改良髓芯减压植骨联合体外冲击波治疗早期股骨头坏死的疗效  

Efficacy of advanced core decompression and synthetic bone substitutes grafting combined with an extracorporeal shock wave for early femoral head necrosis

作　　者：及松洁[1] 张隆浩[2] 徐黎[3] 杨德金[1] 吕明[1] 姜旭[1] 周一新[1] JI Songjie;ZHANG Longhao;XU Li;YANG Dejin;LÜMing;JIANG Xu;ZHOU Yixin(Department of Adult Joint Surgery,Beiing Jishuitan Hospital,Beiing 100035,China;不详)

机构地区：[1]北京积水潭医院矫形骨科,北京100035 [2]北京积水潭医院冲击波治疗中心,北京100035 [3]北京积水潭医院影像科,北京100035

出　　处：《实用医学杂志》2022年第15期1913-1918,共6页The Journal of Practical Medicine

基　　金：国家自然科学基金面上项目(编号:81472139);吴阶平医学基金会临床科研专项资助基金(编号:320.6750.2021-20-4);北京积水潭医院青年人才培养学科新星计划项目(编号:XKXX201814)。

摘　　要：目的比较单纯行改良减压植骨手术与减压植骨手术联合冲击波治疗早期股骨头坏死的近期疗效。方法收集符合纳入标准的2018年1月至2020年1月北京积水潭医院矫形骨科及北京朝阳中西医结合急诊抢救中心骨科收治的早期股骨头缺血坏死患者。按随机原则分为两组,研究组为改良减压植骨手术联合体外冲击波治疗的病例,对照组为单纯行改良减压植骨手术病例。最终66例患者进入结果分析。其中男59髋,女15髋。平均年龄(36.8±10.4)岁,左侧29例,右侧37例。研究组共30例(30髋),术前VAS评分为(6.7±0.8),Harris评分为(68.3±5.0),Kerboul角(197.7±61.2)°。对照组共36例(36髋),术前VAS评分为(6.7±0.9),Harris评分为(68.3±5.0),Kerboul角为(201.9±61.4)°。随访时间分别为24个月。记录术后3、6、12、24个月患髋VAS评分和Harris评分变化。在最后一次随访时进行MRI检查,测量Kerboul角重新评估坏死区域的大小。结果两组随访24个月,研究组有4例塌陷,对照组有6例塌陷。无病例进行全髋关节置换。随访24个月研究结束时,两组VAS评分和Harris评分均比术前有明显改善。研究组术后3、6、12个月的VAS和Harris评分均优于对照组(P<0.05)。但是随访至24个月时两组没有差异。研究组Kerboul角为(175.0±80.4)°,对照组Kerboul角为(193.1±73.6)°,两组均比术前改善,但两组间差异无统计学意义。研究组△Kerboul为(-22.7±20.3)°,对照组为(-8.9±26.3)°,研究组对kerboul角的改善更为明显(P=0.042)。结论改良髓芯减压人工骨植入手术联合体外冲击波和单纯改良减压人工骨植入手术治疗早期股骨头坏死的早期疗效令人满意,前者在随访早期比后者可以更好的减轻疼痛,改善功能,对于Kerboul角改善也更为明显。Objective To compare the short-term effect of advanced core decompression(ACD)plus synthetic bone substitutes(SBS)grafting alone with ACD+SBS combined with extracorporeal shock wave therapy(ESWT)for early-stage osteonecrosis of the femoral head(ONFH).Methods Patients who met the inclusion criteria from January 2018 to January 2020 were randomly divided into two groups.The research group was the case of ACD+SBS+ESWT,and the control group was the case of ACD+SBS alone.Finally,66 patients entered the result analysis.There were 30 cases(30 hips)in the research group.The preoperative VAS score was(6.7±0.8),the Harris score was(68.3±5.0),and the Kerboul angle was(197.7±61.2)°.There were 36 cases(36 hips)in the control group.The preoperative VAS score was(6.7±0.9),the Harris score was(68.3±5.0),and the Kerboul angle was(201.9±61.4)°.The follow-up time was 24 months.The changes in VAS score and Harris score of the affected hip at 3 months,6 months,12 months,and 24 months after operation were recorded.An MRI was performed at the last follow-up,and the Kerboul angle was measured to reassess the size of the necrotic area.Results The two groups were followed up for 24 months.There were 4 cases of collapse in the research group and 6 cases in the control group.No patients underwent a total hip replacement.At the end of the 24-month follow-up study,Significant improvement of VAS and Harris in both groups was seen before surgery.The VAS and Harris scores of the study group were better than those of the control group at three months,six months,and 12 months after operation(P<0.05).However,there was no difference between the two groups at 24 months of follow-up.The Kerboul angle of the research group was(175.0±80.4)°,and that of the control group was(193.1±73.6)°.Both groups were improved compared to preoperative,but there was no difference between the two groups.TheΔkerboul angle of the study group was(-22.7±20.3)°,and that of the control group was(-8.9±26.3)°.The improvement of the kerboul angle in the study gr

关 键 词：股骨头坏死 髓芯减压术 保髋治疗 体外冲击波治疗法 植骨替代 

分 类 号：R687.1[医药卫生—骨科学] R459.9[医药卫生—外科学] R445[医药卫生—临床医学]