股骨头坏死早中期力学修复支撑点放置位置选择  

Selection of placement position of support points for early and mid-term mechanical repair of femoral head necrosis

作　　者：李帅垒 陈晓波 宋晓兰 理阳 孙永强 LI Shuai-lei;CHEN Xiao-bo;SONG Xiao-lan;LI Yang;SUN Yong-qiang(Henan Luoyang Orthopedic Hospital,Henan Province Orthopedic Hospital,Zhengzhou 450008,Henan,China)

机构地区：[1]河南省洛阳正骨医院河南省骨科医院郑州院区,河南郑州450008

出　　处：《中国骨伤》2024年第8期808-813,共6页China Journal of Orthopaedics and Traumatology

基　　金：河南省中医药管理局重大专项(编号:2019ZYZD01)。

摘　　要：目的:探讨股骨头坏死早中期力学修复时主要力学支撑点的放置位置对预防股骨头塌陷的作用。方法:回顾性分析2018年6月至2019年6月早中期非创伤性股骨头坏死17例22髋,男14例18髋,女3例4髋;年龄34~47岁;其中激素性6例,酒精性8例,特发性3例。根据中日友好医院(China-Japan Friendship Hospital,CJFH)分型,L1型9髋,L2型8髋,L3型5髋。所有病例给予死骨刮除,自体髂骨颗粒打压植骨,异体腓骨柱支撑治疗。术后给予三七接骨丸口服3个月。术后及随访行双髋关节X线检查,手术前后采用髋关节Harris评分评价临床疗效。结果:所有病例获得随访,时间24~38个月。17例22髋Harris评分由术前58~77分提高至末次随访68~94分;术后髋关节功能评价结果:优3髋,良11髋,可3髋,差5髋。2髋L2型进展到国际骨循环研究协会(Association Research Circulation Osseous,ARCO)ⅢB期继续观察,2髋L2型、2髋L3型进展到ARCOⅣ期行全髋关节置换术,1髋术后3个月时出现感染给予旷置术。结论:基于CJFH分型基础之上,根据骨坏死的面积、体积、部位及人体生物学特点一定程度上能预测塌陷,并在此基础上找到主要力学支撑点进行力学修复预防塌陷。Objective To investigate the clinical efficacy of the placement of the main mechanical support points in the early and middle stages of mechanical repair of femoral head necrosis in preventing collapse of the femoral head.Methods A retrospective analysis was performed for 17 cases 22 hips of non-traumatic femoral head necrosis in the early and middle stages from June 2018 to June 2019,including 14 males 18 hips and 3 females 4 hips,aged 34 to 47 years old.Among them,6 cases were hormonal,8 were alcoholic and 3 were idiopathic.According to China-Japan Friendship Hospital(CJFH)classification,9 hip were type L1,8 were L2,5 were L3.All cases were given dead bone scraping,autologous iliac granules pressed bone grafting,and allogeneic fibula column support treatment.After surgery,Sanqi Jiegu Pill(三七接骨丸)was administered orally for 3 months.X-rays of both hips were performed after surgery and follow-up,and the clinical efficacy was evaluated by hip Harris score before and after surgery.Results All cases were followed up for 24 to 38 months.The Harris score of 22 hips increased from 58 to 77 preoperative to 68 to 94 at the final follow-up.At the final follow-up,3 hips were excellent,11 hips were good,3 hips were acceptable,5 hips were poor.Two hips of L2 type progressed to ARCOⅢB stage and continued to be observed,2 hips of L2 type and 2 hips of L3 type progressed to ARCOⅣstage,and received total hip replacement,and 1 hip infection at 3 months after surgery was given a cement spacer.Conclusion Based on CJFH classification,collapse can be predicted to a certain extent according to the area,volume,location and human biological characteristics of osteonecrosis,and the main mechanical support points are found on this basis to prevent collapse.

关 键 词：股骨头坏死 生物力学 塌陷 修复 

分 类 号：R681.8[医药卫生—骨科学]