股方肌蒂骨柱加钛网伞状支撑术治疗非创伤性股骨头坏死的初步临床观察

目的 探讨股方肌蒂骨柱加钛网伞状支撑术治疗非创伤性股骨头坏死(osteonecrosis of the femoral head,ONFH)的初步临床效果.方法 2008年1月至2009年6月,设计应用股方肌蒂骨柱加钛网伞状支撑术治疗非创伤性ONFH 16例(20髋),年龄21-46岁,平均30.4岁.激素性ONFH 2例 (4髋),酒精性ONFH 14例(16髋).ARCO Ⅱ B期4髋,ⅡC期14髋,ⅢA期2髋.手术时彻底清除股骨头内坏死骨,取大小合适的钛网支撑于原ONFH的软骨下,将带股方肌蒂骨柱套入合适长度、直径1.6 cm的圆柱状钛网中,将此骨柱-钛网复合体植入股骨头内嵌紧.术后定期随访并参照百分法进行疗效评价.结果 手术时间130-190 min,平均155 min;手术出血量300-600 ml,平均420 ml.术后患者无深静脉血栓发生.患者术后均获随访,随访时间3-15个月,平均12.1个月.患者术后4个月左右开始负重行走.所有患者髋关节疼痛和关节功能明显改善.术后3-4个月X线片示植骨愈合良好,18髋股骨头高度保持良好,2髋股骨头高度降低,其中1髋与过早负重有关.结论 股方肌蒂骨柱加钛网伞状支撑术治疗ARCO Ⅱ C和ⅢA期非创伤性ONFH的近期效果良好,远期疗效有待进一步观察.

Clinical observation of deliquesce strut with titanium web and cage containing bone grafting pedicled with femoral quadratus to treat non-traumatic osteonecrosis of the femoral head

objective To investigate the clinical outcome for the treatment of nontraumatic os-teonecrosis of the femoral head (ONFH) by a technique of deliquesce strut with titanium web and cage con-taining bone grafting pedicled with femoral quadratus.Methods Sixteen adult patients (20 hips) suffered from non-traumatic ONFH underwent the surgery of the deliquesce strut with titanium web and cage contain-ing bone grafting pedicled with femoral quadratus from January 2008 to June 2009.The mean age was 30.4 years (21-46).The steroid-induced ONFH was in 2 patients (4 hips),alcohol-induced ONFH in 14 patients (16 hips).According to Association Research Circulation Osseous (ARCO) classification,4,14 and 2 hips were in stage ⅡB,ⅡC and ⅢA.respectively.The results were followed and evaluated by the method of hundred percent score.Results The mean operation time was 155 minutes.The mean blood loss was 420 ml.All the wounds healed uneventfully.Anticoagulation medicine was not routinely used,and no deep vein thrombus (DVT) occurred.All patients were followed for an average time of 12.1 months (range,3 to 15 months).Weight-bearing was permitted 4 months postoperatively.Pain disappeared or significantly improved in all hips with hip function improved greatly.Bong-grafting healing was noted 3 to 4 months postoperatively.The normal height of the femoral head was maintained in 18 hips.Collapse occurred in 2 hips.There were resuits of excellent in 16 hips and better in 4 hips in this group.Conclusion For non-traumatic ONFH in stage ARCO ⅡC or ⅢA,satisfactory clinical outcome can be achieved by the new technique in the short-term period,the long-term clinical outcome has yet to be observed.