打压植骨术治疗股骨头坏死的近期疗效

The clinical effect of treating osteonecrosis of the femoral head via bone impaction grafting

目的探讨打压植骨术治疗股骨头坏死(ONFH)的近期疗效。方法采用打压植骨术治疗52例(60髋)ONFH患者,随访时以ARCO分期、Harris评分及股骨头生存率作为疗效评价标准。结果术后患者均未发生感染、神经受损、股骨颈骨折、下肢深静脉血栓等并发症。52例均获随访,时间11～54个月。按ARCO分期:术前:ⅡA期2例,ⅡB期6例(8髋),ⅡC期22例(25髋),ⅢA期14例(17髋),ⅢB期4例,ⅢC期4例;术后:ⅡA期1例,ⅡB期4例,ⅡC期4例(6髋),ⅢA期9例(10髋),ⅢB期4例,ⅢC期5例,Ⅳ期25例(30髋)。Harris评分:术前44～77分,末次随访时57～91分。以THR为终点事件,股骨头生存率为78.2%。术前ARCO分期中,Ⅱ期股骨头生存率高于Ⅲ期股骨头生存率(P<0.05)。结论打压植骨术对于治疗早中期ONFH患者疗效满意,术前分期越早,疗效越好。

Objective To analyze the short-term therapeutic effect of treating osteonecrosis of the femoral head（ONFH） via bone impaction grafting.Methods To utilize bone impaction grafting to treat 52 patients（60 hips） and the standard for therapeutic effect consists of the ARCO（Association Research Circulation Osteous） classification,Harris score and the femoral head survival rate.Results There existed no infections,nerve damage,fracture of the collum femoris,deep vein thromb（DVT） and other complications in patients.All the patients were followed-up,and the time was 11～54 months.In light of the ARCO classification,2 patients,6（8 hips）,22（25 hips）,14（17 hips）,4 as well as 4 preoperatively were in stage ⅡA,ⅡB,ⅡC,ⅢA,ⅢB,ⅢC respectively.1 patient,4,4（6 hips）,9（10 hips）,4,5 as well as 25（30 hips） postoperatively were in stage ⅡA,ⅡB,ⅡC,ⅢA,ⅢB,ⅢC respectively.The preoperative Harris score was 44～77,and the Harris score of the ultimate follow-up was 57～91.Regarding THR as the terminus,the femoral head survival rate was 78.2%.In the ARCO classification preoperatively,the femoral head survival rate in stage Ⅱ surpass that in stage Ⅲ（P0.05）.Conclusions The therapeutic effect of bone impaction grafting is gratified in treating patients with ONFH in the early and middle stage,and the therapeutic effect is better when the classification is earlier.