微创减压加打压植骨治疗股骨头坏死的临床应用研究

Clinical application of minimally invasive core decompression combined with impaction bone grafting to the treatment of femoral head necrosis

目的:探讨一种简单有效治疗股骨头缺血性坏死的新方法,以保护髋关节,改善临床症状。方法:2003年3月至2008年4月治疗股骨头缺血性坏死患者55例(手术61髋),男37例,女18例;年龄12～55岁,平均39.8岁;病史8个月～16年。采用髋关节部分滑膜切除,股骨头微创减压加打压植骨联合手术治疗股骨头缺血性坏死,从术前、术后X线片的股骨头塌陷程度和髋关节功能Harris评分两方面对疗效进行评价。结果:共治疗股骨头无菌性坏死55例(61髋),随访6个月～5年,平均2.2年。X线片显示未发生塌陷或塌陷无加重的39髋,11髋塌陷加重不超过2mm,9髋塌陷2～4mm,2髋塌陷加重超过4mm。术前Harris评分平均(59.74±11.56)分,术后平均(89.75±9.58)分,术后比术前得分明显提高(t=2.3461,P<0.05)。按Harris疗效评价标准:优31髋,良22髋,可6髋,差2髋。结论:采用微创减压加打压植骨治疗股骨头无菌性坏死能够减少股骨头的应力负荷,稳定股骨头的内环境,有利于骨坏死修复,可有效预防股骨头坏死塌陷。适用于FicatⅡ、Ⅲ期股骨头坏死的患者,尤以中青年患者为宜。

Objective：To explore a simple,effective threrapeutic method for the treatment of ischemia necrosis of femoral head. Methods：From March 2003 to April 2008,61 hips of 55 patients,including 37 males and 18 females,aged from 12 to 55 years old（averaged39.8）,with ischemia necrosis of femoral head were treated by three methods combination of partial synovectomy,minimally invasive core decompression and impaction bone grafting. The course of diseace was from 8 months to 16 years. The therapeutic effects were evaluated according to the preoperative and postoperative X ray and Harris scoring for hip funtion. Results：These 55 patients （61 hips） were followed up for from 6 mouths to 5 years （means 2.2 years）. X ray results showed that collapse or aggrevation occurenced in 39 hips,the aggravation of collapse no more than 2 mm in 11 hips,the collapse from 2 to 4 mm in 9 hips,the collapse surpassed 4 mm in 2 hips. Harris scores increased obviously from preoperative （59.74±11.56） points to postoperative （89.75±9.58） points （t=2.3461,P0.05）. The results were excellent in 31 hips,good in 22 hips,fair in 6 hips and poor in 2 hips. Conclusion：Minimally invasive core decompression combined with impaction bone grafting can reduce the stress load of femoral head,stabilized the environment of femoral head,promote osteonecrotic bone rapairing and prevent effectively the femoral head form collapsing. This method can be applied to femoral head necrosis at Ficat II,III stage,especially for young and middle-age patients.