高位头颈开窗植骨术与异体腓骨支撑术治疗早期股骨头坏死的疗效对比研究  

Comparative Study on the Effect of the Bone Grafting through Fenestration at High Level and Allogeneic Fibula Support in the Treatment of Early Femoral Head Necrosis

作　　者：王兆贺 韦标方[2] 杜希望 WANG Zhaohe(Shandong First Medical University / Shandong Academy of Medical Sciences, Shandong Taian 271000, China)

机构地区：[1]山东第一医科大学/山东省医学科学院,山东泰安271000 [2]山东省临沂市人民医院股骨头专科,山东临沂276000

出　　处：《河北医学》2021年第4期575-579,共5页Hebei Medicine

基　　金：山东省科学技术发展计划项目,(编号:2014GSF119022);山东省临沂市人民医院研究生培养计划,(编号:YJS2020030)。

摘　　要：目的:比较高位头颈开窗病灶清除植骨术与髓芯减压、同种异体腓骨支撑术治疗ARCOⅡ期股骨头坏死的疗效。方法:回顾性分析2015年1月至2019年6月期间就诊于本院的60例(68髋)股骨头坏死患者。其中,24例(26髋)行高位头颈开窗病灶清除植骨术治疗(A组),36例(42髋)行髓芯减压、同种异体腓骨支撑术治疗(B组)。术后采用Harris评分及VAS评分进行临床效果评价,通过复查X线片可以察看股骨头的形态变化,对患者保髋临床效果进行评价。结果:两组患者均获随访,A组患者随访12~40个月,平均(26.2±1.7)个月;B组患者随访12~38个月,平均(25.4±1.2)个月。A组患者中有4例保髋失败,保髋成功率为84.6%;B组12髋保髋失败,保髋成功率为71.4%。末次随访两组保髋成功患者时,Harris评分:A组(93.23±2.19)分,B组(85.46±2.32)分,两组评分均高于术前,差异有统计学意义(t=27.652,P<0.05;t=25.527,P<0.05);VAS评分:A组(1.21±0.54)分,B组(2.43±0.60)分,两组评分均低于术前,差异有统计学意义(t=16.743,P<0.05;t=17.514,P<0.05);组间各评分比较差异有统计学意义(P<0.05)。结论:对于早期股骨头坏死的治疗,高位头颈开窗病灶清除植骨术的临床疗效优于髓芯减压、同种异体腓骨支撑术,能够改善髋关节症状。Objective:To compare the curative effect of debridement of high head and neck fenestration and bone grafting with core decompression and allograft fibula support in the treatment of ARCO stage II femoral head necrosis.Methods:60 patients(68 hips)with osteonecrosis of femoral head in our hospital from January 2015 to June 2019 were retrospectively analyzed.Among them,24 cases(26 hips)were treated with high head and neck fenestration,debridement and bone grafting(group A),36 cases(42 hips)were treated with core decompression and allograft fibula support(group B).Harris score and VAS score were used to evaluate the clinical effect after operation.The morphological changes of the femoral head could be observed by reexamination of X-ray film,and the clinical effect of hip preservation was evaluated.Results:Patients in both groups were followed up.Patients in group A were followed up for 12~40 months with an average of(26.2±1.7)months;patients in group B were followed up for 12 to 38 months with an average of(25.4±1.2)months.In group A,4 patients failed to preserve hips,and the success rate of hip preservation was 84.6%;in group B,12 hips failed to preserve hips,and the success rate of hip preservation was 71.4%.At the last follow-up of the two groups of patients with successful hip preservation,Harris score:group A(93.23±2.19)points,group B(85.46±2.32)points,the scores of the two groups were higher than those before surgery,and the difference was statistically significant(t=27.652,P<0.05;t=25.527,P<0.05);VAS score:group A(1.21±0.54)points,group B(2.43±0.60)points,the scores of the two groups were lower than those before surgery,the difference was statistically significant(t=16.743,P<0.05;t=17.514,P<0.05);the difference in scores between the groups was statistically significant(P<0.05).Conclusion:For the treatment of early avascular necrosis of the femoral head,the clinical effect of high head and neck fenestration debridement and bone grafting is better than core decompression and allograft fibula support,which

关 键 词：股骨头坏死 高位头颈开窗 腓骨支撑术 

分 类 号：R68[医药卫生—骨科学]