髋关节外科脱位联合髂骨植骨术治疗股骨头坏死的中短期疗效观察  

Observation on the Short-term Effect of Surgical Dislocation of Hip Joint Combined with Iliac Bone Grafting in the Treatment of Femoral Head Necrosis

作　　者：陈小华 陈卫宁 CHEN Xiaohua;CHEN Weining(Department of Orthopedics,Fuzhou Second Hospital Affiliated to Xiamen University,Fuzhou,Fujian Province,350007 China;College of Traditional Chinese Medicine,Fujian University of Traditional Chinese Medicine,Fuzhou,Fujian Province,350122 China)

机构地区：[1]厦门大学附属福州第二医院骨科,福建福州350007 [2]福建中医药大学中医学院,福建福州350122

出　　处：《中外医疗》2022年第11期41-44,53,共5页China & Foreign Medical Treatment

摘　　要：目的探讨髋关节外科脱位联合髂骨植骨术治疗股骨头坏死(ONFH)的临床疗效。方法方便收集2017年1月—2019年12月该院采用髋关节外科脱位联合髂骨植骨术治疗股骨头坏死患者,共26例30髋(4例为双侧)。术后行髋关节正位及蛙式位X线和CT或MRI评估股骨头坏死修复情况,观察患者并发症发生情况,评估术前、术后Harris评分及iHOT-12评分。结果至末次随访Harris评分(85.87±8.63)分显著高于术前(58.33±9.44)分,差异有统计学意义(t=-11.801,P<0.001),iHOT-12评分(70.33±10.01)分显著高于术前(40.53±10.19)分,差异有统计学意义(t=-11.011,P<0.001),优良率达86.67%,改善率达90.00%。3例出现了下肢深静脉血栓(2例为肌间静脉血栓,1例为单侧胫后静脉血栓),经抗血栓治疗后均再通。30髋大转子截骨均已愈合,切口愈合良好,未见异位骨化、感染、神经损伤等情况。结论髋关节外科脱位联合髂骨植骨术治疗股骨头坏死的短期疗效良好,它既可保护股骨头血运,充分显露关节结构,又能清除坏死灶,一期获得头内稳定,明显改善髋关节功能,是一种较好的保髋治疗手段。Objective To investigate the clinical effect of surgical dislocation of the hip joint combined with iliac bone grafting in the treatment of necrosis of the femoral head(ONFH).Methods A total of 26 cases with 30 hips(4 cases were bilateral)were conveniently collected from January 2017 to December 2019 in the hospital with surgical dislocation of the hip combined with iliac bone grafting for the treatment of femoral head necrosis.Postoperative X-ray and CT or MRI of the hip joint were performed to evaluate the repair of femoral head necrosis.The incidence of complications was observed,and Harris score and iHOT-12 score were evaluated before and after surgery.Results The Harris score(85.87±8.63)points at the last follow-up was significantly higher than the preoperative(58.33±9.44)points,the difference was statistically significant(t=-11.801,P<0.001).The iHOT-12 score(70.33±10.01)points was significantly higher than the preoperative(40.53±10.19)points,the difference was statistically significant(t=-11.011,P<0.001),the excellent and good rate was 86.67%,and the improvement rate was 90.00%.Deep vein thrombosis of lower extremities occurred in 3 cases(2 cases were intramuscular venous thrombosis,1 case was unilateral posterior tibial vein thrombosis),and all were recanalized after antithrombotic therapy.The osteotomy of the greater trochanter of the 30 hips was healed,and the incision healed well.Heterotopic ossification,infection,and nerve damage were not found.Conclusion Surgical dislocation of the hip joint combined with iliac bone grafting has a good short-term effect in the treatment of femoral head necrosis;it can not only protect the blood supply of the femoral head,fully expose the joint structure,but also remove the necrotic foci,obtain intracranial stability in one stage,and significantly improve the hip Joint function,is a better hip preservation treatment.

关 键 词：股骨头坏死 髋关节外科脱位 髂骨植骨 保髋 

分 类 号：R4[医药卫生—临床医学]