开窗减压植骨后应用外固定架牵开髋关节治疗年轻患者股骨头坏死的初步临床效果

Hinged distraction of the hip after decompression and bone grafting through a femoral neck window in the treatment of femoral head necrosis in young patients: The preliminary outcomes

目的分析应用经股骨颈开窗、减压植骨后使用外固定架牵开髋关节间隙的手术方法治疗年轻患者股骨头坏死的初步临床观察结果。方法回顾分析2017年3月至2018年3月北京积水潭医院创伤骨科采用经颈开窗、减压植骨后使用铰链式外固定架牵开髋关节间隙的标准术式治疗的7例股骨头坏死患者的临床资料。7例患者均为男性,年龄(25.7±9.8)(15~38)岁。其中6例为股骨颈骨折后股骨头坏死,1例为激素性股骨头坏死(单侧)。参照国际骨循环学会(ARCO)分期标准:Ⅱ期2例,Ⅲ期4例,Ⅳ期1例。结果随访1~12个月。7例患者术后外固定架耐受良好,未发生严重针道感染等并发症。其中1例患者术后6个月拆除外固定架,2例患者术后6个月通过调整外固定架恢复关节间隙,并于术后12个月拆除外固定架。术前存在轻度至中度疼痛的6例患者术后疼痛均消失。7例患者均未见股骨头形态明显改变。3例患者术后12个月CT示坏死股骨头有一定修复。结论经股骨颈开窗、减压植骨后使用外固定架牵开髋关节间隙治疗年轻患者股骨头坏死可行,患者通常可以耐受外固定架带来的不适,治疗期间股骨头坏死均无进展。

Objective To investigate the treatment of femoral head necrosis in young patients with hip distraction after decompression and bone grafting through a femoral neck window. Methods From March 2017 to March 2018,7 cases of femoral head necrosis treated by hinged distraction of the hip after decompression and bone grafting through a femoral neck window were retrospectively analyzed. All of the 7 patients were male and with an average age of （25.7±9.8） yeats （ranged from 15 to 38 years）. There were 6 cases of osteonecrosis of femoral head after femoral neck fracture and one case of steroid osteonecrosis. According to the staging of As- sociation Research Circulation Osseons （ARCO）, there were 2 cases in I1 stage, 4 cases in m stage and one case in IV stage. Results The patients were followed up 1-12 months. The external fixators were well tolerated in 7 cases and no complication such as severe needle tract infection was found. The external frame was removed at 6 months after operation in one case. Two cases were adjusted the fixator and resumed the joint space at 6 months after operation and were reserved the external fixator at 12 months after operation. After operation, the hip pain disappeared in 6 patients with mild to moderate pain before operation previously. There was no signifi- cant change in the shape of the femoral head in 7 cases. Three cases which necrotic femoral head repair were observed by CT images at 12 months after operation. Conclusion Treatment of femoral head necrosis in young patients with hip distraction after decompression and bone grafting through a femoral neck window is feasible. Patients can tolerate the discomfort caused by the external fixator, and necrosis of the femoral head do not develop further during treatment period.