改良多孔髓芯减压修复早期股骨头缺血性坏死:髋关节置换率5年随访

Modified porous pulp core decompression in the treatment of early avascular necrosis of the femoral head: hip replacement rate in 5-year follow-up

背景:股骨头髓芯减压作为一种经典的治疗早期股骨头坏死的方法,已得到广泛认可,但是相当多的报道以术后评分等主观数据进行分析,影响结果的可靠性。目的:进一步验证髓芯减压治疗早期股骨头缺血性坏死的临床效果及影像学变化。方法:符合国际骨循环研究会(ARCO)骨坏死分期标准ARCOⅠ-Ⅱ期患者67例(99髋),其中治疗组40例(57髋),行改良多孔髓芯减压术治疗;对照组27例(42髋),进行药物及综合治疗。治疗前及治疗后1,3个月评估Harris评分,治疗后6个月复查骨盆平片、双髋关节侧位片、髋关节MRI及Harris评分。结果与结论:经5年随访后,治疗组57例髋,最终28例行髋关节置换,占49%;对照组42例髋,其中29例行关节置换,占69%,治疗组最终髋关节置换率明显低于对照组;说明髋关节髓芯减压明显延缓了患者行关节置换的时间(P<0.05)。对照组髋关节置换率高峰期为术后两三年,治疗组髋关节置换率高峰期为术后三四年。治疗组治疗后Harris评分及坏死指数显著优于治疗前(P<0.05);患者治疗前Harris评分及坏死指数无明显相关性(P>0.05),经髓芯减压干预后,仍无相关性。结果证实股骨头髓芯减压治疗早期股骨头缺血坏死对缓解疼痛症状、提高步行能力和改善患肢功能均有明显效果,且能延缓全髋置换的时间,尤其适用于ARCOⅠ-Ⅱ期股骨头坏死的患者。

BACKGROUND： Femoral core decompression is a classical method for early femoral head necrosis that has been widely concerned. However, some scholars applied postoperative scores and other subjective data for analysis, which affected the reliability of experimental results. OBJECTIVE： To verify clinical effect and imaging changes of core decompression in treatment of early avascular necrosis of the femoral head. METHODS： Sixty-seven patients （99 hips） with osteonecrosis at I -]I grade according to the staging criteria of the Association Research Circulation Osseuse were involved in this study. The involved patients were divided into two groups： treatment group （40 cases, 57 hips; receiving modified porous pulp core decompression treatment） and control group （27 cases, 42 hips; receiving drugs and comprehensive treatment）. Harris scores were evaluated before treatment and at 1, 3 months after treatment. Patients were detected with pelvic plain film, hip CT in lateral projection, hip MRI and Harris hip score at postoperative 6 months. RESULTS AND CONCLUSION： After 5 years of follow-up, 28 hips in the treatment group （57 hips） underwent hip replacement, accounted for 49%; and 29 hips in the control group （42 hips） underwent hip replacement, accounted for 69%, hip replacement rate of treatment group was obviously lower than that of control group. Hip core decompression significantly delayed the joint replacement time （P 〈 0.05）. The hip replacement rate was postoperative 2-3 years in the control group and postoperative 3-4 years in the treatment group. In the treatment group, postoperative Harris scores and necrosis index were significantly better than that before treatment （P 〈 0.05）. There was no correlation between preoperative Harris score and necrosis index （P 〉 0.05）, and the correlation was still not found after core decompression surgery. Femoral head pulp core decompression can ease the pain symptoms, improve the walking ability and improve the limb function in treatment of early avascular necrosis of the femoral head, delay the time of total hip replacement, it is especially suitable for patients with ARCO I -II osteonecrosis.