高位头颈开窗植骨支撑术治疗不同股骨头坏死面积患者的临床效果研究-现代医学

高位头颈开窗植骨支撑术治疗不同股骨头坏死面积患者的临床效果研究

单位：1. 泰山医学院, 山东泰安 271000;
2. 临沂市人民医院股骨头专科, 山东临沂 276000

分类号：R615

出版年·卷·期（页码）：2019·47·第五期（513-517）

摘要：

目的：探讨高位头颈开窗植骨支撑术治疗不同股骨头坏死面积患者的早中期临床疗效。方法：收集2012年1月至2013年12月在临沂市人民医院股骨头专科住院并被诊断为股骨头坏死FicatⅡ期患者87例，其中男49例（65髋），女30例（36髋）；年龄19~51岁，平均年龄39.1岁；随访79例，失访8例，失访率9.2%。参照日本骨坏死研究会（JIC）的标准，将患者依据坏死面积进行分型，其中A型11髋，B型65髋，C型25髋。采用高位头颈开窗植骨支撑术治疗，彻底清除坏死骨的同时，植入自体髂骨，促进股骨头内新骨形成。术后通过门诊进行随访，分别在术后第1个月、3个月、6个月、1年及以后每年收集患者的Harris功能评分及X线检查结果。结果：平均随访（42.4±12.4）个月，随访期间患者未出现感染等相关并发症。3型患髋的末次随访Harris评分均高于术前，差异有统计学意义（P<0.05）。C型患者术后末次随访Harris评分低于A、B型患者，差异有统计学意义（P<0.01），患髋总优良率由术前的34.7%提高至末次随访的82.2%。A、B型患者股骨头均未发生塌陷，C型患者有8例发生了股骨头塌陷，保头率68%（17/25）。结论：高位头颈开窗植骨支撑术对早期股骨头坏死患者有良好的临床疗效，可以显著减轻患者疼痛，改善髋关节功能，特别适用于FicatⅡ期的A、B型患者。

Objective:To discuss the clinical effect ofbone grafting through fenestration at high level on patients with different femoral head necrosis. Methods:From January 2012 to December 2013, 87 patients with Ficat stageⅡONFH were given bone grafting through fenestration at high level.And then 79 patients were followed up for an average of (42.4±12.4) months,with the mean age of 39.1 years(range,19-51 years).According to the necrotic area of femoral head, patients were divided into three sections:11 hips in group A,65 hips in group B and 25 hips in group C. The patients were given the bone grafting through fenestration at high level of femoral head and neck, involved parts of the femoral head cartilage.The effectiveness was evaluated by changes in radiographic images and Harris hip scores. Results:Seventy-nine patients (101 hips) were followed up. After the treatments with bone grafting through fenestration at high level, no infections and other complications occurred in all the patients. The Harris hip scores of the three sections were significantly higher than those before operation (P<0.05).The Harris score of group C was significantly lower than that of group A and B (P<0.01).The collapses of the femoral head were not happened in group A and B, however 8 collapses of the femoral head occurred in group C. Conclusion:Bone grafting through fenestration at high level in the treatment of osteonecrosis of the femoral head were proven to have good effects for the Ficat stage Ⅱpatients especially for group A and B.

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