MRI指导下经皮钻孔减压术治疗股骨头缺血性坏死的疗效

Core decompression guided by MRI in the treatment of femoral head necrosis

目的分析MRI指导下股骨头髓芯减压术(core decompression,CD)治疗股骨头缺血性坏死(osteonecrosis of the femoral head,ONFH)的疗效。方法选取2016年1-12月就诊骨科中心诊断为ONFH的32例为研究对象,在MRI指导下行CD。采用疼痛视觉模拟评分(visual analogue scale,VAS)、人工全髋关节疗效评分标准(Harris)评分进行疗效分析,应用MRI观察坏死区域的位置及体积变化情况。结果32例术前VAS评分为5.52±1.14,Harris总分为35.8±5.89(疼痛15.26±3.11;功能17.70±4.83;僵硬2.84±1.95),术后6个月VAS评分为4.59±0.5,Harris总分为62.0±5.42(疼痛29.76±3.27;功能29.06±4.47;僵硬5.18±1.42),术后12个月VAS评分为2.55±0.5、Harris总分为80.77±3.78(疼痛37.94±3.02;功能38.4±2.27;僵硬7.43±1.13),术后6个月、12个月与术前比较差异均有统计学意义(P<0.05)。结论MRI成像引导的CD治疗ONFH在技术上是可行的、准确的、安全的。

Objective To evaluate the therapeutic effect of MRI-guided core decompression against osteonecrosis of the femoral head.Methods A total of 32 patients who were diagnosed with ONFH at the Third Medical Center of the PLA General Hospital in 2016 were selected.The general information about these patients was collected to ensure that they had no contraindications to surgery before they were subjected to epidural anesthesia and surgery.The visual analogue scale(VAS)and Harris score were used to analyze the effect.MRI was used to observe the size and position of the necrotic area.Results The preoperative VAS score was 5.52±1.14,and Harris total score was 35.8±5.89(pain 15.26±3.11;function 17.70±4.83;stiffness 2.84±1.95).The VAS score after 6 months was 4.59±0.5,and Harris total score was 62.0±5.42(pain 29.76±3.27;function 29.06±4.47;stiffness 5.18±1.42),compared with 2.55±0.5 and 80.77±3.78(pain 37.94±3.02;function 38.4±2.27;stiffness 7.43±1.13)after twelve months.There was statistically significant difference between the preoperative scores and postoperative ones(P<0.05).Conclusions MRI-guided core decompression used for osteonecrosis of the femoral head is technically feasible,accurate and safe.Patients with early osteonecrosis may benefit from such treatment.