股骨头缺血坏死早期微创保头手术的疗效观察  

Minimally invasive head preservation surgery in the early stage of osteonecrosis necrosis of femoral head:a clinical report of 216 cases of 296 hips

作　　者：郭晓忠[1,2] 

机构地区：[1]北京积水潭医院矫形骨科 [2]航空总医院骨关节科

出　　处：《骨科临床与研究杂志》2019年第4期225-231,共7页Journal Of Clinical Orthopedics And Research

摘　　要：目的 探讨股骨头缺血坏死早期采用髓心减压异体骨移植+结构性骨支撑手术的疗效.方法 1998年6月至2018年9月.北京积水潭医院矫形骨科收治股骨头缺血坏死患者216例(296髋).其中男184例.女32例.年龄40.1±6.9(16~61)岁.采用股骨头髓心减压.异体骨移植+结构性骨支撑手术方法对其进行治疗.分析其中术后10年及以上行经大转子外侧入路、股骨头髓心减压、异体松质骨植骨+异体腓骨移植术治疗的41例(72髋)患者的随访结果.结果 该组患者平均随访162.8±6.3(119~232)个月.末次随访时失访率为20.83%.优良率为75.44%.手术成功率为80.70%.75.44%的股骨头外形良好.Harris评分由术前的(71.6±3.2)分提高到术后的(91.6±2.8)分.差异有统计学意义(P=0.031).术后所有患者均未发生伤口感染、下肢静脉血栓、局部血肿、神经损伤症状等并发症.结论 股骨头缺血坏死早期微创保头手术损伤小、出血少、关节功能恢复快、临床效果好.Objective To investigate the effect of allogeneic bone transplantation plus structural bone support in early stage of osteonecrosis of femoral head(ONFH). Methods Among 216 patients (296 hips) with ONFH were treated by allogeneic bone transplantation plus structural bone support. aging from 40. 1 ±6. 9 (16 - 61) years old in Department of Orthopedics. Beijing Jishuitan Hospital between June 1998 and September 2018. In this series. 41 patients (72 hips) were examined retrospectively with ONFH treated by the lateral approach of the great trochanter. decompression of the femoral head. allogeneic cancellous bone grafting and allogeneic fibula grafting. Results Patients in this group were followed up for 162. 8 ± 6. 3(119 - 232) months. The rate of lost to follow￣up was 20. 83%. good rate was 75. 44%. the rate of success was 80. 70%. the good shape of femoral headat the last follow￣up was 75. 44%. Harris score was improved from preoperative (71. 6 ±3. 2) to postoperative (91. 6 ±2. 8)(P =0. 031). Postoperative complications were not found in allpatients. Conclusion In the early stage of ONFH, minimally invasive head preservation surgery has the advantages of less injury, less bleeding, rapid recovery of joint function and good clinical effect.

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]