双通道髓芯减压联合髓腔冲洗技术治疗非创伤性股骨头坏死  

Clinical study of double-channel core decompression combined with medullary cavity irrigation for non-traumatic osteonecrosis of femoral head

作　　者：马金辉[1] 李宏旭 刘浩洋 王佰亮[1] 王卫国[1] 高福强[1] 孙伟 程立明[1] MA Jinhui;LI Hongxu;LIU Haoyang;WANG Bailiang;WANG Weiguo;GAO Fuqiang;SUN Wei;CHENG Liming(Department of Bone and Joint Surgery,China-Japan Friendship Hospital,Beijing,100029,P.R.China;Peking University China-Japan Friendship School of Clinical Medicine,Beijing,100029,P.R.China;Department of Bone and Joint Surgery,Chengdu Hip-Preserving Femoral Head Orthopedic Hospital,Chengdu Sichuan,610036,P.R.China)

机构地区：[1]中日友好医院骨科·关节外科,北京100029 [2]北京大学中日友好临床医学院,北京100029 [3]成都保髋股骨头骨科医院骨关节外科,成都610036

出　　处：《中国修复重建外科杂志》2025年第4期399-405,共7页Chinese Journal of Reparative and Reconstructive Surgery

基　　金：首都医科大学教育教学改革研究课题(2023JYY388);中央高水平医院临床科研业务费-中日友好医院“菁英计划”人才培育工程项目(ZRJY2021-TD01);中央高水平医院临床科研业务费专项(2024-NHLHCRF-PYI-01);国家自然科学基金面上项目(52373273)。

摘　　要：目的与单纯髓芯减压(core decompression,CD)治疗相比,探讨双通道CD联合髓腔冲洗技术对非创伤性股骨头坏死(osteonecrosis of the femoral head,ONFH)塌陷进展以及临床结果的影响。方法回顾性分析2024年1月—10月因ONFH行双通道CD联合髓腔冲洗治疗且符合选择标准的19例(30髋)患者(CD+冲洗组)临床资料,按照1∶2比例纳入年龄、性别、身体质量指数(body mass index,BMI)匹配的54例(60髋)单纯CD患者作为对照(CD组)。两组患者性别、年龄、BMI、手术侧别、ONFH类型以及术前国际骨循环协会(ARCO)分期、骨髓水肿分期、疼痛视觉模拟评分(VAS)、Harris评分等基线资料比较,差异均无统计学意义(P>0.05)。记录并比较两组患者术后住院时间以及并发症发生情况;术前及术后出院时VAS评分,计算手术前后差值(变化值);术前及术后出院、3个月时Harris评分。随访期间行X线片、CT和双髋MRI复查,术后3个月行ARCO分期和骨髓水肿分期,并与术前比较确定是否存在影像学进展或缓解。结果术后两组患者切口均Ⅰ期愈合,无感染、股骨颈骨折等手术相关并发症发生。两组患者均获随访,CD+冲洗组随访时间为(146.8±27.7)d,CD组为(164.3±48.2)d,组间差异无统计学意义(t=1.840,P=0.069)。两组术后住院时间差异无统计学意义(P>0.05)。术后出院时CD+冲洗组VAS评分低于CD组,变化值高于CD组,差异均有统计学意义(P<0.05)。CD+冲洗组术后出院时、3个月时Harris评分均高于CD组,差异均有统计学意义(P<0.05);组内随时间延长,Harris评分逐渐增高,各时间点间差异均有统计学意义(P<0.05)。影像学复查示,术后3个月两组ARCO分期以及影像学进展差异均无统计学意义(P>0.05);而CD+冲洗组骨髓水肿分期以及骨髓水肿缓解均优于CD组,差异有统计学意义(P<0.05)。结论双通道CD联合髓腔冲洗技术能明显减轻ONFH患者髋关节疼痛和改善关节功能,缓解股骨头骨髓水肿�Objective To compare the effects of double-channel core decompression(CD)combined with medullary cavity irrigation with those of simple CD on progression of collapse and clinical outcomes in non-traumatic osteonecrosis of the femoral head(ONFH).MethodsA retrospective analysis was conducted on the clinical data of 19 patients(30 hips)with non-traumatic ONFH who underwent double-channel CD combined with medullary cavity irrigation and admitted between January 2024 and October 2024(CD+irrigation group).According to a 1:2 ratio,54 patients(60 hips)who underwent simple CD and were matched in terms of age,gender,and body mass index(BMI)were included as the control(CD group).There was no significant difference in baseline data such as age,gender,BMI,affected side,ONFH type,preoperative Association Research Circulation Osseous(ARCO)stage,bone marrow edema stage,visual analogue scale(VAS)score for pain,and Harris score between the two groups(P>0.05).The postoperative discharge time and occurrence of complications were recorded for both groups.The VAS scores before operation and at discharge after operation were compared,and the differences between pre-and post-operation(change values)were calculated for intergroup comparison.The Harris scores before operation and at discharge and 3 months after operation were also compared.During follow-up,X-ray film,CT,and MRI were performed for reexamination.The ARCO stage and bone marrow edema stage were evaluated at 3 months after operation and compared with those before operation to determine whether there was radiological progression or relief.ResultsAll incisions in both groups healed by first intention after operation,with no infection,femoral neck fracture,or other operation-related complications.All patients were followed up,and the follow-up time of the CD+irrigation group was(146.8±27.7)days,and that of the CD group was(164.348.2)days;there was no significant difference between the two groups(t-1.840,P-0.069).There was no significant difference in the length of hospital stay

关 键 词：股骨头坏死 髓芯减压 髓腔冲洗 骨髓水肿 

分 类 号：R687.3[医药卫生—骨科学]