股骨头前、外侧保留角和联合保留角在股骨头坏死经髋关节外科脱位打压植骨支撑术适应证选择中的作用  

The role of anterior,lateral and combined preserved angles of femoral head in the selection of indications for impaction bone grafting through surgical hip dislocation approach for treating osteonecrosis of the femoral head

作　　者：洪志楠 宋雨珂 何晓铭 何伟 魏秋实 HONG Zhinan;SONG Yuke;HE Xiaoming;HE Wei;WEI Qiushi(The Third Affiliated Hospital of Guangzhou University of Chinese Medicine,Guangzhou 510378,Guangdong,China)

机构地区：[1]广州中医药大学第三附属医院,广东广州510378

出　　处：《中医正骨》2024年第9期69-75,共7页The Journal of Traditional Chinese Orthopedics and Traumatology

基　　金：国家自然科学基金项目(82274544,82004392);广东省基础与应用基础研究基金项目(2023A1515010551);毕节市科学技术局2022年度“揭榜挂帅”项目[毕科合重大专项[2022]1号];广东省中医骨伤研究院开放课题重点项目(GYH202101-01,GYH202101-04)。

摘　　要：目的:探讨股骨头前侧保留角(anterior preserved angle,APA)、外侧保留角(lateral preserved angle,LPA)和联合保留角(combined preserved angle,CPA)在股骨头坏死(osteonecrosis of the femoral head,ONFH)经髋关节外科脱位打压植骨支撑术适应证选择中的作用。方法:以2020年1月至2022年12月在广州中医药大学第三附属医院接受经髋关节外科脱位打压植骨支撑术治疗的ONFH患者为研究对象。收集患者的性别、年龄、ONFH分期和分型,以及手术前后、随访期间双侧髋关节蛙位和正位X线片等信息。在患者术前双侧髋关节蛙位和正位X线片上分别测量股骨头APA和LPA,二角之和为股骨头CPA。以行全髋关节置换术为终点事件,采用Kaplan-Meier法分析经髋关节外科脱位打压植骨支撑术后股骨头生存情况;采用受试者工作特征(receiver operating characteristic,ROC)曲线确定股骨头APA、LPA和CPA预测经髋关节外科脱位打压植骨支撑术治疗失败的最佳临界值,并根据此临界值进行二分类后采用Kaplan-Meier法分析其对股骨头生存情况的预测效果。结果:(1)一般情况。共纳入109例患者,随访时间8~47个月,中位数25个月。患者术前股骨头APA 43.71°±14.43°,LPA 53.08°±15.62°,CPA 96.79°±24.60°。随访期间,18髋改行全髋关节置换术,其中17髋发生在经髋关节外科脱位打压植骨支撑术后2年内。(2)经髋关节外科脱位打压植骨支撑术后股骨头生存情况。术后1年、2年和3年股骨头生存率分别为97.5%、86.1%和81.6%。(3)股骨头APA、LPA和CPA对经髋关节外科脱位打压植骨支撑术治疗失败的预测价值评价结果。股骨头APA、LPA和CPA预测经髋关节外科脱位打压植骨支撑术治疗失败的曲线下面积分别为0.835、0.765、0.854,敏感度分别为67.3%、75.2%、91.1%,特异度分别为88.9%、72.2%、72.2%,临界值分别为39.5°、46.5°、75.0°。(4)股骨头APA、LPA和CPA对经髋关节外科脱位打压植骨支撑�Objective:To explore the role of anterior preserved angle(APA),lateral preserved angle(LPA)and combined preserved angle(CPA)of femoral head in the selection of indications for impaction bone grafting through surgical hip dislocation(SHD)approach for treating osteonecrosis of the femoral head(ONFH).Methods:The patients who underwent impaction bone grafting through SHD approach for ONFH in the Third Affiliated Hospital of Guangzhou University of Chinese Medicine from January 2020 to December 2022 were selected as the subjects,and their information,including gender,age,ONFH staging and typing,as well as the X-ray films of bilateral hip joints in normotopia and froglike position before and after the surgery and during follow-up period,was collected.The APA and LPA of the femoral head were measured on the presurgical X-ray films of bilateral hip joints in normotopia and froglike position,respectively,and the sum of the two angles was the CPA of femoral head.With total hip arthroplasty(THA)as the endpoint event,the survival of femoral head after the impaction bone grafting through SHD approach was analyzed by using Kaplan-Meier method.Furthermore,the optimal critical values of APA,LPA and CPA of femoral head in predicting the failure of impaction bone grafting through SHD approach in treating ONFH were determined by using the receiver operating characteristic(ROC)curve.The binary classification was performed on the APA,LPA and CPA of femoral head based on the critical values,and then the Kaplan-Meier method was used to analyze the predictive effects of APA,LPA and CPA of femoral head on the survival of the femoral head.Results:①General condition.One hundred and nine patients were included in the study,and they were followed up for 8-47 months with a median of 25 months.The preoperative femoral head APA,LPA and CPA were 43.71±14.43,53.08±15.62,and 96.79±24.60 degrees,respectively.During the follow-up period,18 hips were re-treated with THA,among which 17 ones experienced a re-operation within 2 years after impactio

关 键 词：股骨头坏死 髋关节 脱位 股骨头前侧保留角 股骨头外侧保留角 股骨头联合保留角 骨移植 适应证 

分 类 号：R687.3[医药卫生—骨科学]