两种入路"电灯泡"术治疗股骨头坏死比较  

Comparison of two approaches for lightbulb procedure in the treatment of femoral head necrosis

作　　者：刘国杰 刘沛 孙永强 陈楠 陈晓波 翟沛 宗超 阎亮 LIU Guo-jie;LIU Pei;SUN Yong-qiang;CHEN Nan;CHEN Xiao-bo;ZHAI Pei;ZONG Chao;YAN Liang(Luoyang Orthopedic Hospital of Henan Province,Zhengzhou 450000,China;Gaoxin(Tian's)Traumatic Orthopaedics Hospital,Zibo 255000,China)

机构地区：[1]河南省洛阳正骨医院(河南省骨科医院),河南郑州450000 [2]淄博高新(田氏)骨伤医院,山东淄博255000

出　　处：《中国矫形外科杂志》2022年第3期208-213,共6页Orthopedic Journal of China

基　　金：国家自然科学基金项目(编号:81673776)。

摘　　要：[目的]比较经直接前入路(direct anterior approach,DAA)与传统Watson-Jones入路"电灯泡"术股骨头颈部开窗减压植骨治疗早期非创伤性股骨头坏死的疗效.[方法]回顾分析2014年6月-2018年6月采用"电灯泡"术治疗的89例(116髋)早期非创伤性股骨头坏死患者的临床资料.其中,40例(54髋)采用DAA入路,49例(62髋)采用传统Watson-Jones入路.比较两组围手术期、随访及影像资料.[结果]所有患者均顺利完成手术,术中无严重并发症.两组手术时间和术中放射线暴露时间的差异均无统计学意义(P>0.05).DAA组切口长度、术中出血量显著优于传统组(P<0.05).随访24~45个月,平均(32.09±14.08)个月,两组下地活动时间和完全负重活动时间的差异均无统计学意义(P>0.05).随术后时间推移,两组VAS评分均显著降低(P<0.05),而髋内-外旋ROM和Harris评分均显著增加(P<0.05);术后6个月,DAA组VAS评分和Harris评分均显著优于传统组(P<0.05).至末次随访时,保髋成功率方面差异无统计学意义(P>0.05),DAA组为81.48%,传统组为72.58%.影像方面,术后6个月及末次随访时,两组关节间隙、股骨头塌陷、病灶面积的差异均无统计学意义(P>0.05).[结论]相较于传统Watson-Jones入路,DAA入路"电灯泡"技术治疗早期股骨头坏死的创伤更小,早期功能更好.[Objective]To compare the clinical outcomes of direct anterior approach(DAA)versus conventional Watson-Jones approach for lightbulb procedures,involving femoral neck-head fenestration,debridement and bone autografting,for treatment of early-stage non-traumatic femoral head necrosis.[Methods]A retrospective study was done on total of 116 patients who received lightbulb procedures for early-stage nontraumatic femoral head necrosis from June 2014 to June 2018.Among them,40 patients(54 hips)had the operation performed through DAA approach,while the other 49 patients(62 hips)had lightbulb procedure conducted through the conventional Watson-Jones approach.The perioperative,follow-up and radiographic documents were compared between the two groups.[Results]All patients in both groups were successfully operated on without serious complications.Although there were no significant differences in the operative time and intraoperative radiation exposure time between the two groups(P>0.05),the DAA group had significantly less intraoperative blood loss than that in the conventional group(P<0.05).The follow-up lasted for 24 to 45 months,with an average of(32.09±14.08)months.There were no significant differences in the time to return walking and time to full weight-bearing activity between the two groups(P>0.05).The VAS scores decreased significantly(P<0.05),whereas the hip internal-external rotation range of motion(ROM)and Harris score significantly increased in both groups over time(P<0.05).At 6 months after operation,the DAA group was significantly superior to the conventional group in terms of VAS score and Harris score(P<0.05).By the time of the latest follow-up,successful rate of hip preservation was 81.48%in the DAA group,whereas 72.58%in the conventional group.Radiographically,there were no statistically significant differences in terms of joint space,femoral head collapse or lesion area between the two groups at 6 months after surgery or at the latest followup(P>0.05).[Conclusion]Compared with the conventional Watson-Jon

关 键 词：股骨头坏死 "电灯泡"术 保髋 手术入路 

分 类 号：R681.8[医药卫生—骨科学]