摘要
目的探讨髓芯减压病灶清除打压植骨术治疗股骨头坏死的动态临床效果。方法根据纳入与排除标准,收集经髓芯减压病灶清除打压植骨术治疗并获得3年以上随访的股骨头坏死患者临床资料共41例50髋,分别将术前、术后3个月,术后1年及术后3年不同随访时点的X线和临床材料进行动态观察,以Harris评分、X线稳定率、股骨头形态、囊变面积、骨关节炎发生为评价指标,分析统计随访结果。结果 Harris评分术后3年的优良率为84.00%,明显高于治疗前66.00%(Z=16.08,P=0.00);X线稳定率术后1年达到80%以上,而3年与1年比较差异无统计学意义,其中L1型91.66%优于L3型的75.00%;股骨头塌陷程度无论在术后1年或3年,总体、L1型与治疗前比较均无统计学差异(P>0.05),而L3型则存在统计学意义的差异(P<0.05);股骨头囊变面积在任何随访时点,总体、L1型和L3型与治疗前比较,均存在统计学差异(P<0.01);骨关节炎程度,无论是总体、L1型,还是L3型,术后3月、1年与治疗前比较无统计学差异(P>0.05),而在3年时,L1型骨关节炎的程度亦无统计学差异(P>0.05),而总体、L3型骨关节炎的程度则与治疗前比较有统计学差异(P<0.01)。结论髓芯减压病灶清除植骨术治疗股骨头坏死在不同分期均有良好的疗效,且保留外侧柱的效果好于全股骨头坏死;动态观察治疗过程中的股骨头塌陷程度、囊变面积及骨关节炎等相关指标,有利于了解疗效特点和病情状态,及时调整治疗和康复的方案。
Objective To investigate the clinical effects of the core decompression and the focal lesion debridement combining the bone grafting on the osteonecrosis of the femoral head （ ONFH ） .＆amp;nbsp;Methods The clinical information of 41 cases （ 50 hips ） with ONFH were collected according to the including criteria.All these patients were treated by the core decompression and focal lesion debridement combining the bone grafting surgery, and followed up for more than three years.The data such as radiographic images and clinical records in different time points （ before the surgery, three months, one year and three years after the surgery） were adopted for this investigation.Harris Hip Score （ HHS） , the stability rate in the X-ray image, the morphology of the femoral head, the area of the cystic lesion, and the morbidity of osteoarthritis were used as indicators for the assessment.Results The HHS excellent rate in the third year was 84.00%which was higher than that in the first year （66.00%, Z=16.08, P=0.00）. The stability rate in the X-ray image was 80%and did not changed significantly in the following two years. The L1 type （91.66%） received better results than the L3 type （75.00%）.The change of the collapse degree of the femoral head was not statistically significant in L1 type （ P〉0.05 ） , but it had significant difference in L3 type （P〈0.05）.For L1 and L3, the cystic lesion area varied dramatically in each single time point （P＆lt;0.01）.Compared with the preoperative data, the osteoarthritis degree showed no statistical difference after the surgery in L1 group （ P〉0.05 ） , while there was a significant difference in the osteoarthritis degree of the L3 group after the treatment （ P〈0.01） .Conclusion The core decompression and the focal lesion debridement combining the bone grafting surgery possesses favorable effects in the treatment of ONFH in different stages.It has better outcome in the lateral lesion type than the diffusive lesion of the whole femoral head.The observation of the collapse degree, the cystic lesion area and the osteoarthritis degree is beneficial for understanding the curative effects and can provide useful informations for adjusting the treatment and rehabilitation regimen.
出处
《中华关节外科杂志（电子版）》
CAS
2014年第5期16-20,共5页
Chinese Journal of Joint Surgery(Electronic Edition)
基金
"十一五"国家科技支撑计划项目(2007BAI20B035)
北京市自然科学基金资助项目(7142170)
关键词
股骨头坏死
疗效
动态研究
Femur head necrosis
Curative effect
Dynamic study
