多孔髓芯减压并关节清理治疗早期股骨头缺血性坏死的临床评价

CLINICAL EVALUATION OF MULTIHOLE CORE DECOMPRESSION AND ARTHROSCOPIC DEBRIDEMENT IN THE TREATMENT OF AVASCULAR NECROSIS OF FEMORAL HEAD

目的 探讨多孔髓芯减压并关节清理治疗早期股骨头缺血性坏死的临床效果。方法 对1998年3月～2003年9月我院早期股骨头缺血性坏死病例按年龄、病变分期等入选标准进行筛选，符合条件者72例，应用股骨头髓芯减压并髋关节镜清理术（改良手术组）治疗股骨头缺血性坏死41例（46髋），应用单纯髓芯减压或并骨移植（传统手术组）治疗31例（34髋）。对其疗效和影像学效果进行回顾性评价分析。采用HARRIS髋关节评分标准进行临床评价，根据FICAT骨坏死分期标准进行影像学评价。将术后HARRIS评分≥80分定义为临床成功，术后分期稳定定义为影像学成功。结果 改良手术组和传统手术组临床成功率分别为86．9％和58．8％，影像学成功率分别为82．6％和70．6％。改良手术组疗效优于传统手术组（uc=2．247，P〈0．05；Х^2=7．013，P〈0．01）。结论 髓芯减压结合关节镜关节清理术可有效进行骨内减压，改善关节内环境，从而有效减轻疼痛、预防股骨头塌陷，延迟病人需全髋关节置换的时间。髋关节镜微创技术的应用为股骨头坏死的诊断和治疗开辟了一新的方法。该方法适用于早期（0、Ⅰ、Ⅱ期）病变。

Objective To assess the multihole core decompression and arthroscopic debridement in the management of avascular necrosis of femoral head. Methods A retospective study was done in 72 patients, from March, 1998 to September, 2003, who met the criteria of age and stage. In which, 41 cases （46 hips） in the modified surgery group were treated by multihole decompression and arthroscopic debridement; 31 cases （34 hips） in the traditional group by core decompression alone or combined with bone grafting. Clinical evaluation was done based on HARRIS hip function scores, radiological evaluation by the classification system of FICAT and Alert. The post operative HARRIS score ≥80 was defined as clinical success, and postoperative stable stag ing as radiological success. Results The success rate of the modified group and traditional group was 86.9% and 58.8%, respectively. The radiological success rate of the two groups was 82.6% and 70.6 %, respectively. The curative effect of modified group was better than that of traditional one （uc=2. 247,P〈0.05; Х^2 =7. 013,P〈0.01）. Conclusion Multihole decompression combined with arthroscopic debridement can efficiently decrease intraosseous pressure and improve the intraarticular environment, prevent the femoral head from collapsing, and delay total hip replacement. The application of hip arthroscopy opens up a new way for the diagnosis and therapy of avascular necrosis of femoral head. This method is indicated for early stage （stage 0,Ⅰ, Ⅱ） lesions.