保留圆韧带的股骨颈旋转截骨术治疗中青年股骨头软骨下骨折的早期疗效  

Early efficacy of rotational femoral neck osteotomy with preservation of the round ligament in treating subchondral insufficiency fracture of the femoral head in young and middle‑aged population

作　　者：齐保闯 罗殿中 饶宇 唐志方 浦路桥 施洪鑫 蒙旭晗 任俊筱 徐永清 李川 Qi Baochuang;Luo Dianzhong;Rao Yu;Tang Zhifang;Pu Luqiao;Shi Hongxin;Meng Xuhan;Ren Junxiao;Xu Yongqing;Li Chuan(Department of Orthopedics,920th Hospital of Joint Logistics Support Force of PLA,Kunming 650032,China;Graduate School of Kunming Medical University,Kunming 650500,China;Department of Orthopedics,Fourth Medical Center,PLA General Hospital,Beijing 100048,China;Medical School of Dali University,Dali 671003,China;First Clinical Medical College of Yunnan University of Chinese Medicine,Kunming 650500,China;Kunming Institute of Zoology,Chinese Academy of Sciences,Kunming 650201,China)

机构地区：[1]解放军联勤保障部队第九二〇医院骨科,昆明650032 [2]昆明医科大学研究生院,昆明650500 [3]中国人民解放军总医院第四医学中心,北京100048 [4]大理大学临床医学院,大理671003 [5]云南中医药大学第一临床医学院,昆明650500 [6]中国科学院昆明动物研究所,昆明650201

出　　处：《中华创伤杂志》2023年第8期673-679,共7页Chinese Journal of Trauma

基　　金：云南省科技人才与平台计划(202105AD160027);云南省骨科与运动康复临床医学研究中心(202102AA310068);全军临床重点专科建设项目;联勤医学重点专科项目。

摘　　要：目的探讨保留圆韧带的股骨颈旋转截骨术治疗中青年股骨头软骨下骨折(SIFFH)的早期疗效。方法采用回顾性病例系列研究分析2017年1月至2022年1月解放军联勤保障部队第九二〇医院收治的13例SIFFH患者的临床资料,其中男10例,女3例;年龄22~49岁[(33.5±8.3)岁]。左髋6例,右髋7例。患者均行保留圆韧带的股骨颈旋转截骨术治疗,术后给予规范的关节功能训练。记录手术时间、术中出血量;比较术前、术后3,6个月及末次随访时改良Harris髋关节功能评分和视觉模拟评分(VAS);通过影响学检查,观察股骨头是否塌陷、截骨处不愈合及其他并发症情况。结果患者均获随访13~24个月[(17.9±3.1)个月]。手术时间为(127.3±9.8)min。术中出血量为(393.9±21.9)ml。术后3,6个月及末次随访时改良Harris髋关节功能评分分别为(61.6±3.3)分、(80.2±4.4)分、(91.9±4.1)分,较术前的(51.4±3.5)分明显提高(P均<0.05),术后各时间点差异有统计学意义(P均<0.05)。术后3,6个月及末次随访时VAS分别为(4.9±1.1)分、(3.0±0.9)分、(1.4±0.5)分,较术前的(6.7±0.9)分明显降低(P均<0.05),术后各时间点差异有统计学意义(P均<0.05)。影像学检查无股骨头塌陷,截骨处均愈合。无骨不连、切口感染、周围神经损伤等严重并发症。结论保留圆韧带的股骨颈旋转截骨术治疗中青年SIFFH,可缩短手术时间、减少术中出血量、促进髋关节功能恢复、减轻疼痛并减少并发症,早期疗效满意。Objective To investigate the short‑term efficacy of rotational femoral neck osteotomy with preservation of the round ligament in the treatment of subchondral insufficiency fracture of the femoral head(SIFFH)in young and middle‑aged people.Methods A retrospective case series study was used to analyze the clinical data of 13 patients with SIFFH,who were admitted to 920th Hospital of Joint Logistics Support Force from January 2017 to January 2022.The patients included 10 males and 3 females,aged 22‑49 years[(33.5±8.3)years].There were 6 patients with fracture on the left hip and 7 on the right hip.All the patients were treated by rotational femoral neck osteotomy with preservation of the round ligament.Postoperatively,standardized joint functional training was given.The operative time and intraoperative bleeding were recorded.The modified Harris hip score and visual analogue score(VAS)were compared preoperatively,at 3,6 months postoperatively and at the final follow‑up.Radiological examinations were used to observe the occurrence of any collapse of the femoral head,non‑union at osteotomy site or other complications.Results The patients were followed up for 13‑24 months[(17.9±3.1)months].The operative time was(127.3±9.8)minutes,with the intraoperative bleeding of(393.9±21.9)ml.The values of modified Harris hip score were(61.6±3.3)points,(80.2±4.4)points,and(91.9±4.1)points at 3,6 months postoperatively and at the final follow‑up,respectively,being significantly higher than the preoperative(51.4±3.5)points(all P<0.05),and there were significant differences between different postoperative timepoints(all P<0.05).The values of VAS were(4.9±1.1)points,(3.0±0.9)points,and(1.4±0.5)points at 3,6 months postoperatively and at the final follow‑up,respectively,being significantly lower than preoperative(6.7±0.9)points(all P<0.05),and there were significant differences between different postoperative timepoints(all P<0.05).Imaging examination showed no femoral head collapse,with all the bones healed a

关 键 词：股骨头 股骨骨折 股骨头坏死 截骨术 圆韧带 

分 类 号：R687.3[医药卫生—骨科学]