髓芯减压植骨术联合微创血管介入治疗早期股骨头缺血坏死  

Treatment of early avascular necrosis of femoral head with core decompression and bone grafting combined with minimally invasive vascular intervention

作　　者：符熙 陈兴明[1] 赵杉杉 郑督宙 朱冬梅[1] FU Xi;CHEN Xing-ming;ZHAO Shan-shan;ZHENG Du-zhou;ZHOU Dong-mei(Department of Radiology,Foshan Hospital of Traditional Chinese Medicine,Foshan 528000,China)

机构地区：[1]佛山市中医院放射科,广东佛山528000

出　　处：《佛山科学技术学院学报（自然科学版）》2023年第2期63-68,共6页Journal of Foshan University(Natural Science Edition)

摘　　要：目标:评估股骨头髓芯减压植骨术联合微创血管介入治疗塌陷前期股骨头缺血坏死(ANFH)保头手术的中期结果。方法:回顾性分析122例非外伤性塌陷前期ANFH,其中43例行股骨头髓芯减压植骨术,45例行微创血管介入治疗,34例行联合治疗,随访至股骨头塌陷或3年以上,评估三组治疗对ANFH中期结果(关节面塌陷>2 mm)的价值及术后关节面塌陷的危险因素。结果:不同保头手术术后关节面塌陷及塌陷时间具有统计学意义(P均<0.05),其中联合治疗中期关节面塌陷发生率较低,为29.41%,塌陷时间的中位数为24个月。ARCOⅠ、Ⅱ期ANFH保头术后发生关节面塌陷>2 mm差异具有统计学意义(P=0.002)。使用类固醇(>2 g/2~3 m)、大量饮酒(>100 g/d)及至少2个凝血因子异常的ANFH患者保头术后关节面塌陷差异具有统计学意义(P均<0.05)。ARCO分期是ANFH保头手术关节面塌陷>2 mm的独立危险因素(P=0.03)。结论:髓芯减压植骨术联合微创血管介入治疗中期预后效果良好,能有效延缓股骨头塌陷进展,在积极保头手术的同时,应尽量减少暴露于危险因素,延迟THA手术的需要,实现患者利益最大化。Objective To evaluate the mid-term results of head preserving surgery for avascular necrosis of the femoral head(ANFH)in the early stage of collapse after core decompression and bone grafting combined with minimally invasive vascular intervention.Methods A retrospective analysis was made on 122 cases of non-traumatic pre-collapse ANFH,including 43 cases of femoral head decompression and bone grafting,45 cases of minimally invasive vascular interventional therapy and 34 cases of combined therapy.The patients were followed up to femoral head collapse or more than 3 years.The value of three groups of treatment on the mid-term results of ANFH(articular surface collapse>2 mm)and the risk factors of postoperative articular surface collapse were evaluated.Results The articular surface collapse and its time after different head conserving operations were statistically significant(P<0.05).The incidence of articular surface collapse in the middle stage of combined therapy was 29.41%,and the median collapse time was 24 months.There was a statistically significant difference(P=0.002)in articular surface collapse>2 mm after ARCO I and II ANFH head preservation.There were statistically significant differences in articular surface collapse of ANFH patients who used steroids(>2 g/2~3 m),drank heavily(>100 g/d)and had at least two abnormal coagulation factors after head conserving surgery(P<0.05).ARCO staging was an independent risk factor for articular surface collapse>2 mm in ANFH head conserving surgery(P=0.03).Conclusion Core decompression and bone grafting combined with minimally invasive vascular intervention has a good medium-term prognosis,which can effectively delay the progress of femoral head collapse.While actively preserving the head,we should try to reduce exposure to risk factors,delay the need for THA surgery,and maximize the interests of patients.

关 键 词：股骨头坏死 核心减压 放射学 介入性 血管造影术 

分 类 号：R681.8[医药卫生—骨科学]