激素性股骨头坏死的保髋治疗策略及疗效  

Preserving hip treatment of steroid-induced osteonecrosis of the femoral head

作　　者：傅维民[1] 刘保一[1] 王本杰[1] 赵德伟[1] Fu Weimin;Liu Baoyi;Wang Benjie;Zhao Dewei(Department of Orthopaedics,Affiliated Zhongshan Hospital of Dalian University,Dalian 116001,China)

机构地区：[1]大连大学附属中山医院骨科,116001

出　　处：《中华骨科杂志》2019年第23期1424-1431,共8页Chinese Journal of Orthopaedics

基　　金：大连市科技创新基金(2018J11CY030)。

摘　　要：目的探讨激素性股骨头坏死早期诊断及保髋治疗的预后.方法回顾性分析2010年1月至2017年6月确诊为单侧激素性股骨头坏死的患者73例,男27例,女46例;年龄(34.26±10.35)岁.ARCOⅠ期21例、Ⅱa期24例、Ⅱb期8例、Ⅱc期18例、Ⅲa期2例.对ARCOⅠ期21例患者采用限制负重及药物治疗;对Ⅱa、Ⅱb期32例患者行髓芯减压术;对Ⅱc、Ⅲa期20例患者行带旋股外侧血管蒂大转子骨瓣转移术.随访期间当Ⅰ期进展为Ⅱa、Ⅱb期后行髓芯减压术,Ⅱa、Ⅱb期进展为Ⅱc或Ⅲa期时行带旋股外侧血管蒂大转子骨瓣转移术,进展为Ⅲb期后采用带血管蒂骨瓣联合钽金属棒植入,进展为Ⅲc期及以上时行大转子骨瓣重建股骨头或关节置换术.评估Harris髋关节评分,以关节置换为终点绘制股骨头生存曲线.结果73例均获得随访,平均随访时间为29个月(18~48个月).21例Ⅰ期患者经保守治疗后,14例(67%)未见影像学ARCO分期进展,6个月后3例进展为Ⅱb期、4例进展为Ⅱc期.32例Ⅱa、Ⅱb期患者术后25例(78%)未进展,4例6个月进展为Ⅲa期、1例6个月进展为Ⅲb期、2例12个月时进展为Ⅲc期.18例Ⅱc期患者术后14例(78%)未进展,2例6个月进展至Ⅲa期、1例24个月进展至Ⅲc期、1例42个月进展至Ⅳ期.2例Ⅲa期患者术后1例无进展,另1例36个月时进展至Ⅳ期.Harris髋关节评分以更换治疗方案前为评价终点,Ⅰ期患者治疗前Harris髋关节评分为(90.48±5.36)分,末次随访时为(91.76±8.19)分,差异无统计学意义(t=1.231,P=0.402);Ⅱa、Ⅱb期患者从(75.22±8.30)分提高至(84.47±16.77)分,差异有统计学意义(t=5.624,P<0.001);Ⅱc、Ⅲa期患者从(59.80±9.24)分提高至(77.75±20.75)分,差异有统计学意义(t=12.033,P<0.001).4例患者最终接受了关节置换术,治疗后2年股骨头生存率为98.6%,4年为94.5%.结论激素性股骨头坏死通过筛查获得早期诊断后可根据不同分期选择相应的保髋治疗方案,短期临�Objective To investigate the early diagnosis and treatment options for steroid-induced osteonecrosis of the femoral head(SONFH).Methods Retrospective analysis was conducted in 73 patients with unilateral SONFH from January 2010 to June 2017.There were 27 males and 46 females,aged 34.26±10.35 years(range,20-45 years).The following type of cases were included,21 cases of ARCO I,24 cases of Ila,8 cases of lib,18 cases of lie and 2 cases of Illa.Patients with ARCO I were limited in weight and were treated with low molecular weight heparin sodium and ginkgo dharma drugs after excluding bleeding risk.Core decompression was performed in patients with ARCO Ila and lib vascularized greater trochanter bone transfer was conducted in patients with lie and Illa.During the follow-up duration,when the ARCO I progressed to ARCO Ila and lib,the core decompression was performed.When the ARCO Ila and Hb progressed to the ARCO lie or Illa,the vascularized greater trochanter bone transfer was conducted.Vascularized greater trochanter bone combined with the tantalum rod was implanted in ARCO Illb.The femoral head reconstruction w让h the larger trochanter bone flap or joint replacement was performed in ARCO IIIc and above.The Harris hip score was used to evaluate the clinical outcomes.The femoral head survival curve of SONFH was drawn with the end of joint replacement.Results All 73 patients were followed up for an average of 29 months(range,18 to 48 months).After treatment of 21 patients with ARCO I,a total of 14(67%)patients had no ARCO staging progress.After 6 months,three patients progressed to ARCO lib and 4 patients progressed to ARCO lie.All 32 patients with ARCO Ila and lib were treated,of which 25(78%)did not progress but 4 patients progressed to ARCO IHa at 6 months.Only one patient progressed to ARCO Illb at 6 months,and 2 patient progressed to ARCO IIIc at 12 months.There were 18 patients with ARCO lie underwent treatment,of which 14 patients(78%)did not progress but 2 patients progressed to ARCO Illa at 6 months and 2 pa

关 键 词：糖皮质激素类 股骨头坏死 游离组织瓣 减压术 外科 

分 类 号：R68[医药卫生—骨科学]