髓芯减压植骨术治疗不同坏死病灶位置股骨头坏死的疗效分析  

Clinical study on core decompression in treating osteonecrosis of the femoral head of the necrotic bone-in different site

作　　者：崔旭 郝阳泉[2] 董博[1] 袁普卫[1] 张宇飞 宇文星 鲁超 CUI Xu;HAO Yang-quan;DONG Bo;YUAN Pu-wei;ZHANG Yu-fei;YU Wen-xing;LU Chao(Shaanxi University of Traditional Chinese Medicine,Xianyang,712000,Shaanxi,China;Department of Joint Surgery,Xi'an Honghui Hospital,Xi'an Jiaotong University,Xi'an710000,Shaanxi,China)

机构地区：[1]陕西中医药大学,陕西咸阳712000 [2]西安交通大学附属红会医院关节外科,陕西西安710000

出　　处：《中国骨伤》2023年第3期289-294,共6页China Journal of Orthopaedics and Traumatology

基　　金：陕西省中医药管理局中西医结合临床协作创新项目(编号:2020-ZXY-010);中国博士后科学基金项目(编号:2017M613179)。

摘　　要：目的:分析髓芯减压植骨保髋手术对不同坏死病灶位置早期股骨头坏死(osteonecrosis of the femoral head,ONFH)的临床疗效。方法:回顾分析2017年1月至2018年12月骨循环协会(Association Research Circulation Osseous,ARCO)Ⅱ期ONFH患者105例,男71例,女34例,年龄(55.20±10.98)岁,病程(15.91±9.85)个月。所有患者按日本骨坏死研究会(Japanese Investigation Committee,JIC)分型分为4组:A型17例,B型26例,C1型33例,C2型29例。所有患者行髓芯减压植骨术,术前及术后3、6、12、24个月随访时采用视觉模拟评分(visual analogue scale,VAS)、Harris髋关节评分,复查X线片观察2年内股骨头塌陷情况。结果:105例患者手术成功获得随访,时间(24.45±2.75)个月,无手术并发症发生。Harris评分在术前及术后3、6个月时各组间比较差异均无统计学意义(P>0.05),在术后12、24个月时各组间比较差异有统计学意义(P<0.01),各组术前及术后各时间点间Harris评分比较差异有统计学意义(P<0.01)。VAS在术前及术后3、6个月时各组间比较差异均无统计学意义(P>0.05),在术后12、24个月时各组间比较差异有统计学意义(P<0.01),各组术前及术后各时间点间的VAS比较差异有统计学意义(P<0.01)。4组患者在术前、术后3、6个月时均未发生股骨头塌陷;术后12个月C组发生股骨头塌陷3例,C2组发生4例(P>0.05);术后24个月B组发生股骨头塌陷1例、C1组发生6例、C2组发生8例(P<0.05)。结论:髓芯减压植骨术可提高股骨头坏死保髋疗效,而股骨头坏死保髋疗效与骨坏死病灶位置密切相关,临床治疗中应考虑到病灶位置对保髋疗效的影响,以更好的在术前制定保髋方案。Objective To analyze the clinical effect of decompression and bone grafting on osteonecrosis of the femoral head(ONFH)at different sites of necrotic lesions.Methods A total of 105 patients with ARCOⅡstage ONFH admitted from January 2017 to December 2018 were retrospectively analyzed.There were 71 males and 34 females,with an average age of(55.20±10.98)years old.The mean course of all patients was(15.91±9.85)months.According to Japanese Inveatigation Committee(JIC)classification,all patients were divided into 4 types:17 cases of type A,26 cases of type B,33 cases of type C1 and 29 cases of type C2.All four groups were treated with decompression of the pulp core and bone grafting.Visual analogue scale(VAS)and Harris hip joint score were used before and at 3,6,12,and 24 months after the operation,and the collapse of the femoral head was observed by X-ray examination within 2 years.Results All 105 patients were successful on operation without complications,and the mean follow-up duration was(24.45±2.75)months.Harris score showed that there was no statistical difference among four groups before surgery and 3,6 months after surgery(P>0.05);at 12 and 24 months after surgery,there were significant differences among all groups(P<0.01).There were significant differences in intragroup Harris scores at preoperative and postoperative time points among four groups(P<0.01).VAS showed that there was no statistical difference among four groups before and 3,6 months after surgery(P>0.05);at 12 and 24 months after surgery,there were significant differences among all groups(P<0.01).There were significant differences in VAS at preoperative and postoperative time points among four groups(P<0.01).None of the patients in four groups had femoral head collapse before and 3,6 months after surgery.At 12 months after operation,there were 3 cases of femoral head collapse in group C and 4 cases in group C2(P>0.05);At 24 months after operation,1 case of femoral head collapse occurred in group B,6 cases in group C1 and 8 cases in group C2(P

关 键 词：股骨头坏死 髓芯减压术 植骨术 塌陷 

分 类 号：R684.3[医药卫生—骨科学]