闭合钻孔减压并同种异体骨移植治疗中青年股骨头坏死

Therapeutic effect of drilling decompression and allogeneic bone grafting on osteonecrosis of the femoral head in young and middle-aged patients

目的:探讨闭合钻孔减压并同种异体骨移植治疗中青年股骨头坏死的特点及疗效。方法:对20～45岁股骨头坏死患者22例28髋采用闭合钻孔并同种异体骨移植术,分析手术时间、术中出血量、术前后Harris评分、并发症及影像学表现。结果:平均手术时间1h10min,平均术中出血量55ml。术后20例25髋得到3～36个月随访,术后18例21髋疼痛明显缓解,有效率84%。Harris评分从术前72分上升至86分(P<0.05),影像学示3～6个月时植骨区无骨吸收,1年后植骨与周围骨髓愈合。结论:本术式出血少、操作简单,不取骨不入关节,适于基层医院开展,可避免过早行关节置换。

Objective：To explore the therapeutic effect of drilling decompression and allogeneic bone grafting on osteonecrosis of the femoral head in young and middle-aged patients. Methods：We ret- rospectively evaluated 22 patients of osteonecrosis of the femoral head with a mean age of 35. 5 years （20 to 45） who had undergone drilling decompression and allogeneic bone grafting. The oper- ative time, blood loss, the pre-operative and post-operative of Harris score, complications, and im- aging performance were analyzed. Results：The mean operating time was 70 minutes, and intraop- erative blood loss was 55 ml. At the time of review, 20 patients （25 hips） were followed up for 22 months （3 to 36）, and 18 patients （21 hips） were relieved of pain （84%）. The Harris score was in- creased from 72 pre-operatively to 86 post-operatively （P〈0.05）. Imaging shows no resorption of bone graft area after 3~6 months, and all graft in each patient united after one year. Conclusion： This technique is less bleeding and simple. It avoids the corresponding risk of complications because of taking no autologous bone and without involving the joint, is conducive to the recovery of func- tion, and is suitable for primary hospital. Moreover, this surgical procedure avoids premature line of joint replacement for young and middle-aged patients.