髓芯减压异体腓骨支撑移植治疗股骨头坏死  

Core decompression with or without allogenic fibula support grafting for femoral head necrosis

作　　者：张占磊 张鹏[1] 李钟[1] 毕梦娜[1] 张上上[1] 朱江伟[1] 马邹 ZHANG Zhan-lei;ZHANG Peng;LI Zhong;BI Meng-na;ZHANG Shang-shang;ZHU Jiang-wei;MA Zou(Department of Geriatric Orthopedics,Sichuan Orthopaedic Hospital,Chengdu 610000,China)

机构地区：[1]四川省骨科医院老年骨科,四川成都610000

出　　处：《中国矫形外科杂志》2024年第17期1537-1543,共7页Orthopedic Journal of China

基　　金：四川省科技厅重点研发项目(编号:2022YFS0387)。

摘　　要：[目的]探讨采用髓芯减压异体腓骨支撑移植治疗股骨头坏死(osteonecrosis of the femoral head,ONFH)的临床疗效。[方法]回顾性分析2018年6月—2020年6月本院就诊的ONFH患者的临床资料,根据医患沟通结果,43例采用髓芯减压+同种异体骨植入结合异体腓骨支撑术(支撑组),27例采用髓芯减压术(未支撑组)。比较两组围手术期、随访及影像结果。[结果]支撑组手术时间[(55.1±9.2)min vs(40.3±10.3)min,P<0.001]、切口总长度[(5.5±0.6)cm vs(3.1±0.7)cm,P<0.001]、术中失血量[(33.7±5.0)ml vs(30.9±4.6)ml,P=0.022]、术中透视次数[(4.2±1.0)次vs(3.6±1.0)次,P=0.017]均显著多于未支撑组(P<0.05),但前者切口愈合情况[例,甲/乙/丙,(30/10/3)vs(10/9/8),P=0.010],下地行走时间[(3.4±0.4)d vs(4.6±0.7)d,P<0.001]和住院天数[(4.8±0.9)d vs(7.1±1.3)d,P<0.001]均显著优于后者。两组均随访24个月,术后支撑组的ARCO分级、骨水肿和关节积液征的程度均显著改善(P<0.05),但T?nnis分期无显著变化(P>0.05)。术后未支撑组的上述指标均无显著变化(P>0.05)。两组术前、术后6个月上述指标的差异均无统计学意义(P>0.05),术后24个月时,支撑组的ARCO分级[例,I/II/III/IV,(29/12/2/0)vs(11/10/6/0),P=0.030]、骨水肿[(例,<15%/15%~30%/≥30%),(34/8/1)vs(14/10/3),P=0.044]和关节积液征[例,0/1/2/3,(30/11/2/0)vs(10/14/3/0),P=0.026]均显著优于未支撑组。[结论]在治疗ONFH方面,通过髓芯减压+同种异体骨植入结合异体腓骨支撑术,具有明显的优势,并取得较理想的临床效果。[Objective]To compare the clinical outcome of core decompression with or without fibula allograft in the treatment of osteonecrosis of the femoral head(ONFH).[Methods]A retrospective study was done on the patients who received hip preservation treatment for ONFH in our hospital from June 2018 to June 2020.According to the results of doctor-patient communication,43 cases were treated with core decompression with fibular allograft support(supported group),while other 27 cases were treated with core decompression only(unsupported group).The data of perioperative period,follow-up and imaging were compared between the two groups.[Results]Although the supported group was significantly inferior to the unsupported group in terms of operating time[(55.1±9.2)min vs(40.3±10.3)min,P<0.001],total length of incision[(5.5±0.6)cm vs(3.1±0.7)cm,P<0.001],intraoperative blood loss[(33.7±5.0)ml vs(30.9±4.6)ml,P=0.022],and intraoperative fluoroscopy times[(4.2±1.0)vs(3.6±1.0),P=0.017],the former was significantly superior to the latter in terms of incision healing grade[case,A/B/C,(30/10/3)vs(10/9/8),P=0.010],ambulation time postoperatively[(3.4±0.4)days vs(4.6±0.7)days,P<0.001]and hospitalization[(4.8±0.9)days vs(7.1±1.3)days,P<0.001].As time went in the follow-up period lasted for 24 months,the ARCO grade,bone edema and joint effusion signs significantly improved(P<0.05),while the Tonnis stage remained unchanged(P>0.05)in the supported group.However,there were no significant changes in the abovesaid items in the unsupported group(P>0.05).There was no significant difference in the above indexes before and 6 months after surgery between the two groups(P>0.05).At 24 months after surgery,the supported group proved significantly superior to the unsupported group in terms of ARCO classification[case,I/II/III/IV,(29/12/2/0)vs(11/10/6/0),P=0.030],bone edema[case,<15%/15%~30%/≥30%,(34/8/1)vs(14/10/3),P=0.044]and joint effusion[case,0/1/2/3,(30/11/2/0)vs(10/14/3/0),P=0.026].[Conclusion]For hip preservation treatment of ONFH,cor

关 键 词：股骨头坏死 髓芯减压 异体腓骨支撑术 

分 类 号：R681.8[医药卫生—骨科学]