髓芯减压植骨加异体腓骨支撑治疗早期股骨头缺血性坏死的单中心长期临床疗效研究  

Long-term efficacy of core decompression with allogeneic peroneal transplantation in treatment of osteonecrosis of the femoral head in single center

作　　者：郭晓忠[1,2] 李兵 岳聚安 李瑞 GUO Xiaozhong;LI Bing;YUE Juan;LI Rui(Department of Orthopedics, Beijing JiShuiTan Hospital, Beijing 100035;Department of Orthopedics, Aviation General Hospital, Beijing 100020;Department of Orthopedics, DCN Orthopedic Hospital, Beijing 100143, China)

机构地区：[1]北京积水潭医院矫形骨科,北京100035 [2]航空总医院关节外科,北京100020 [3]德尔康尼骨科医院骨科,北京100143

出　　处：《中华骨与关节外科杂志》2018年第12期904-909,共6页Chinese Journal of Bone and Joint Surgery

摘　　要：背景:股骨头缺血性坏死早期治疗困难,治疗方案缺乏共识,因此探寻一种微创且术后疗效佳的髓芯减压术式,能够有效的改善股骨头坏死患者的生活质量。目的:探讨髓芯减压植骨加异体腓骨移植治疗早期股骨头缺血性坏死疗效。方法:采用髓芯减压植骨加异体腓骨移植术治疗股骨头缺血性坏死患者41例(72髋),年龄22~61岁,平均(40.1±6.9)岁,其中Ⅲc期21髋,Ⅲb期1髋,Ⅱc期49髋,Ⅱb期1髋。术后从临床结果和影像学表现综合评价疗效。结果:9人15髋失访,最终32例57髋纳入研究,其中Ⅲc期16髋,Ⅲb期1髋,Ⅱc期39髋,Ⅱb期1髋,患者随访119~232个月,平均(162.8±6.3)个月;末次随访时10例(14髋)功能差,Harris评分(61.3±4.1)分,且已进展到ARCOⅣ期,其中8例(11髋,Ⅲc期4髋、Ⅱc期7髋)因病情进展分别于术后(38.4±7.2)个月及术后(80.4±4.8)个月行全髋关节置换术;Harris评分由术前(71.6±3.2)分提高到术后(91.6±2.8)分(P=0.031),最终纳入研究的患髋末次随访时手术成功率为80.7%,优良率为75.4%。结论:股骨头髓芯减压植骨加异体腓骨移植术治疗早期股骨头缺血坏死,手术损伤小,术后关节功能恢复快,临床疗效佳,是一种值得推广的治疗早期股骨头缺血性坏死的术式。Background:Osteonecrosis of the femoral head (ONFH) is hard to cure at its early stage, and the treatment strategy is not unified. Therefore, it is very important to explore a minimally invasive head-preserving surgery which has good postoper-ative efficacy and can effectively improve the quality of life in patients with ONFH. Objective:To explore the long-term effica-cy of core decompression with allogeneic peroneal transplantation in treatment of ONFH at early stage. Methods:A total of 41 patients with ONFH (72 hips) were treated by core decompression with allogeneic peroneal transplantation, aging from 22 to 61 years,with the mean as (40.1±6.9) years old, including IIIc 21 hips, IIIb 1 hip, IIc 49 hips and IIb 1 hip. The efficacy was evaluated through clinical results and imaging findings. Results:Nine patients (15 hips) were lost to follow up. 32 patients (57 hips) were enrolled in the study, including IIIc 16 hips, IIIb 1 hip, IIc 39 hips, II b 1 hip, who were followed up for 119-232 months, with the mean as (162.8±6.3)months. 10 patients (14 hips) had poor function with the Harris score as 61.3±4.1 and had progressed to ARCO IV;8 of them (11 hips) including IIIc 4 hips, IIc 7 hips, had to receive total hip arthroplasty at(38.4± 7.2)months and(80.4±4.8)months after operation due to disease progression. Harris score was improved from preoperative 71.6±3.2 to postoperative 91.6±2.8 (P=0.031).The success rate was 80.7% and the good rate was 75.4% at the final follow up visit. Conclusions:Core decompression with allogeneic peroneal transplantation is a good surgical method in treatment of ear-ly ONFH with the advantages as slight injury, fast function recovery and good clinical efficacy, which is worth being popularized.

关 键 词：股骨头 坏死 手术 骨移植 

分 类 号：R687.3[医药卫生—骨科学]