关节镜清理联合多孔减压治疗股骨头缺血性坏死  

Arthroscopic debridement combined with multiple decompressions for avascular necrosis of femoral head

作　　者：豆太[1] 索南昂秀[1] 郭强[1] 王军[1] DOU Tai;SUONAN Angxiu;GOU Qiang;WANG Jun(Department of Orthopaedics,Qinghai Provincial People's Hospital,Xining 810007,China)

机构地区：[1]青海省人民医院骨科,西宁810007

出　　处：《中国矫形外科杂志》2020年第17期1558-1562,共5页Orthopedic Journal of China

摘　　要：[目的]探讨髋关节镜下滑膜清理联合多孔减压治疗股骨头缺血性坏死的临床疗效。[方法]回顾性分析2016年1月~2018年12月本院收治ONFH患者52例(67髋)。依据手术方法,23例(31髋)行髋关节镜下滑膜清理联合多孔减压术(清理减压组)、29例(36髋)行单纯多孔减压术(单纯减压组)。比较两组围手术期、随访和影像资料。[结果]两组患者均顺利手术,清理减压组的手术时间和住院时间显著长于单纯减压组(P<0.05)。随访12个月以上,随时间推移,两组患者VAS评分显著减少,而Harris评分显著增加(P<0.05)。术后3个月、6个月,清理减压组VAS和Harris评分显著优于单纯减压组(P<0.05)。清理减压组中无症状加重者,无翻修手术者;单纯减压组中2例患者在减压术后1年行全髋关节置换。MRI检查显示,清理减压组总有效率为93.54%;而单纯减压组中,总有效率为69.44%;差异有统计学意义(P<0.05)[结论]髋关节镜下滑膜清理联合多孔髓芯减压治疗早期股骨头缺血性坏死能够显著增加髓芯减压精确性,显著提高保髋的成功率。[Objective]To explore the clinical outcomes of arthroscopic debridement combined with multiple decompressions for avascular osteonecrosis of the femoral head(ONFH).[Methods]A retrospective study was conducted on 52 patients(67 hips)who underwent femoral head decompression for ONFH in our hospital from January 2016 to December 2018.In term of surgical procedure conducted,23 patients(31 hips)received arthroscopic debridement combined with multiple decompressions(the ADMD group),while the remaining 29 patients(36 hips)underwent multiple decompressions only(the MDO group).The perioperative,follow-up and radiographic data were compared between the two group.[Results]All the patients in both groups had operation finished successfully.The ADMD group consumed significantly longer operation time and hospital stay than the MDO group(P<0.05).As time went during follow-up period lasted for more than 12 months,the VAS score significantly decreased,whereas the Harris score significantly increased in both group(P<0.05).The ADMD group proved significantly superior to the MDO group at 3 and 6 months postoperatively in VAS and Harris scores(P<0.05).To the latest follow up,no symptom worsened and revised surgery occurred in anyone of the ADMD group,whereas 2 patients turned to total hip arthroplasty due collapse of femoral head in the MDO group in 12 months.As results of MRI evaluation,the total efficient rate was of 93.54%in the ADMD group,while 69.44%in the MDO group,which was statistically significant(P<0.05).[Conclusion]The arthroscopic debridement combined multiple decompressions does significantly increase the accuracy of operation,and improve the success rate of hip preservation for avascular necrosis of the femoral head.

关 键 词：股骨头缺血性坏死 多孔减压术 关节镜 

分 类 号：R681.8[医药卫生—骨科学]