改良多孔道髓芯减压术与传统钻孔减压术治疗早期股骨头缺血坏死的疗效观察

Therapeutic effects of modified porous core decompression versus traditional core decompression on early femoral head avascular necrosis

目的观察改良细针多孔道髓芯减压术与传统钻孔减压术治疗早期股骨头坏死的临床效果。方法选取2010年6月1日-2015年12月1日于我院行早期股骨头坏死髓芯减压术的病例共89例120髋,按照术式不同分为治疗组(44例59髋,行改良多孔道髓芯减压术)及对照组(45例61髋,行粗孔道钻孔减压术)。两组性别、年龄、Harries评分、Ficat分期差异无统计学意义(P>0.05),分析两组手术时间、术中出血量、住院天数等指标的差异;对术后3个月、6个月、12个月的髋关节Harries评分和影像学成功率(髋关节X线和MRI确定Ficat分期,未进展视为影像学成功)进行临床评价。结果治疗组手术时间、术中出血量、住院天数为(31.21±6.37)min、(10.45±1.32)ml、(4.50±1.45)d,对照组为(62.32±9.32)min、(21.50±2.63)ml、(9.50±1.96)d,差异均有统计学意义(P<0.05);术后3个月实验组Harries评分为(83.12±3.76),对照组为(82.09±4.10)差异无统计学意义(P>0.05);术后6个月、12个月实验组Harries评分为89.77±2.67、91.39±3.29,对照组为83.25±3.42、86.68±4.08,差异均有统计学意义(P<0.05);术后3个月实验组影像学成功率为91.5%,对照组为83.6%,差异无统计学意义(P>0.05);术后6个月、12个月实验组影像学成功率为84.7%、78.0%,对照组为67.2%、59.0%,差异均有统计学意义。结论与传统的钻孔减压术相比,改良细针多孔道髓芯减压术具有疗效更满意、术式更简单、手术创伤更小、术后恢复更快等优点,值得临床推广应用。

Objective To observe the clinical therapeutic effects of modified porous core decompression versus traditional core decompression on early femoral head avascular necrosis. Methods Clinical data about 89 patients（120 hips） with early femoral head avascular necrosis who underwent core depression in Chinese PLA General Hospital from June 1, 2010 to December 1, 2015 were collected. Patients were divided into two groups： experimental group（n=44, 59 hips） received modified porous core decompression and control group（n=45, 61 hips） received traditional core decompression. The differences in baseline data, including gender, age, Harries scores and Ficat stage, between two groups were insignificant（P〈0.05）. While, the differences in perioperative indexes between two groups were analyzed, including operating time（min）, perioperative bleeding（ml） and length of stay（d）. Harries scores were tested before and 3, 6, 12 months after surgery, and iconography success rates were evaluated at 3, 6, 12 months after surgery by the changes in hip X-ray and MRI photograph. Results There were significant differences in the operating time（min）, perioperative bleeding（ml） and length of stay（d） between experimental group and control group [（31.21±6.37） min vs（62.32±9.32） min,（10.45±1.32） ml vs（21.50±2.63） ml,（4.50±1.45） d vs（9.50±1.96） d, P〈0.05]. There was no significant difference in Harries score at 3 months after surgery between two groups（83.12±3.76 vs 82.09±4.10, P〈0.05）. While, significant differences were found in Harries score at 6, 12 months after surgery between two groups（89.77±2.67 vs83.25±3.42, 91.39±3.29 vs 86.68±4.08, P〈0.05）. The iconography success rate at 3 months after surgery in experimental group was 91.5% and 83.6% in the control group with no statistically significant difference（P〉0.05）, while, it showed statistically significant difference in the iconography success rate at 6, 12 months after surgery between two groups（84.7% vs 67.2%, 78.0% vs 59.0%, P〈0.05）. Conclusion Compared to traditional core decompression, modified porous core decompression is a better choice for patients with early femoral head avascular necrosis with more satisfying therapeutic effect, simpler surgery method, less bleeding in surgery and quicker recovery after operation.