作　　者： (李冀）; (李众利）; (苏祥正）; (刘春晖）; (张浩）; (王克涛）;

机构地区： 中国人民解放军总医院骨科,北京100850

出　　处： 《中国修复重建外科杂志》 2017年第9期1025-1030,共6页

摘　　要： 目的通过与单纯髓芯减压比较,探讨小直径多孔道髓芯减压联合髋关节镜清理治疗早期股骨头缺血性坏死的疗效。方法回顾分析2010年3月—2013年12月收治并符合选择标准的91例早期股骨头缺血性坏死患者临床资料。其中,39例(53髋)采用小直径多孔道髓芯减压联合髋关节镜清理治疗(A组),52例(74髋)采用单纯小直径多孔道髓芯减压治疗(B组)。两组患者术前均有明显髋关节疼痛、活动受限等症状。两组患者性别、年龄、病因、侧别、骨坏死分期及术前Harris评分等一般资料比较,差异均无统计学意义(P>0.05),具有可比性。结果两组手术均顺利完成。A组手术时间为(73.3±10.6)min,较B组(41.5±7.2)min明显延长(t=8.726,P=0.000)。术后切口均Ⅰ期愈合。A组术后2例出现牵引造成的暂时性坐骨神经失用,其余患者均无相关并发症发生。两组患者均获随访,A组随访时间24~52个月,平均39.3个月;B组随访时间24~48个月,平均34.6个月。末次随访时,两组Harris评分均较术前明显提高(t=–10.327,P=0.001;t=–8.216,P=0.008);且A组评分高于B组(t=–4.247,P=0.029)。X线片复查示,随访期间A组FicatⅠ期1髋、Ⅱ期5髋发生股骨头塌陷,手术总有效率为88.68%(47/53);B组FicatⅠ期4髋、Ⅱ期12髋发生股骨头塌陷,手术总有效率为78.38%(58/74);两组手术总有效率比较,差异有统计学意义(χ2=5.241,P=0.041)。两组发生股骨头塌陷患者均行人工髋关节置换术。结论小直径多孔道髓芯减压联合髋关节镜清理治疗早期股骨头缺血性坏死能有效缓解患者关节疼痛,改善关节功能,延缓股骨头缺血性坏死进程。 Objective To evaluate the effectiveness of multiple smaU-diameter drilling decompression combined with hip arthroscopy for early oeteonecrosis of the femoral head （ONFH）. Methods Between March 2010 and December 2013, 91 patients with early ONFH were treated with the operation of multiple small-diameter drilling decompre- ssion combined with hip arthroscopy in 39 cases （53 hips, group A） or with drilling decompression alone in 52 cases （74 hips, group B）. The patients in 2 groups had obvious hip pain and limited motion before operation. There was no significant difference in gender, age, etiology, effected side, stage of osteonecrosis, and preoperative Harris score between 2 groups （P〉0.05）. Results All operations succeeded and all incisions healed by first intention. The operation time was significantly longer in group A [（73.3±10.6） minutes] than in group B [（41.5±7.2） minutes] （t=8.726, P=0.000）. Temporary of sciatic nerve apraxia after operation occurred in 2 patients of group A, and no complication occurred in other patients. Patients were followed up 24-52 months （mean, 39.3 months） in group A and 24-48 months （mean, 34.6 months） in group B. At last follow-up, the Harris scores were 83.34±8.76 in group A and 76.61±9.22 in group B, showing significant differences when compared between 2 groups （t=-4.247, P=0.029） and when compared with preoperative values in 2 groups （t=-10.327, P=0.001; t=-8.216, P=0.008）. X-ray films showed that the collapse of the femoral head was observed in 6 hips （1 hip at stage I and 5 hips at stage II） in group A, and in 16 hips （4 hipsat stage I and 12 hips at stage II ） in group B; and hip arthroplasty was performed. The total effective rates were 88.68% （47/53） in group A and 78.38% （58/74） in group B, respectively; showing significant difference between 2 groups （χ2=5.241, P=0.041）. Conclusion Multiple small-diameter drilling decompression combined with hip arthroscopy is effective in pain relief, improvement o

关 键 词： 股骨头缺血性坏死 小直径多孔道髓芯减压 髋关节 关节镜