摘要
背景：关节镜辅助下经皮微创髓芯减压、植入复合自体骨髓骨诱导活性材料联合钛棒支撑治疗Ⅱ期股骨头坏死（osteonecrosis of the femoral head，ONFH）的手术方法及早期术后疗效己得到学术界的认可，但少见术后股骨头生存率的统计学分析报道。目的：分析关节镜辅助下病灶清除、植骨、钛棒支撑治疗Ⅱ期股骨头坏死术后的生存率。方法：2003～2013年确诊的股骨头坏死ARCO分期Ⅱ期58例74个髋，其中ⅡA期15髋、ⅡB期34髋、11C期25髋。“C”型臂透视定位及关节镜辅助下，经皮微创进行髓芯减压，股骨头内病灶清除，植入复合自体骨髓的骨诱导材料，并钛棒支撑股骨头。术后定期随诊，生存率分析包括：疼痛评分，Harris髋关节评分，x线观察，Kaplan-Meier生存曲线分析。结果：无论VAS评分还是Harris评分术后各时间点与术前比较改善明显，差异均有统计学意义（P〈0．05）。X线观察发现原ⅡB期5例（5髋）、ⅡC期6例（6髋）病变恶化并且股骨头塌陷，其中10例进展为Ⅲ期实施THA；手术后总改善率79．72％，ⅡA期改善率最好93．33％，lIB期改善率82．35％，ⅡC期改善率最低68％，末次随访生存率为64．2％（95％可信区间，64．2％～90．1％），ⅡC期病变3年生存率最低，加重的病例均为激素性ONFH患者。结论：关节镜辅助下病灶清除、植骨、钛棒支撑治疗Ⅱ期股骨头坏死，除ⅡC期激素性病变疗效改善极差并且生存率最低应慎重选择外，对其他Ⅱ期病变生存率及临床疗效较佳，并且有效防止股骨头塌陷。
Background： Arthroscopic assisted minimally invasive percutaneous decompression and bone grafting has been applied in the treatment of osteonecrosis of the femoral head （ONFH）, and there are many reports on the curative effect at early-stage. But there are few literatures on long-term survival analysis of the femoral head. Objective： To assess the long- term survival rate of the stage ]I ONFH treated by arthroscopy assisted lesion clearance, bone graft and titanium rod sup- port. Methods： A total of 58 patients （74 hips） diagnosed as stage Ⅱ ONFH according to the ARCO staging system during 2003-2013 were enrolled in this study. There were15 hips at stage Ⅱ A, 34 hips at stage ⅡB and 25 hips at stage 1I C. Mini- mally-invasive percutaneous decompression and lesion clearance within the femoral head were accurately performed by the C-arm and arthroscopy, and then the OAM composite of autologous bone marrow was implanted and the femoral head was supported using the titanium rod. VAS pain score, Harris hip score and X-ray examination were assessed at 6, 12, 24 and 36 month postoperatively. Kaplan-Meier survival curve was used for the survival analysis. Results： Postoperative VAS score and the Harris score at each time point were significantly different from preoperative one （P〈0.05）. X-ray showed 5 cases （5 hips） progressed from stage 11 B to stage 1I C, the femoral head of 6 cases （6 hips） at staged Ⅱ C collapsed at 24 months after the operation which underwent THA. The total improvement rate after the surgery was 79.72% （93.33% for stage ⅡA, 82.35% for stage l/B and 68% for stage Ⅱ C）. The total survival rate of these patients was 64.2% （95% CI, 64.2% -90.1%）. Conclusions： Arthroscopy assisted lesion clearance, bone graft and titanium rod support is effective for the stage Ⅱ ONFH and can prevent the femoral head from collapsing. But for stage Ⅱ C patients who had a history of the use of hormone, this surgery should be chosen carefully because the outcome is always very poor.
出处
《中国骨与关节外科》
2016年第5期394-397,共4页
Chinese Journal of Bone and Joint Surgery
基金
河北省卫生厅2007年医学科学研究重点课题计划(07341)
河北省张家口市2007年科学技术与发展指令计划(0711045D-5)
关键词
股骨头坏死
关节镜
存活率
治疗结果
Femur Head Necrosis
Arthroscopes
Survival Rate
Treatment Outcome
