the greater trochanter without fixation. After treatment, anteroposterior X-ray films of the hip were regularly reviewed. RESULTS AND CONCLUSION: All the patients were followed up successfully for 12-120 months (average 48 months). The pain of the hip in all patients disappeared or mostly relieved after the operation. The motion of hip joint became better. According to the score of 100 points recommended by Chinese Medical Association, the surgical outcomes were excellent in 48 hips (58%), good in 27 hips (33%), fair in 6 hips (7%), and poor in 2 hips (2%). The good rate was 90%. The gluteus medius bone grafting with vascular pedicle combined with bone morphogenetic protein and autogenous cancellous bone for non-traumatic osteonecrosis of the femoral head can obtain mini-trauma, better recovery of necrotic bone and excellent clinical results. However, the long-term effects need further studies.