开窗与髓芯减压植骨治疗中期股骨头坏死  

Fenestration versus core decompression and bone grafting for medium-term femoral head necrosis

作　　者：查杨晓志 陈雁雄 张俊 连星烨 孟增东 ZHA Yang-xiao-zhi;CHEN Yan-xiong;ZHANG Jun;LIAN Xing-ye;MENG Zeng-dong(Department of Orthopedics,Kunming University of Science and Technol-ogy Affiliated Hospital,The First People's Hospital of Yunnan Province,Kunming,Yunnan 650032,China)

机构地区：[1]昆明理工大学附属医院(云南省第一人民医院)骨科,云南昆明650032

出　　处：《中国矫形外科杂志》2025年第1期5-11,共7页Orthopedic Journal of China

基　　金：云南省卫生健康委员会医学领军人才培养计划项目(编号:L-2018004);云南省“兴滇英才支持计划”名医专项项目(编号:XDYCMY-2022-0027);云南省科技厅科技计划重点研发计划项目(编号:202403AC100003)。

摘　　要：[目的]比较股骨头-颈交界开窗减压打压植骨术与股骨头髓芯减压打压植骨重建棒置入术治疗中期股骨头缺血性坏死(osteonecrosis of the femoral head,ONFH)的临床疗效。[方法]回顾性分析本院2014年6月—2022年4月收治的100例ONFH患者的临床资料,按照术前医患沟通结果,行开窗(开窗组)与髓芯(髓芯组)减压植骨治疗各50例。比较两组围手术期、随访及影像资料。[结果]开窗组手术时间[(54.4±7.2)min vs(46.3±6.8)min,P<0.001]、切口总长度[(4.2±0.8)cm vs(3.5±0.6)cm,P<0.001]、术中失血量[(100.5±12.0)ml vs(50.8±7.4)ml,P<0.001]均显著多于髓芯组,但前者的植骨量[(2.5±0.5)g vs(4.3±0.6)g,P<0.001]、下地行走时间[(96.0±5.2)d vs(106.3±10.6)d,P<0.001]、住院天数[(5.5±0.7)d vs(7.0±1.2)d,P<0.001]均显著少于髓芯组。随访时间平均(30.0±3.5)个月,开窗组完全负重活动时间显著早于髓芯组[(180.8±26.5)d vs(200.0±35.0)d,P=0.003]。随时间推移,两组术后VAS评分、HHS评分、iHOT-33评分及髋伸-屈、髋内-外旋ROM均显著改善(P<0.05)。开窗组术后3个月VAS评分[(2.8±0.6)vs(3.1±0.8),P=0.036]、HHS评分[(76.7±5.6)vs(72.4±6.5),P<0.001]、iHOT-33评分[(64.8±6.0)vs(60.5±5.6),P<0.001]均显著优于髓芯组。末次随访时开窗组股骨头生存率的差异无统计学意义[42/50(84.0%)vs 37/50(74.0%),P=0.220]。21例保髋失败患者中,行翻修髋关节置换术10例(47.6%)。影像方面,与术前相比,术后6个月及末次随访时,两组ARCO分级、T?nnis分期无显著变化(P>0.05),但是,两组病灶、关节积液征象显著改善(P<0.05)。相应时间点,两组上述指标比较的差异均无统计学意义(P>0.05)。[结论]开窗减压植骨治疗中期ONFH在完全负重活动时间及术后3个月髋关节功能改善上优于髓芯减压植骨。[Objective]To compare the clinical efficacy of fenstration at femoral head-neck interface for decompression and impacting bone grafting(the FDBG)versus core decompression,and impacting bone grafting with a strut graft(the CDBG)for medium-term osteonecro⁃sis of the femoral head(ONFH).[Methods]A retrospective study was conduted on 100 patients who underwent surgical treatment for medi⁃um-term ONFH in our hospital from June 2014 to April 2022.According to the preoperative doctor-patient communication,50 patients re⁃ceived the FDBG,while other 50 patients underwent the CDBG.The perioperative,follow-up and imaging data of the two groups were com⁃pared.[Results]The FDBG group proved significantly greater than the CDBG group in term of operation time[(54.4±7.2)min vs(46.3±6.8)min,P<0.001],total length of incision[(4.2±0.8)cm vs(3.5±0.6)cm,P<0.001],intraoperative blood loss[(100.5±12.0)ml vs(50.8±7.4)ml,P<0.001],whereas the former was significantly less than the latter regarding volume of bone graft[(2.5±0.5)g vs(4.3±0.6)g,P<0.001],ambu⁃lation time[(96.0±5.2)days vs(106.3±10.6)days,P<0.001]and hospitalization days[(5.5±0.7)days vs(7.0±1.2)days,P<0.001].All patients in both groups were followed up for a mean of(30.0±3.5)months,and the FDBG group resumed full weight-bearing activity significantly ear⁃lier than the CDBG group[(180.8±26.5)days vs(200.0±35.0)days,P=0.003].The VAS score,HHS score,iHOT-33 score,hip extensionflexion range of motion(ROM)and hip internal-external rotation ROM significantly improved in both groups over time(P<0.05).The FDBG group was significantly superior to the CDBG group in terms of VAS score[(2.8±0.6)vs(3.1±0.8),P=0.036],HHS score[(76.7±5.6)vs(72.4±6.5),P<0.001]and iHOT-33 score[(64.8±6.0)vs(60.5±5.6),P<0.001]3 months postoperatively.At the last follow-up,there was no statisti⁃cally significant difference in the survival rate of the femoral head between the FDBG and CDBG groups[42/50(84.0%)vs 37/50(74.0%),P=0.220].Among the 21 patients who failed hip preservat

关 键 词：中青年 股骨头缺血性坏死 股骨头-颈交界开窗减压打压植骨术 股骨头髓芯减压打压植骨重建棒置入术 

分 类 号：R681.8[医药卫生—骨科学]