Survival analysis of hips treated with core decompression or vascularized fibular grafting because of avascular necrosis
Survival analysis of hips treated with core decompression or vascularized fibular grafting because of avascular necrosis
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DOI：
10.2106/00004623-199809000-00004
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发表时间：
1998-09-01
影响因子：
5.3
通讯作者：
Urbaniak, JR
中科院分区：
文献类型：
--
作者：
Scully, SP;Aaron, RK;Urbaniak, JR
股骨头缺血性坏死是一个多方面的过程，导致关节不协调和随后的关节骨关节病。临床医生一致认为，主要治疗应侧重于保护关节的自然表面;然而，对于如何最好地实现这一点尚未达成共识。虽然已经报告了一些治疗干预措施，但疗效差异很大，几乎没有统计学比较。本研究的目的是使用统计学分析来比较两种广泛使用的手术，带血管腓骨移植术（614例髋关节; 480例患者）和髓芯减压（九十八髋; 72例患者），用于治疗缺血性坏死，患者仅根据年龄和疾病阶段分层，并以全髋关节置换术作为失败的终点进行生存分析，11个患有Ficat I期疾病的髋关节在接受任一方案治疗后均不需要全关节置换术，对患有II期疾病的髋关节的分析显示，50个月的存活率为65（43个髋关节中的28个），89%（111个髋关节中的99个）血管化腓骨移植后，对于患有Ficat III期疾病的髋关节，50个月的存活率为21（47个髋关节中的10个），81%（500个髋关节中的405个髋关节），在Ficat II期或LII期疾病的髋关节中，吻合血管腓骨移植后最终的全关节置换率明显低于髓芯减压后（p < 0.0001），结果表明，与血管化腓骨移植相关的发病率增加是合理的，因为它延迟或预防了患有II或III期疾病的髋关节的关节塌陷。
Avascular necrosis of the femoral head is a multifaceted profess that leads to articular incongruity and subsequent osteoarthrosis of the joint. Clinicians concur that primary treatment should focus on preservation of the natural surface of the joint; however, there has not been a consensus on how best to accomplish this. While a number of therapeutic interventions have been reported, the efficacy has varied markedly and there have been few statistical comparisons. The purpose of the current study was to use statistical analysis to compare the results of two widely used procedures, vascularized fibular grafting (614 hips; 480 patients) and core decompression (ninety-eight hips; seventy-two patients), for the treatment of avascular necrosis, The patients mere stratified according to age and the stage of disease, and a survival analysis was performed with total hip arthroplasty as the end point for failure,None of the eleven hips that had Ficat stage-I disease needed a total joint replacement after being treated with either regimen, Analysis of the hips that had stage-II disease revealed rates of survival, at fifty months, of 65 per cent (twenty-eight of forty-three hips) after core decompression and 89 per cent (ninety-nine of 111 hips) after vascularized fibular grafting, For the hips that had Ficat stage-III disease, the rates of survival at fifty months were 21 per cent (ten of forty-seven hips) after core decompression and 81 per cent (405 of 500 hips) after vascularized fibular grafting, Among the hips that had Ficat stage-II or LII disease, the rate of eventual total joint arthroplasty after vascularized fibular grafting was significantly lower than that after core decompression (p < 0.0001),The results indicate that the increased morbidity associated with vascularized fibular grafting is justified by the associated delay in or prevention of articular collapse in hips that have stage-II or III disease.