带血管蒂大转子或髂骨骨膜瓣移位修复股骨头缺血性坏死

背景：股骨头缺血性坏死从儿童到老年均有发病,虽然目前治疗方法较多,但如何根据患者年龄和分期进行治疗尚无定论。目的：根据不同年龄和分期采用不同方法治疗股骨头缺血性坏死患者,对获得随访结果进行回顾性分析。方法：自1998年10月至2008年10月,收治股骨头缺血性坏死患者共202例(242髋),根据年龄分组,儿童组(4-14岁)45例47髋,采用带血管蒂大转子或髂骨骨膜瓣移位术式;青壮年组(15-45岁)100例125髋,采用带血管蒂大转子或髂骨骨瓣移位术式;中老年组(46-81岁)57例70髋,采用混合型或非骨水泥型全髋关节置换。结果与结论：202例患者均得到随访,术后随访6个月-10年,平均6.3年。儿童组、青壮年组、中老年组优良率分别为87%,89%,86%,均获得满意的临床效果;青壮年组术后Harris评分提高至(88.1±0.9)分,目测类比评分降低至(0.9±0.4)分;中老年组术后Harris评分提高至(91.5±1.0)分,目测类比评分降低至(0.60±0.07)分。结果显示：带血管蒂大转子或髂骨骨膜瓣移位术较适用于儿童股骨头缺血性坏死患者;带血管蒂大转子或髂骨骨瓣移位术较适用于中青年股骨头缺血性坏死患者,尤其是15-45岁Ficat Ⅱ、Ⅲ期患者;混合型或非骨水泥型全髋关节置换适用于老年股骨头缺血性坏死患者及保头治疗失败患者。

Vascularized greater trochanter or iliac periosteal flap displacement repairs avascular necrosis of femoral head

BACKGROUND:Femoral head avascular necrosis is common in children and elderly. Though, there are many methods can be used for the treatment, it has been inconclusive in the treatment according to the age and stage of the patients. OBJECTIVE:To treat the femoral head avascular necrosis with different methods according to the age and stage, and to retrospectively analyze the follow-up results. METHODS: Totally 202 patients (242 hips) with femoral head avascular necrosis were included from October 1998 to October 2008. The patients were divided into groups according to age, included child group (4-14 years old, n=45, 47 hips); youth group (15-45 years old, n=100, 125 hips); and elderly group (46-81 years old, n=57,70 hips). The patients in the child group were treated with vascularized greater trochanter or iliac periosteal flap displacement, the patients in the youth group were treated with vascularized greater trochanter or iliac periosteal flap displacement, and the patients in the elderly group were treated with hybrid or cementless total hip arthroplasty. RESULTS AND CONCLUSION:All the 202 patients were followed-up for 6 months to 10 years, average 6.3 years. The excellent and good rate of the child group, youth group and elderly group were 87%, 89% and 86% respectively, and all the patients obtained the satisfactory clinical effect; the Harris score of the youth group was increased to (88.1±0.9) points, and the visual analog scale score was decreased to (0.9±0.4) points; the Harris score of the elderly group was increased to (91.5±1.0) points, and the visual analog scale score was decreased to (0.60±0.07) points. The results indicate that vascularized greater trochanter or iliac periosteal flap displacement is suitable for the children and the youths with femoral head avascular necrosis, especially the patients with the age of 15-45 years in Ficat Ⅱ and Ⅲ stage; hybrid or cementless total hip arthroplasty is suitable for the elder patients with femoral head avascular necrosis, as well as the patients with failure femoral head retention treatment.