术前疼痛持续时间对打压支撑植骨术治疗股骨头坏死疗效的影响  

The effect of duration of preoperative pain on the outcomes of impaction with strut graft in the treatment of femoral head necrosis

作　　者：李勇[1] 何伟[1] 张庆文[1] 方斌[1] 王海彬[1] 陈镇秋[1] 陈雷雷[1] 

机构地区：[1]广州中医药大学第一附属医院三骨科,全国中医髋关节病重点专科,510405

出　　处：《中国骨与关节杂志》2012年第5期458-461,500,共5页Chinese Journal of Bone and Joint

基　　金：国家自然科学基金(81173284);广东省科技计划项目(2011B060300029;2011B061300079)

摘　　要：目的观察术前疼痛持续时间对支撑植骨术远期疗效的影响。方法从2004年至2006年有109例患者(128髋)因股骨头坏死行髓芯减压打压支撑植骨术得到完整随访。根据术前疼痛持续时间分为长期疼痛组(疼痛>6个月)共42例,50髋;短期疼痛组(疼痛≤6个月)共67例,78髋。用Harris评分评估临床疗效,按照X线片表现评估影像学疗效。需再行保髋手术或转行全髋关节置换作为观察终点根据随访病例资料,分别比较术前基线水平的年龄、性别、ARCO分期,以及术后2、5年时的临床结果。结果经过5年以上随访,长期疼痛组平均随访78个月,共13髋行全髋置换;短期疼痛组平均随访76个月,共17髋行全髋置换,两组临床股骨头保留率差异无统计学意义(P>0.05)。影像学疗效评估两组在术后2、5年均存在不同程度再塌陷,差异无统计学意义(P>0.05)。临床疗效Harris评分显示两组患者术后Harris评分均有提高。两组比较显示,在术后2年两组Harris评分差异无统计学意义(P>0.05);而在5年时短期疼痛组Harris评分较长期疼痛组改善明显,差异有统计学意义(P=0.007)。结论对术前有疼痛的患者,疼痛持续时间对于打压支撑植骨术治疗骨股骨头坏死的临床股骨头保留率及早期临床功能评分没有明显影响。但在术后5年以上的随访中,长期疼痛组的Harris评分低于短期疼痛组。Objective There are few studies on whether the duration of preoperative pain will affect the outcomes of hip-preserving surgery. The study is to observe the effect of the duration of preoperative pain on the long-term efficacy of strut grafting when it is more or less than 6 months respectively. Methods From 2004 to 2006, 109 patients （128 hips） with femoral head necrosis who were treated with core decompression and impaction with strut graft got complete follow-up. According to the duration of preoperative pain, the patients were divided into 2 groups： 42 cases （50 hips） of long-term pain group （more than 6 months）, and 67 cases （78 hips） of short-term pain group （6 months and less）. The clinical effects were evaluated using Harris hip score, and the radiographic outcomes were assessed based on the X-ray films. The end of observation was determined when another hip-preserving surgery or total hip arthroplasty was needed. According to the follow-up data, the age, gender and Association of Research Circulation Osseous （ARCO） classification were respectively compared at baseline preoperatively, and the clinical outcomes at 2 and 5 years postoperatively were also compared. Results After more than 5 years of follow-up, the mean follow-up periods for the long-term pain group and short-term pain group were 78 and 76 months respectively. Total hip artbroplasty was performed on 13 hips in the long-term pain group and 17 hips in the short-term pain group respectively, and the differences of clinical retention rates of the femoral head between the 2 groups were not statistically significant （P〉0.05）. According to the radiographic outcomes, secondary collapse in different degrees occurred in 2 groups at 2 and 5 years postoperatively, and the differences were not statistically significant （P〉0.05）.Both groups demonstrated increases in Harris hip score postoperatively. These scores did not differ significantly between the 2 groups at 2 years postoperatively （P〉0.05）. However, the sh

关 键 词：骨坏死 髓芯减压 疼痛 异体植骨 预后 

分 类 号：R687.3[医药卫生—骨科学]