双粗通道减压植骨+结构性骨支撑治疗早期股骨头坏死疗效分析  

Effect analysis of double channel decompression and bone grafting plus structural bone support in the treatment of early osteonecrosis of the femoral head

作　　者：孙强[1] 郭晓忠 王冉东[1] 李兵 岳聚安 刘忘言 陈蛟 Sun Qiang;Guo Xiaozhong;Wang Randong;Li Bing;Yue Ju′an;Liu Wangyan;Chen Jiao(Department of Bone and Joint Surgery,Aviation General Hospital,Beijing 100012,China;Department of Orthopaedics,Beijng Jishuitan Hospital,Beijing 100035,China)

机构地区：[1]航空总医院骨关节科,北京100012 [2]北京积水潭医院矫形骨科,100035

出　　处：《中华损伤与修复杂志（电子版）》2022年第6期490-495,共6页Chinese Journal of Injury Repair and Wound Healing(Electronic Edition)

基　　金：首都医学发展科研基金(2009-3098);航空总医院院级课题(YJ202018)。

摘　　要：目的分析双粗通道减压植骨+结构性骨支撑治疗早期股骨头坏死(ONFH)的临床疗效。方法依据纳入与排除标准,选择自2016年10月至2020年10月在航空总医院骨关节科行双粗通道减压植骨+结构性骨支撑治疗的早期ONFH患者93例(133髋)纳入研究,其中国际骨循环研究会(ARCO)分期:Ⅱ期60髋,Ⅲ期73髋;中日友好医院(CJFH)分型:C型20髋,L1型42髋,L2型49髋,L3型22髋。患者麻醉后,首先将直径10 mm的髓心减压钻头自大粗隆外侧沿前内侧导针扩髓直至软骨下方3 mm左右,应用植骨器将7.5 mg同种异体松质骨骨粒经减压通道植入坏死区域;然后将直径10 mm的髓心减压钻头自大粗隆外侧沿前外侧导针扩髓直至软骨下方3 mm左右,将2.5 mg骨粒植入通道顶部压实,选择合适长度的支撑棒沿着导针插入外上道并拧紧,取出导针再次透视确保支撑棒位置良好,冲洗并缝合切口。分析比较术前及末次随访时所有患者、不同ARCO分期、不同CJFH分型早期ONFH患者Harris髋关节功能评分。分析比较末次随访时所有患者、不同ARCO分期、不同CJFH分型早期ONFH患者的影像学进展率与保髋成功率。数据行配对t检验、χ^(2)检验。结果随访时间平均(29.26±10.02)个月。末次随访时,患者总体Harris髋关节功能评分由术前(78.99±13.50)分提高到(82.49±17.18)分,差异有统计学意义(t=-1.890,P=0.021)。术前及末次随访时ARCOⅡ期患者Harris评分比较,差异无统计学意义(t=0.944,P=0.349),ARCOⅢ期患者Harris髋关节功能评分由术前(73.83±10.98)分提高到(82.43±17.72)分,差异有统计学意义(t=-3.797,P<0.05)。末次随访时CJFH分型中C型、L2型、L3型患者术前及末次随访时的Harris髋关节功能评分比较,差异均无统计学意义(t=-1.855、-0.639、1.749,P=0.079、0.526、0.095)。L1型患者末次随访时Harris髋关节功能评分为(87.45±15.27)分,较术前[(79.11±13.36)分]明显提高,差异有统计学意义(t=-2.393,PObjective To analyze the clinical efficacy of double channel decompression and bone grafting plus structural bone support in the treatment of early osteonecrosis of the femoral head(ONFH).Methods According to the inclusion and exclusion criteria,a total of 93 patients(133 hips)with early ONFH who underwent double channel decompression and bone grafting plus structural bone support in the Department of Bone and Joint Surgery,Aviation General Hospital from October 2016 to October 2020 were enrolled in the study,including Association Research Circulation Osseous(ARCO)stageⅡ60 hips,ARCO stageⅢ73 hips,China-Japan Friend ship Hospital(CJFH)type:type C 20 hips,type L142 hips,type L249 hips,type L322 hips.After the anesthesia was taken for the patients,firstly,the 10 mm diameter midullary decompression drill bit was used to reamer the medullary along the anteromaterial guide needle on the outside of the greater trochanter until about 3 mm below the cartilage.A 7.5 mg allogeneic scellous bone granules was implanted into the necrotic area through a decompression channel with a bone grafting.Then,the 10 mm diameter midullary decompression drill bit was used to reamer the medullary along the anterolateral guide needle on the outside of the greater trochanter until about 3 mm below the cartilage.The 2.5 mg bone granules were implanted at the top of the channel and compacted.A support rod of appropriate length was inserted into the second channel along the guide wire and tightened.The guide wire was removed and fluoroscoped again to ensure that the support rod was in good position.Harris hip function scores of all ONFH patients,different ARCO stages and CJFH types of early ONFH patients were compared before operation and at last follow-up respectively.The imaging progression rate and hip preservation success rate of all ONFH patients,different ARCO stages and CJFH types of early ONFH patients were compared before operation and at last follow-up respectively.Data were processed with paired t test and chi-square test.Results

关 键 词：股骨头坏死 减压术 外科 关节成形术 置换 髋 保髋手术 

分 类 号：R687.3[医药卫生—骨科学]