髓芯减压植骨术治疗早、中期股骨头缺血性坏死的远期疗效

LONG-TERM FOLLOW-UP OF EARLY-MIDDLE STAGE AVASCULAR NECROSIS OF FEMORAL HEAD WITH CORE DECOMPRESSION AND BONE GRAFTING

目的探讨髓芯减压植骨术治疗早、中期股骨头缺血性坏死(avascular necrosis of the femoral head,ANFH)的远期疗效。方法回顾分析2000年1月-2006年12月采用髓芯减压植骨术治疗的87例(114髋)ANFH患者资料。其中男74例(97髋),女13例(17髋);年龄20～56岁,平均38岁。酒精性54例(62.1%),激素性26例(29.9%),特发性7例(8.0%)。病程3～46个月,平均18个月。Ficat分期:Ⅰ期16髋,Ⅱ期68髋,Ⅲ期30髋。根据手术前后Harris髋关节功能评分变化和Ficat分期改变进行临床评价和影像学评价;以改行人工关节置换术为终点,采用Kaplan-Meier法进行生存分析。结果 87例均获随访,随访时间5年～11年10个月,平均8年9个月。患者Harris髋关节功能评分由术前(73.13±7.17)分提高至末次随访时的(81.59±13.23)分,差异有统计学意义(t=—9.318,P=0.000)。总临床成功率为69.3%(79/114),总影像学成功率为54.4%(62/114)。Kaplan-Meier生存分析提示总生存率为84.2%(96/114),FicatⅢ期生存率60.0%(18/30)显著低于FicatⅠ期100%(16/16)和FicatⅡ期91.2%(62/68),差异有统计学意义(P<0.01);FicatⅠ、Ⅱ期间比较差异无统计学意义(χ2=1.520,P=0.218)。结论髓芯减压植骨术是治疗FicatⅠ、Ⅱ期(早期)ANFH的一种安全有效治疗方法,术后远期临床疗效满意;而对FicatⅢ期(中期)患者远期临床疗效差。

Objective To evaluate the long-term effectiveness of treating early-middle stage avascular necrosis ot me femoral head （ANFH） with core decompression and bone grafting, Methods Between January 2000 and December 2006, 87 ANFH patients （114 hips） were treated with core decompression and bone grafting, including 54 cases （62.1%） of alcohol- induced ANFH, 26 cases （29.9%） of steroid-induced ANFH, and 7 cases （8.0%） of idiopathic ANFH. There were 74 males （97 hips） and 13 females （17 hips）, aged 20-56 years （mean, 38 years）. The disease duration was 3-46 months （mean, 18 months）. According to Ficat staging, 16 hips were at stage Ⅰ, 68 hips at stage Ⅱ, and 30 hips at stage Ⅲ. The Harris score and Ficat stage were compared between pre- and post-operation to assess the outcomes clinically and radiologically. The hip survival was analyzed by the Kaplan-Meier method. Results Eighty-seven patients were followed up 5 years to 11 years and 10 months （mean, 8 years and 9 months）. The Harris hip score was significantly increased from 73.13±7.17 at preoperation to 81.59 ± 13.23 at postoperation （t=- -9.318, P=0.000）. The clinical success rate was 69.3% （79/114） and the radiological success rate was 54.4% （62/114）. Kaplan-Meier survival analysis showed that the overall survival rate was 84.2% （96/114）; the survival rates of Ficat stage Ⅰ [100% （16/16）] and stage Ⅱ[91.2% （62/68）] were higher than that of stage Ⅲ [60.0%（18/30）] （P 〈 0.01）; there was no significant difference between Ficat stage Ⅰ and Ⅱ （χ2=1.520, P=0.218）. Conclusion Core decompression with bone grafting is a safe and effective procedure for the treatment of Ficat stagesⅠ-Ⅱ （early stage） ANFH, and the long-term effectiveness is satisfactory. But the long-term effectiveness is unsatisfactory for the patients at the Ficat stage Ⅲ （middle stage）.