游离髂骨瓣联合带血管蒂大转子骨瓣移植对中青年ARCO III期 股骨头坏死患者的保髋作用

BACKGROUND: Free iliac flap combined with or without vascularised greater trochanter bone grafting is adopted in the treatment of young and middle-aged patients with non-traumatic ARCO III necrosis of the femoral head. However, the efficacy of these two operation treatments is still unclear.OBJECTIVE: To compare the clinical outcomes of free iliac flap combined with or without vascularised greater trochanter bone graft in young and middle-aged patients with ARCO III necrosis of the femoral head.METHODS: Those ARCO III necrosis of the femoral head patients aged 18-45 years who were treated with free iliac flap combined with vascularised greater trochanter bone graft(group A) or with free iliac flap(group B) from January 2009 to November 2013 at the First Affiliated Hospital of Guangzhou University of Chinese Medicine were included in this study. All patients signed the informed consents and the study was approved by the ethics committee of the hospital. The incision length, hospitalization time, operation time and blood loss were recorded.The Harris scores and Visual Analogue Scale scores at baseline and end of follow-up in ARCO III subtypes were compared. The good and excellent rate of hip joint and hip preserving rate were calculated.RESULTS AND CONCLUSION:(1) A total of 71 patients(group A 37 patients with 42 hips; group B 34 patients with 38 hips) were included.The follow-up time was 3.5-7 years.(2) The operation time and intraoperative blood loss in the group A were significantly higher than those in the group B(P < 0.05).(3) The Harris scores and Visual Analogue Scale scores were improved significantly after surgery in ARCO III subtypes of two groups. The Harris scores and Visual Analogue Scale scores in the group A were significantly superior to group B in necrosis of the femoral head patients with ARCO III b and c(P < 0.05). The Harris scores and Visual Analogue Scale scores had no significant difference between two groups in necrosis of the femoral head patients with ARCO III a(P > 0.05).(4) The hip preserving rate in the groups A and B was 91% and 74%(Z=3.9, P < 0.05), respectively. According to the result of Harris scores, the good and excellent rate of hip joint in the groups A and B was 82% and 75%, respectively.(5) There were no serious complications after surgery.(6) These results imply that free iliac flap combined with or without vascularised greater trochanter bone grafting is an effective treatment method for young and middle-aged patients with ARCO III necrosis of the femoral head. They can effectively improve the hip joint function and release joint pain. However, free iliac flap combined with vascularised greater trochanter bone grafting can achieve good clinical outcomes in young and middle-aged patients with ARCO III b and c necrosis of the femoral head. [ABSTRACT FROM AUTHOR]