小孔径钻孔减压并髋关节镜清理术治疗早期股骨头缺血性坏死的临床研究

Clinical evaluation of small diameter decompression and arthroscopy in the treatment of early avascniar necrosis of femoral head

目的探讨小孔径、多孔道、低钻速钻孔减压并髋关节镜清理术治疗早期股骨头缺血性坏死(ANFH)的疗效。方法应用斯氏针钻孔减压治疗早期股骨头缺血性坏死226例(383髋),其中男169例(296髋),女57例(87髋)。在 C 型臂监视下对所有病例采用3.5 mm 斯氏针进行小孔径、多孔道、低钻速钻孔减压,对于209髋合并髋关节滑膜炎或软骨损伤的病例同时行髋关节镜下滑膜切除、软骨修整术。结果术后随访164例(285髋);随访时间3～60个月(平均35个月);术前Harris 评分56～78分(平均68分),术后增加到58～92分(平均79分)。随访时198髋(69.5%)疗效优良(Harris 评分>80);70髋(24.5%)疗效为中(Harris 评分70～79分);17髋(6.0%)疗效差(Harris 评分<69分)。疗效差的17髋在随访时病程分期进展并发生不同程度的股骨头塌陷。有关节积液的139髋行关节镜手术,术后随访时行 MRI 者87髋,发现关节积液减少59髋。本组共发生10例并发症,经对症处理全部恢复。结论小孔径、多孔更有利、低钻速钻孔减压术在减压效果上优于传统的髓芯减压术;小孔径减压减少了对股骨头骨质的破坏,可以有效的延迟股骨头塌陷的发生;与传统髓芯减压术相比,多孔道减压更有利于改善股骨头坏死区的血液循环。髋关节镜手术有利于清除髋关节内致痛物质,改善关节内环境紊乱、去除游离或潜行剥离的软骨碎片,提高术后疗效。

Objective To investigate the therapeutic effect of small diameter, multiple porous, low drill velocity decompression and hip arthroscopy in treatment of early avascular necrosis of femoral head （ANFH）. Methods 226 ANFH patients （383 hips） , 169 males （296 hips） and57 females （87 hips） , aged 36.5 （14-64） , underwent drilling decompression with 3.5 mm Steinmann pin at a low velocity under the C-arm X-ray monitoring , all the 383 hips were decompressed with Steinmann pin, small diameter, multiple porous, low drill velocity. Synovectomy and cartilage trimming were performed through hip arthroscopy at the same time on the 209 hips combined with hip arthrosynovitis or cartilage trauma. 164 cases were followed up for 35 months （3-60 months）. Results The Harris score was increased from 68 （56-78） pre-operatively to 79 （58-92） post-operatively. Excellent curative effect was found in 198 of the 383 hips （69.5%） with a Harris score 〉80, medium curative effect was found in 70 hips （24.5%） with a Harris score between 70 and 79 ; and bad effect found in 17 hips （6.0%） with a Harris score 〈 69. During the follow-up, these 17 hips presented progress in staging of clinical course and collapse of femoral head. 139 hips with hydrops articuli were treated with arthroscopy, and 87 of the 139 hips underwent hip MRI during the follow-up. It was found that the hydrops articuli decreased in 59 hips and increased in 10 hips. Complications were found in 10 cases and all of them were recovered after treatment. Conclusion The effect of small diameter, multiple porous and low drill velocity decompression is equal to or surpasses traditional core decompression. Small diameter decompression has the advantage of less osseous destruction of femoral head, delaying femoral head collapse and improving blood circulation in the necrosis zone of femoral head. Hip arthroscopy can greatly improve the therapeutic effect of ANFH through scavenging painproducing substance, removing the cartilage chips caused by isolation or undermining dissection, and correcting internal environment disorder.