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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
作者:杜希望1  韦标方2  王兆贺1 
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
关键词:股骨头坏死 自体骨移植 坏死面积 疗效 
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.

参考文献:

[1] LARSON E, JONES L C,GOODMAN S B,et al.Early-stage osteonecrosis of the femoral head:where are we and where are we going in year 2018?[J].Int Orthop,2018,42(Suppl 1):1-6.
[2] WEI B F.Treatment of osteonecrosis of the femoral head with core decompression and bone grafting[J].Hip Int,2011,21(2):206-210.
[3] 李子荣.股骨头坏死临床诊疗规范(2015年版)[J].中华关节外科杂志(电子版),2015,9(1):133-138.
[4] CAO H,GUAN H,LAI Y,et al.Review of various treatment options and potential therapies for osteonecrosis of the femoral head[J].J Orthop Translat,2016(4):57-70.
[5] 赵德伟,谢辉.成人股骨头坏死保髋手术治疗的策略及探讨[J].中国修复重建外科杂志,2018,32(7):792-797.
[6] 张鹤山,李子荣.股骨头坏死诊断与治疗的专家建议[J].中华骨科杂志,2007,27(2):146-148.
[7] 张洪雨,马志强,刘建宇.干细胞治疗股骨头坏死的相关研究[J].东南大学学报(医学版),2015,34(2):291-294.
[8] 韦标方,韦伟,孙丙银,等.高位股骨头颈开窗植骨支撑术治疗早期股骨头坏死[J].中华骨科杂志,2014,34(7):777-782.
[9] SUGANO N,ATSUMI T,OHZONO K,et al.The 2001 revised criteria for diagnosis,classifi cation,and staging of idiopathic osteonecrosis of the femoral head[J].J Orthop Sci,2002,7(5):601-605.
[10] WANG B L,SUN W,SHI Z C,et al.Treatment of nontraumatic osteonecrosis of the femoral head using bone impaction grafting through a femoral neck window[J].Int Orthop,2010,34(5):635-639.
[11] HARRIS W H.Traumatic arthritis of the hip after dislocation and acetabular fractures:treatment by mold arthroplasty.An end result study using a new method of result evaluation[J].J Bone Joint Surg Am,1969,51(4):737-755.
[12] EISENSCHENK A,LAUTENBACH M,SCHWETLICK G,et al.Treatment of femoral head necrosis with vascularized iliac crest transplants[J].Clin Orthop Relat Res,2001(386):100-105.
[13] 冯学涛,孙鲁伟,王景彦,等.灯泡状病灶清除打压植骨术治疗股骨头坏死的疗效[J].实用骨科杂志,2016,468(5):1316-1324.
[14] 康鹏德,裴福兴.早期股骨头坏死的(Ficat Ⅰ、Ⅱ期,塌陷前)治疗[J].中国骨与关节损伤杂志,2010,25(1):91-94.
[15] 舒科杰,尹良军,陆洋,等.股骨头缺血坏死保髋治疗研究进展[J].中国矫形外科杂志,2015,23(21):1971-1974.
[16] LIU L H,ZHANG Q Y,SUN W,et al.Corticosteroid-induced osteonecrosis of the femoral head:detection,diagnosis,and treatment in earlier stages[J].Chin Med J (Engl),2017,130(21):2601-2607.

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