探索国际骨微循环协会分型对早期股骨头坏死治疗的指导意义  

Exploring the guiding significance of Association Research Circulation Osseous staging in the treatment of early-stage osteonecrosis of the femoral head

作　　者：孙强[1] 郭晓忠 岳聚安 王冉东 李兵 刘忘言 陈蛟 SUN Qiang;GUO Xiaozhong;YUE Ju'an;WANG Randong;LI Bing;LIU Wangyan;CHEN Jiao(Joint Surgery Department,Aviation General Hospital,Beijing 100012;Orthopaedic Surgery Department,Beijing Jishuitan Hospital affiliated to Capital Medical University,Beijing 100035,China)

机构地区：[1]航空总医院关节外科,北京100012 [2]首都医科大学附属北京积水潭医院矫形骨科,北京100035

出　　处：《中华骨与关节外科杂志》2023年第12期1062-1067,共6页Chinese Journal of Bone and Joint Surgery

基　　金：首都医学发展科研基金(2009-3098)。

摘　　要：目的:探索国际骨微循环协会(ARCO)分型对早期股骨头缺血性坏死(ONFH)治疗的指导意义。方法:回顾性分析2016年7月至2020年11月行纳米羟基磷灰石/聚酰胺66支撑棒结合同种异体骨治疗的早期ONFH患者93例133髋。采用Harris髋关节评分(HHS)评估髋关节功能;根据X线片测量股骨头塌陷的深度,股骨头塌陷>2 mm被认为影像学失败;最终行全髋关节置换术(THA)被认为手术失败,随访终止。结果:随访时间为6~68个月,平均(45.3±9.5)个月。术前患者HHS评分为(79.1±13.7)分,末次随访时提高到(81.7±20.5)分(P=0.125);通过ARCO分型分析发现,末次随访时ARCO 1型和ARCO 2型患者HHS评分均较术前明显提高(P<0.05),但ARCO 3型患者HHS评分均较术前明显降低(P<0.05)。末次随访时共73髋影像学评估塌陷>2 mm,影像学失败率为54.9%,其中ARCO 3型患者的塌陷率最高为87.5%,其次是ARCO 2型患者为18.0%,ARCO 1型患者无塌陷(P<0.05)。20髋行THA,手术失败率为15.0%,其中ARCO 3型患者的失败率最高为31.3%,其次是ARCO 2型患者为6.6%,ARCO1型患者失败率最低为4.2%(P<0.05)。单因素分析显示,ARCO分型是影像学失败(χ^(2)=67.13,P<0.001)和手术失败(χ^(2)=16.23,P<0.001)的影响因素。Cox回归分析显示,ARCO 3型ONFH是早期股骨头坏死微创保头失败的独立危险因素。结论:ARCO分型对早期ONFH的微创保头手术治疗的临床疗效有一定预判性,不建议ARCO 3型ONFH患者行微创保头手术治疗。Objective:To explore the guiding significance of Association Research Circulation Osseous(ARCO)staging in the treatment of early-stage osteonecrosis of the femoral head(ONFH).Methods:A retrospective analysis was conducted on 93 patients(133 hips)with early-stage ONFH treated with nano-hydroxyapatite/polyamide 66 support rods combined with allogeneic bone from July 2016 to November 2020.Harris hip score(HHS)was used to evaluate hip joint function.The depth of femoral head collapse was measured via X-ray imaging,and a femoral head collapse>2 mm was considered imaging failure.Total hip arthroplasty(THA)was considered a failure,leading to termination of follow-up.Results:The follow-up duration ranged from 6 to 68 months,with a mean of(45.3±9.5)months.The preoperative HHS was 79.1±13.7,which increased to 81.7±20.5 at the final follow-up,but the difference was not statistically significant(P=0.125).According to the 2021 new ARCO staging,the HHSs of ARCO stage 1 and stage 2 patients at the final follow-up were significantly higher compared to preoperative scores(P<0.05),but the HHS scores of ARCO type 3 patients were significantly lower compared to preoperative scores(P<0.05).At the final follow-up,73 hips showed collapse>2 mm by imaging evaluation,and the imaging failure rate was 54.9%.Among these,patients with ARCO stage 3 had the highest collapse rate(87.5%),followed by those with ARCO stage 2(18.0%),and no collapse occurred in ARCO stage 1 patients(P<0.05).At the final follow-up,20 hips underwent THA,and the surgical failure rate was 15.0%.Patients with ARCO stage 3 had the highest collapse rate(31.3%),followed by those with ARCO stage 2(6.6%),and those with ARCO stage 1(4.2%).Univariate risk factor analysis showed that the new ARCO staging was a risk factor of imaging failure(χ^(2)=67.13,P<0.001)and surgical failure(χ^(2)=16.23,P<0.001).Cox regression analysis showed that ARCO stage 3 ONFH was an independent risk factor for the failure of minimally invasive head preservation for early ONFH.Conclusions:ARCO sta

关 键 词：股骨头缺血性坏死 分型 微创保头 髋关节置换 

分 类 号：R683.4[医药卫生—骨科学]