经大粗隆单一入路双孔道减压植骨+异体腓骨支撑治疗早期股骨头坏死的疗效分析  

Effect analysis of the single way of the great trochanter with double hole core decompression and bone impaction grafting+allogeneic fibula support for the treatment of early stages of osteonecrosis of the femoral head

作　　者：郭晓忠 岳聚安 王冉东[1] 李兵 孙强[1] 刘忘言 陈蛟 李迎楠 Guo Xiaozhong;Yue Ju′an;Wang Randong;Li Bing;Sun Qiang;Liu Wangyan;Chen Jiao;Li Yingnan(Department of Orthopaedic, Aviation General Hospital of China Medical University, Beijing 100012, China)

机构地区：[1]中国医科大学航空总医院关节外科,北京100012

出　　处：《中华损伤与修复杂志（电子版）》2020年第2期96-102,共7页Chinese Journal of Injury Repair and Wound Healing(Electronic Edition)

摘　　要：目的探讨经大粗隆单一入路双孔道减压植骨+异体腓骨支撑治疗早期股骨头坏死(ONFH)的临床疗效。方法采用经大粗隆单一入路双孔道减压植骨+异体腓骨支撑的方法对2011年3月至2017年3月北京积水潭医院矫形骨科收治的30例(41髋)早期ONFH患者进行治疗。所有患者术前均行双髋关节正侧位X线、CT平扫及MRI检查,根据国际骨循环研究会(ARCO)的骨坏死分期标准对其分期,其中ARCOⅡA期1髋、ARCOⅡB期1髋、ARCOⅡC期33髋、ARCOⅢC期6髋,术前评估患髋Harris评分。术后随访时复查髋关节正侧位X线及CT,评估患者术后髋关节Harris评分,以综合评价术后临床疗效。数据比较采用配对t检验及χ2检验。结果所有患者平均随访(33.6±13.2)个月,术前Harris评分为(74.2±5.81)分,优良率为12.20%;末次随访Harris评分为(87.7±7.2)分,优良率为80.49%;末次随访时Harris评分及术后优良率均较术前明显提高,差异均有统计学意义(t=3.129,χ2=38.45;P值均小于0.05);其中,1例女性患者术前左髋ARCOⅡ期,因病情进展于术后22个月行左侧全髋关节置换术;2例3髋术前ARCOⅡC期,末次随访时病情已进展到ARCOⅢ期,但髋功能良好,末次随访时手术成功率为97.56%。结论经大粗隆单一入路双孔道减压植骨+异体腓骨支撑治疗是治疗早期股骨头坏死的有效方法,该术式具有手术创伤小、术后恢复快、并发症少、临床疗效确切等优点。Objective To evaluate the outcome of the single way of the great trochanter with double hole core decompression and bone impaction grafting+allogeneic fibula support for the treatment of early stages of osteonecrosis of the femoral head(ONFH).Methods From March 2011 to March 2017,totally 30 cases(41 hip)of early ONFH were treated with the modified Phemister Procedure“single way of the great trochanter with double hole core decompression and bone impaction grafting+allogeneic fibula support”in Department of Orthopaedic,Beijing Jishuitan Hospital.All patients underwent bilateral anteroposterior and lateral hip joint X-ray,CT plain scan and MRI before surgery.The Harris hip score was used to evaluate the hip joint function before operation.Pre-operation according to the Association Research Circulation Osseous(ARCO)system,1 hip was graded for stage ARCOⅡA,1 was graded hip for stage ARCOⅡB,33 hip was graded for stage ARCOⅡC,and 6 hip was graded for stage ARCOⅢC.Anteroposterior and lateral X-rays and CT were used to evaluate the imaging progress.The Harris hip score was also used to evaluate the hip joint function at the latest follow-up.The data were analyzed by paired t-test and chi-square test.Results All patients were followed up for an average of(33.6±13.2)months.The average Harris hip score was changed from(74.2±5.8)points before surgery to(87.7±7.2)points at the latest follow-up.The rate of excellent and good was changed from 12.20%before surgery to 80.49%at the latest follow-up,the differences were statistically significant(t=3.129,χ2=38.45;with P values below 0.05).Among them,1 case of women with stage ARCOⅡon the left side hip joint before surgery,underwent total hip replacement in 22 months after surgery;2 cases with 3 for ARCOⅡC,had progression to stageⅢat the time of last follow-up,but the hip joint function was good.At the time of last follow-up the surgery success rate was 97.56%.Conclusions The modified Phemister Procedure“single way of the great trochanter with double hole core

关 键 词：股骨头坏死 腓骨 减压 骨移植 

分 类 号：R68[医药卫生—骨科学]