摘要
目的对ARCOⅡa期至Ⅲa期股骨头坏死(osteonecrosis of the femoral head,ONFH)且接受大通道钻孔减压、病灶清除,并经减压通道行股骨头内自体松质骨、同种异体颗粒骨打压植骨、同种异体腓骨条植骨治疗的患者进行短期临床疗效分析。方法2018年1月至2020年12月,四川省骨科医院纳入47例(59髋)股骨头坏死患者。其中,男39例,女8例;年龄29~51岁,平均37.2岁;ARCOⅡa期16髋,ARCOⅡb期21髋,ARCOⅡc期13髋,ARCOⅢa期9髋;酒精性ONFH 46髋(酒精组),激素性ONFH 13髋(激素组)。术后门诊随访,复查X线片(双髋正位及蛙式位片),观察股骨头形态及骨整合情况,记录患髋Harris评分。结果本组47例(59髋)随访24~36个月,平均随访30个月。术后所有患者疼痛明显缓解,部分患者疼痛消失(包括Ⅱa期14髋,Ⅱb期13髋,Ⅱc期4髋)。6例(9髋)患者病情进展股骨头发生塌陷,其中Ⅱb期1髋,Ⅱc期3髋,Ⅲa期5髋。按病因分,酒精性坏死塌陷6髋,塌陷率13%;激素性坏死塌陷3髋,塌陷率23.1%。酒精组和激素组末次随访时Harris评分与术前比较,差异均有统计学意义(P<0.05);酒精组术后Harris评分(82.7±5.6)分显著高于激素组(78.3±8.3)分,差异具有统计学意义(P<0.05)。不同ARCO分期患者术后髋关节功能均得到一定程度改善,其中Ⅱa及Ⅱb期优良率78.4%,Ⅱc、Ⅲa期优良率50%(P<0.05)。结论针对ARCOⅡa期至Ⅲa期股骨头坏死的患者,采用大直径通道减压、清除死骨,同时植入自体松质骨和同种异体颗粒骨混合物,最后配合同种异体腓骨条加强支撑,短期可有效防止坏死股骨头的塌陷并减轻疼痛、改善患功能。
Objective To analyze the short-term clinical efficacy of patients with osteonecrosis of the femoral head(ONFH)in ARCOⅡa toⅢa stage who underwent decompression by large channel drilling,removal of the lesion,and bone grafting with autogenous cancellous bone in the femoral head,allogeneic granular bone,and allogeneic fibula.Methods From January 2018 to December 2020,47 patients(59 hips)with osteonecrosis of the femoral head were enrolled in Sichuan Orthopaedic Hospital.There were 39 males and 8 females,aged from 29 to 51 years,with an average age of 37.2 years.There were 16 hips in stage ARCOⅡa,21 hips in stage ARCOⅡb,13 hips in stage ARCOⅡc,and 9 hips in stage ARCOⅢa;46 hips had alcoholic ONFH(alcohol group)and 13 hips had hormonal ONFH(hormone group).After the postoperative outpatient follow-up,the X-ray(anteroposteric and frog radiographs of both hips)was reviewed to observe the morphology of the femoral head and bone integration,and the Harris score of the affected hip was recorded.Results A total of 47 patients(59 hips)were followed up for 24-36 months,with an average follow-up of 30 months.Postoperative pain relief was evident in all patients and disappeared in some patients(Ⅱa 14 hips,Ⅱb 13 hips,Ⅱc 4 hips).Femoral head collapse occurred in 6 patients(9 hips),including 1 hip in stageⅡb,3 hips in stageⅡc,and 5 hips in stageⅢa.According to the etiology,6 hips collapsed with alcohol necrosis(13%)and 3 hips collapsed with hormone necrosis(23.1%).There were significant differences in Harris scores between the two groups at the last follow-up compared with those before surgery(P<0.05).The Harris score of alcohol group[(82.7±5.6)scores]was significantly higher than that of hormone group[(78.3±8.3)scores]after operation,and the difference was statistically significant(P<0.05).The hip joint function of patients with different ARCO stages was improved to some extent,among which the excellent and good rate ofⅡa andⅡb was 78.4%,and the excellent and good rate ofⅡc andⅢa was 50%(P<0.05).Conclusion For patients with osteonecrosis of the femoral head at stage ARCOⅡa-Ⅲa,large-diameter channel decompression and removal of dead bone are adopted,and autologous cancellous bone and allogeneic granular bone mixture are implanted at the same time,and finally combined with allogeneic fibula bones to strengthen the support,which could effectively prevent collapse of necrotic femoral head in the short term,reduce pain and improve patients'function.
作者
毕梦娜
李钟
杨磊
斯焱
Bi Mengna;Li Zhong;Yang Lei;Si Yan(Department of Geriatric Orthopedics,Sichuan Orthopaedic Hospital,Chengdu Sichuan,610000,China)
出处
《生物骨科材料与临床研究》
CAS
2023年第5期63-68,共6页
Orthopaedic Biomechanics Materials and Clinical Study
关键词
股骨头坏死
钻孔减压
打压植骨
腓骨
Osteonecrosis of the femoral head
Drilling decompression
Allogeneic bone
Fibula
