骨科患者感染后并发股骨头坏死的影响因素分析

Analysis of influencing factors of femoral head necrosis after infections

目的探讨骨科患者感染后并发股骨头坏死的影响因素,为临床治疗提供参考依据。方法回顾性分析2007年3月-2012年4月骨科收治的21例感染后并发股骨头坏死患者,术前根据Harris评分、影像学表现等对疾病进行确诊,并通过术中所见和术后病理检查结果进行验证,结合术前术后患者总结并发股骨头坏死的影响因素。结果术中可见关节囊增生、间隙变窄、股骨头表面凸凹不平;病理结果提示,关节囊纤维样增生、瘫痕生成、股骨头呈缺血性坏死;并发股骨头坏死的影响因素,其中13例患者因炎性物质的直接破坏所致,另8例则是因为髋周结构异常等间接因素所致。结论炎症反应可以直接破坏股骨头滋养血管或间接令髋部结构异常,迫使股骨头缺血坏死,通过清除增生挛缩组织、减轻囊内压力、重建股骨头及血运等方法,以有效治疗感染后并发股骨头坏死。

OBJECTIVE To explore the influencing factors of femoral head necrosis combined after infections so as to offer help and reference for clinical treatments .METHODS Retrospective analysis from Mar .2007 to Apr .2012 was conducted in 21 cases of patients complicated with femoral head necrosis after infections .Before operations , Harris scoring and imaging findings were used to make a diagnosis ,and then verified the results by intraoperative and postoperative pathologic examinations . The influencing factors of femoral head necrosis were summarized through above analysis .RESULTS Proliferative joint capsule ,narrow joint space ,and unsmooth surface of femoral head can be seen and the pathological results showed joint capsule fibrous hyperplasia ,scar formation ,and avascu‐lar necrosis of the femoral head .The influencing factors can be divided into direct and indirect ,of which 13 pa‐tients directly caused by inflammatory substances ,and another 8 were caused indirectly by abnormal structure of hip .CONCLUSION Inflammation can directly damage femoral head to nourish blood vessels or indirectly led to structural abnormalities of hips ,forcing avascular necrosis .After clearing hyperplasia and contracture tissues ,re‐ducing intraluminal pressure ,reconstructing femoral head and supplying blood and other methods ,osteonecrosis complicated with infections can be effectively cured .