围塌陷期股骨头坏死的头颈开窗植骨  

Head-neck fenestration bone autografting for pericollapse-stage femur head necrosis

作　　者：倘艳锋 曹向阳 岳辰 郭超韡 周水红 杨澜波 刘又文 TANG Yan-feng;CAO Xiang-yang;YUE Chen;GUO Chao-wei;ZHOU Shui-hong;YANG Lan-bo;LIU You-wen(Hip Center,Luoyang Orthopedic Hospital of Henan Province,Luoyang 471002,China)

机构地区：[1]河南省洛阳正骨医院(河南省骨科医院)髋部损伤中心,河南洛阳471002

出　　处：《中国矫形外科杂志》2022年第16期1512-1515,共4页Orthopedic Journal of China

基　　金：国家自然基金项目(编号:81804126);河南省中医药科学研究专项课题(编号:20-21ZY1061);河南省中医药拔尖人才培养项目(编号:豫卫中医涵2021-15号);河南省重点研发与推广专项项目(编号:182102310487)。

摘　　要：[目的]评价经直前入路(direct anterior approach,DAA)高位头颈开窗植骨治疗“围塌陷期”股骨头坏死的临床疗效。[方法]回顾性分析2015年9月—2018年3月股骨头坏死患者32例(37髋)的临床资料,均采取DAA入路,头颈部带部分软骨高位开窗清除坏死骨并自体骨打压植骨。观察临床与影像结果。[结果]所有患者均顺利完成手术,术中无神经、血管损伤等严重并发症。随访(35.23±10.35)个月,随访过程中,5例(5髋)临床症状加重,其中2髋改行THA,判定为保髋失败,占13.51%;27例(32髋)临床症状持续改善,判定为保髋成功,占86.49%。与术前相比,末次随访时髋关节疼痛VAS评分显著降低(P<0.05)。而Harris评分、髋关节屈曲、内旋、外旋ROM均显著增加(P<0.05)。影像方面,与术前比较,末次随访坏死面积、关节面塌陷情况、关节间隙变窄情况无显著变化(P>0.05)。[结论]经DAA高位头颈开窗植骨治疗“围塌陷期”股骨头坏死仍可取得较好临床效果。[Objective]To evaluate the clinical efficacy of head-neck fenestration bone autografting through direct anterior approach(DAA)for pericollapse-stage femoral head necrosis.[Methods]A retrospective study was conducted on 32 patients(37 hips)who underwent head-neck fenestration bone autografting through DAA for pericollapse-stage femoral head necrosis from September 2015 to March2018.The clinical and imaging results were observed.[Results]All patients were successfully operated on without neurovascular injury and other serious complications.During follow-up period lasted for(35.23±10.35)months,5 patients(5 hips)who had clinical symptoms worsen,including 2 hips turned to total hip arthroplasty(THA),were judged as hip preservation failure,accounting for 13.51%,while the remaining 27 patients(32 hips)who got continuous improvement in clinical symptoms were marked as successful hip preservation,accounting for 86.49%.The VAS score for hip pain significantly decreased(P<0.05),while Harris score,hip extension-flexion,internal-external rotation range of motions(ROMs)significantly increased at the latest follow up compared with those preoperatively(P<0.05).Radiographically,there were no significant changes in the area of necrosis,head collapse,and articular space at the latest follow-up compared with those before operation(P<0.05).[Conclusion]This head-neck fenestration bone autografting through DAA still achieves acceptable clinical outcomes for the pericollapse-stage femoral head necrosis.

关 键 词：股骨头坏死 围塌陷期 保髋 自体骨移植 

分 类 号：R681.8[医药卫生—骨科学]