股骨头髓心减压加异体腓骨移植术治疗股骨头坏死

目的探讨股骨头髓心减压加异体腓骨移植术治疗早期股骨头缺血性坏死的疗效。方法1998年6月～2004年8月，采用股骨头髓心减压加异体腓骨移植术治疗Ⅰ～Ⅲ期股骨头缺血性坏死22例39髋，其中男17例，女5例。年龄22～60岁。术前疼痛时间2～12个月，平均6、5个月。所有患者于术前及术后15d，3个月和6个月行双髋关节功能、常规X线片、ECT、CT和MRI检查。结果患者均获随访3～74个月，平均31．4个月。17例临床症状缓解明显，Harris评分从术前平均78分升至术后91．6分。18例X线片显示髋关节形态基本保持完好，无明显坏死进展。ECT、CT和MRI检查均见植骨成骨征象。有2例4髋于1年半后改行人工全髋关节置换术。另有3例4髋症状有所加重，但未行人工关节置换术。结论股骨头髓心减压加异体腓骨移植术治疗早期股骨头缺血性坏死，手术损伤小，术后关节功能2～4周即可恢复或超过术前水平，临床症状改善。其短期疗效肯定，中长期疗效仍需进一步观察。

SURGICAL TREATMENT OF NECROSIS OF THE FEMORAL HEAD IN EARLY STAGES WITH CORE DEPRESSION AND ALLO-FIBULAR GRAFTING

OBJECTIVE: To study the effect of surgical treatment with core depression and allo-fibular grafting on osteonecrosis of the femoral head in early stages. METHODS: From June 1998 to August 2004, 22 patients with necrosis of the femoral head (39 hips) were treated with core depression and allo-fibular grafting, indluding 17 males and 5 females. Necrosis was classified as Stages I - III according to ARCO classification system. Their ages ranged from 22 to 60 years and pain duration was 2 to 12 months preoperatively (6.5 months on average). The regular examinations of joint function, X-ray, ECT,CT and MRI were conducted before surgerg and after 15 days, 3 months, and 6 months of surgery. RESULTS: All patients were followed up for 3 to 74 months (31.4 months on average). Symptoms 17 of the patients were relieved evidently. Harris hip score from 78 points preoperatively to 91.6 points. The X-ray films 18 of the patients showed that the geography of the hip joint kept intact with no deterioration. Osteogenesis was observed by regular examinations. Two cases (4 hips, 10.25%) were revised by total hip replacement, and 3 cases (4 hips, 10.25%) without THR worsened postoperatively. CONCLUSION: The method is less traumatic than common procedures. The joint function can be recovered within 2-4 weeks. Clinical symptoms are greatly improved. This method is effective at least in short term and the long-term effect needs further study.