单中心前瞻性研究囊性变对早期股骨头坏死微创保髋手术后疗效的影响  

A single-center prospective study on the effect of cystic changes on the outcome of minimally invasive hip preservation surgery for early osteonecrosis of the femoral head

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

机构地区：[1]航空总医院骨关节外科,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3期207-212,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：目的观察囊性变是否影响早期股骨头坏死(ONFH)保髋手术后的疗效。方法前瞻性临床随访观察2017年6月至2020年11月航空总医院收治的早期ONFH的患者病历资料。根据术前影像学(CT与MRI)评估结果分组,其中股骨头内有囊性变的患者设为囊性变组,共32例患者37髋;股骨头内不存在囊性变的患者设为非囊性变组,共50例患者59髋。所有患者均采用经大粗隆单一入路双孔道减压植骨+结构性骨支撑微创保髋手术,通过内下通道对股骨头坏死内下区域进行减压植骨,经外上通道对股骨头坏死外上区域进行减压植骨+结构性骨支撑。术后3、6、12个月及之后每年进行1次随访,以最终行髋关节置换术即认为手术失败随访终止,术前和末次随访数据纳入研究进行数据分析。采用Harris髋关节评分对髋关节的功能进行评估;比较2组患者髋关节功能评分、优良率以及不同分型患者(C+L1型、L2+L3型)髋关节功能评分;比较2组患者影像学进展率、失败率。所有纳入研究的患者术前与随访时均行髋关节正侧位X线、CT检查,术后影像学评估如股骨头无塌陷或原有塌陷无加重即认为影像学稳定,如发生软骨下骨折或塌陷加重即认为影像学进展。以最终行髋关节置换即认为手术失败。数据行Wilcoxon符号秩检验、χ^(2)检验,采用Kaplan-Meier方法进行生存分析。结果所有患者均纳入研究,平均随访(30.6±8.6)个月。囊性变组患者末次随访时的Harris髋关节评分为(82.43±16.36)分,较术前[(75.67±13.43)分]明显提高,差异有统计学意义(P=0.022);优良率由术前的37.84%(14/37)提高到62.16%(23/37),差异有统计学意义(χ^(2)=4.378,P<0.05)。非囊性变组患者末次随访时的Harris髋关节评分为(81.76±17.68)分,较术前[(82.90±12.77)分]无明显变化,差异无统计学意义(P=0.965);优良率由术前的55.93%(33/59)提高到62.71%(37/59),差异无统计学意义(χ^(2)=0.562,P>0.05)。Objective To observe whether cystic changes affects the outcome of hip preservation surgery of early osteonecrosis of the femoral head(ONFH).Methods Prospective clinical follow-up was conducted to observe the clinical data of patients with early ONFH at Aviation General Hospital from June 2017 to November 2020.According to the evaluation of preoperative imaging(CT and MRI),patients were divided into the cystic changes group,with a total of 32 patients and 37 hips.Patients without cystic changes were assigned to the non-cystic group,with a total of 50 patients and 59 hips.All patients were treated with minimally invasive single approach to double-channel core decompression and bone grafting with structural bone support by the great trochanter.Decompression bone grafting was performed on the inner and lower areas of femoral head necrosis through the inner and lower channels,and decompression bone grafting plus structural bone support was performed on the outer and upper areas of femoral head necrosis through the outer and upper channels.Follow-up was performed at 3,6,12 months after surgery and once a year thereafter.Follow-up was terminated if total hip arthroplasty was done,which considered a failure.Data from the preoperative and last follow-up visits were included in the study for data analysis.Hip function was assessed by Harris hip score.Hip function scores,excellent and good rates and hip function scores of patients with different types(C+L1,L2+L3)were compared between the two groups.Imaging progression rate and failure rate of 2 groups were compared.All the patients included in the study underwent anteroposterior and lateral hip joint X-ray and CT examination before and during the follow-up.Postoperative imaging evaluation was considered as stable if there was no collapse of femoral head or no aggravation of original collapse,and imaging progress was considered if subchondral fracture or aggravation of collapse occurred.A final THA was considered a failure.Data were processed with Wilcoxon signed-rank test

关 键 词：股骨头坏死 外科手术 微创性 关节成形术 置换 髋 囊性变 外侧柱 保髋手术 

分 类 号：R681.8[医药卫生—骨科学]