成人股骨头缺血性坏死骨髓内压变化规律及减压术的改进  

Change Pattern of Intromedullary Pressure of Avascular Necrosis of Femoral Head in Adults and Improvement of Decompression Procedure

作　　者：贾卫斗[1] 郑铁钢[1] 杨博贵[1] 许英杰[1] 

机构地区：[1]解放军第251医院骨科,河北省张家口市075000

出　　处：《中国骨与关节损伤杂志》2005年第8期515-517,共3页Chinese Journal of Bone and Joint Injury

摘　　要：目的测定健康人股骨近端不同区域骨髓腔内压力正常值.探索成人股骨头缺血坏死不同期、不同部位骨髓腔内压力变化规律,改进传统骨髓内减压术.方法选用26例健康人,52个股骨;117例患者,169个股骨.分股骨大粗隆、股骨颈、股骨头中心及股骨头负重区进行骨髓腔内压力测定.测压后,对117例患者股骨大粗隆、股骨颈、股骨头中心及股骨头负重区进行分区减压术.结果健康人股骨近端骨髓腔内压力,股骨大粗隆＜股骨颈＜股骨头中心＜股骨头负重区.非创伤性股骨头缺血性坏死各期各区的骨髓内压均高于创伤性股骨头坏死.Ⅰ、Ⅱ期股骨头缺血性坏死股骨头中心、股骨头负重区压力明显高于大粗隆及股骨颈;Ⅲ、Ⅳ期股骨头中心及其股骨头负重区压力呈下降趋势,而股骨大粗隆及股骨颈反而升高.99例随访2～5年2个月,根据修订后的'82北京髋关节疗效评定标准评价:优45例,良42例,可7例,差5例.结论股骨近端分区钻孔减压术可缓解疼痛,对于保护性关节活动受限也可很快得以改善,同时可以刺激血管再生,是一种行之有效的治疗方法.Objective To measure the intramedullary pressure of different area of proximal femur of healthy person and patients with avascular necrosis of femoral head, and improve the traditional decompression procedure. Methods Forty- five normal femur of 26 volunteer and 169 femur of 117 patients with avascular necrosis of femoral head were investigated. The intramedullary pressure in trochanter major, femoral neck, center of head and load area of femoral head were measured respectively. Decompression of subarea broach was performed in all patient. Results The order of the intramedullary pressure of healthy person was： trochanter major〈 femoral neck〈 center of femoral head〈load area. The intramedullary pressure of nontraumatic avascular necrosis of femoral head at all stage and area were higher than traumatic avascular necrosis. The intramedullary pressure of head center and load area were higher than that of trochanter major and femoral neck at stage I and l] . The pressure decreased gradually at stagem andIV, but it raised in the trochanter major and femoral neck. Ninety - nine patients were followed up postoperatively from 24 months to 62 months （mean, 40 months）. The patients were evaluated accordin to Beijing hip joint scoring scale made in 1982. Forty- five were excellent, 42 were good, 7 were fair and 5 were poor. Conclusion The decompression of subarea broach relieves pain and improve hip joint function. Besides,it stimulates the regeneration of blood vessels.

关 键 词：股骨头缺血性坏死 测压术 减压术 成人股骨头缺血坏死 非创伤性股骨头缺血性坏死 内减压术 变化规律 髓内压 死骨 股骨头负重区 

分 类 号：R681.8[医药卫生—骨科学] R681.805[医药卫生—外科学]