股骨头坏死塌陷的预测与治疗方法的选择  

Prediction of collapse and selection of preserving femoral head for the osteonec rosis of the femoral head

作　　者：李子荣[1] 张念非[1] 史振才[1] 赵凤朝[1] 聂智青[1] 

机构地区：[1]中日友好医院骨科,北京100029

出　　处：《中华骨科杂志》2003年第4期193-196,共4页Chinese Journal of Orthopaedics

基　　金：卫生部资助课题(98-2-038)

摘　　要：目的回顾性研究股骨头坏死塌陷的危险因素,分析保留股骨头的治疗方法的可行性。方法1993年10月～2000年4月对40例56髋股骨头坏死采取保留股骨头的治疗方法,年龄16～60岁,平均36.8岁。术前均摄髋关节正位及蛙式侧位X线片,冠状面及矢状面MRI。根据ARCO分期,采用三种治疗方法:(1)非手术治疗,计10例14髋,其中Ⅰ期7髋(ⅠA4髋、ⅠC3髋)、Ⅱ期7髋(ⅡA1髋、ⅡB3髋、ⅡC3髋);(2)经关节髓心减压带血管髂骨移植(VICBG),计18例24髋,其中Ⅰ期6髋(ⅠB4髋、ⅠC2髋)、Ⅱ期16髋(ⅡA4髋、ⅡB8髋、ⅡC4髋)、Ⅲ期2髋(ⅢA);(3)经股骨转子间旋转截骨术(TRO),计12例18髋,其中Ⅱ期1髋(ⅡC)、Ⅲ期17髋(ⅢA8髋、ⅢB7髋、ⅢC2髋)。56髋术前Harris评分为46～82分,平均62.9分。结果全部病例随访12～68个月,平均29.2个月。非手术治疗组塌陷9髋(64.3%),VICBG组塌陷10髋(41.7%),TRO组塌陷1髋(5.6%)。不考虑有无手术干预,ⅠA及ⅡA型无一髋进展至Ⅲ期(塌陷开始,0/9),而ⅠB及ⅡB型有7髋(7/15)、ⅠC及ⅡC型全部(13/13)进展至Ⅲ期或Ⅲ期以上。术后Harris评分为47～93分,平均77.4分。结论应用MRI可预测Ⅰ、Ⅱ期股骨头坏死塌陷的可能,坏死面积小于30%为低危、30%～60%为中危、大于60%为高危。根据ARCO分期、患者年龄及坏死范围个体化地选择保留?Objective To explore the risk factors of collapse of osteonecro si s of the femoral head (ONFH) with a retrospective study, and put forward a treat ment protocol according to this study results. Methods From October 1993 to Apri l 2000, 40 cases (56 hips) were followed-up. The term of follow-up ranged from 1 2 to 68 months (average 29.2 months). The age of patients was from 16 to 60 year s old (average 36.8 years old). Preoperatively, the AP and frog view X-ray film, coronal and sagittal MRI were taken. The staging of ONFH proposed by ARCO was a dopted. Clinically the Harris score was used to assess the clinical outcome. The patients were divided into three groups: 1) Non-operative: 10 cases (14 hips), stage Ⅰin 7 hips(ⅠA 4,ⅠC 3),stageⅡin 7 hips (ⅡA 1,ⅡB 3,ⅡC 3); 2) Core dec ompression with vascularized iliac bone graft (VICBG): 18 cases (24 hips ), stag eⅠin 6 hips (ⅠB 4,ⅠC 2), stageⅡin 16 hips (ⅡA 4,ⅡB 8,ⅡC 4), stageⅢ in 2 hips (ⅢA); 3) Transtrochanteric rotational osteotomy(TRO): 12 cases (18 hips), stageⅡin 1 hip (ⅡC), stageⅢ in 17 hips (ⅢA 8, ⅢB 7,ⅢC 2). Harris score was 46 to 82 (mean 62.9). Results Collapse of the femoral head occurred in 9 hips a mong the 14 hips in the nonoperative group, in 10 hips among the 24 hips in the VICBG group. In TRO group, further deterioration was prevented in all but one hi p. Whether theres surgical intervention or not, no collapse occurred in both s tageⅠA and ⅡA, collapse occurred in both stage ⅠB and ⅡB was 7 hips among 15 hips (46.7%), 13 hips progressed into collapse of the femoral head with ⅠC and ⅡC (100%). The Harris score was 47 to 93(mean 77.4) postoperatively. Conclusio n With MR imaging, it is possible to predict the possibility of collapse of ONFH . The lower risk is below 30 percent of necrotic area, the higher risk is 30 to 60 percent of necrotic area, and the higherest risk is beyond 60 percent of necr otic area. The best results can be obtained if selection of treatment individual ly according to AR

关 键 词：股骨头坏死塌陷 预测 治疗方法 选择 

分 类 号：R681.8[医药卫生—骨科学]