背景:髋骨坏死被定义为由于某种形式的血管损伤引起的骨组织坏死,随后导致股骨头塌陷和继发性骨关节炎,导致疼痛和关节功能受损。众所周知,这种疾病会影响中年群体;然而,在印度人口中,甚至更年轻的人更容易受到影响。该疾病对日常生活活动(ADL)和个人生产力具有衰弱作用,并具有经济后果。随着磁共振成像(MRI)在社会中的应用越来越广泛,这种疾病在早期被诊断出来。应给予保留髋关节的手术,例如张肌筋膜(TFL)肌肉椎弓根髂骨移植,以保留天然股骨头。
方法:在Gorakhpur的三级护理教学医院,印度,进行了一项观察性临床研究.这项研究包括40名患者,年龄18-50岁,股骨头坏死(Ficat-Arlet分期系统的II期和III期),他来到我们研究所的骨科门诊部。患者接受多次钻孔治疗,刮宫,股骨头唇裂切除术,除TFL肌蒂植骨。Harris髋关节评分(HHS)用于评估临床结果,放射学评估的重点是血运重建的迹象。
结果:在我们的研究中,最普遍的年龄组是20-30岁(67.5%),男性占主导地位(85%)。在我们的40名患者中,HHS在14例(35%)中显示出优异的结果(90-100),19例(47.5%)的良好结果(80-89),6例(15%)的公平结果(70-79),在一个案例中(2.5%)效果不佳(<70),在最后的后续行动时。最后的随访期从1年到10年不等。
结论:TFL肌蒂植骨手术提供了极好的临床和放射学结果,尤其是在年轻患者中,股骨头保留手术优于全髋关节置换术。该手术在早期和晚期股骨头坏死中均有效,如果没有关节炎的变化。它可以减轻症状并改善功能结果。
BACKGROUND: Osteonecrosis of the hip is defined as necrosis of the bone tissue due to some form of vascular insult, subsequently leading to the collapse of the femoral head and secondary osteoarthritis, which leads to pain and impaired joint function. This disease is widely known to affect middle-aged groups; however, in the Indian population, even younger people are more commonly affected. The disease has a debilitating effect on the activities of daily living (ADL) and the productivity of individuals and has financial consequences. With the increased utilization of magnetic resonance imaging (MRI) in society, the disease is diagnosed in its early stages. Hip-preserving surgery like tensor fascia lata (TFL) muscle pedicle iliac bone grafting should be given a chance to preserve the native femoral head.
METHODS: At a tertiary care teaching hospital in Gorakhpur, India, an observational clinical
study was carried out. This
study comprised 40 patients, ages 18-50 years, with femoral head osteonecrosis (stages II and III of the Ficat-Arlet staging system), who came to our institute\'s orthopedic outpatient department. Patients were treated with multiple drillings, curettage, and cheilectomy of the femoral head, in addition to TFL muscle pedicle bone grafting. The Harris hip score (HHS) was utilized to assess the clinical results, and the radiological assessment focused on signs of revascularization.
RESULTS: In our
study, the most prevalent age group was 20-30 years (67.5%), with a male predominance (85%). Among our cohort of 40 patients, the HHS indicated excellent outcomes (90-100) in 14 cases (35%), good outcomes (80-89) in 19 cases (47.5%), fair outcomes (70-79) in six cases (15%), and poor outcomes (<70) in one case (2.5%), at the time of the final follow-up. The final follow-up period varied from one to 10 years.
CONCLUSIONS: TFL muscle pedicle bone grafting procedure provides excellent clinical and radiological outcomes, especially in young patients in whom femoral head-preserving surgery is preferred over total hip arthroplasty. This procedure is effective in both early and advanced stages of femoral head osteonecrosis, provided there are no arthritic changes. It reduces symptoms and improves functional outcomes.