小孔径扇形钻孔减压术治疗早期股骨头坏死的10年随访观察

Clinical outcomes of core decompression for early ANFH using multiple small-diameter drilling distributed in a fan shape: A 10-year follow-up study

目的探讨小孔径、多孔道、低钻速扇形钻孔减压术治疗早期股骨头缺血坏死的长期疗效。方法选择解放军总医院第一医学中心骨科2001年2月-2006年4月在C形臂监视下采用3.5 mm克氏针进行小孔径、多孔道、低钻速钻孔减压治疗的早期股骨头缺血性坏死226例(383髋)。对所有患者在手术后进行持续临床随访,评估术后1年和术后10年的改良Harris髋关节评分(mHHS评分)变化和影像学结果。结果 226例(383髋)中完成术后10年随访164例(285髋),其中男性128例(221髋),女性36例(64髋);平均年龄14~64(36.5±8.3)岁;随访时间130~204(186±9.7)个月;术前mHHS评分56~78(66.5±5.7)分,术后约1年时随访评分增加到61~93(81.3±5.4)分,最后1次随访时评分为59~90(80.4±5.9)分。最后1次随访时197髋(69.1%)疗效优良(m HHS评分>80),患者无疼痛或轻微疼痛,能胜任日常工作,X线片显示股骨头无明显塌陷;61髋(21.4%)疗效为中(mHHS评分70~79分),患者轻度或中度疼痛,可以生活自理,股骨头塌陷<2 mm;27髋(9.5%)疗效差(mHHS评分<69分),严重疼痛,生活不能自理,股骨头塌陷,其中23髋已经施行髋关节置换。结论小孔径、多孔道、扇形低钻速钻孔减压术能够有效治疗早期股骨头坏死,减少对股骨头的骨质破坏,有助于延迟股骨头塌陷,可推迟或避免髋关节置换。

Objective To investigate the long-term outcome of multiple small-diameter drilling decompression for early avascular necrosis of femoral head(ANFH). Methods From February 2001 to April 2006, 226 cases(383 hips) with early ANFH were treated with core decompression with Kirschner wire drilling in the First Medical Center, Chinese PLA General Hospital. There were 128 males(221 hips) and 36 females(64 hips), aging 36.5±8.3(range, 14-64) years. Under the monitor of C-arm fluoroscope, all the hips were decompressed with 3.5 mm Kirschner wire. Clinical follow-up for all patients after surgery was lasted to postoperative 10 years to evaluate functional and imaging results. Results Of the 226 cases(383 hips), 164 cases(285 hips) completed the postoperative 10 years follow-up, with 128 males(221 hips) and 36 females(64 hips) aged 36.5±8.3 years(range, 14-64 years). The average followup time was 186±9.7(range, 130-204) months. The preoperative mHHS score was 66.5±5.7(range, 56 to 78), and increased to 81.3±5.4(range, 61-93) at 1 year after the surgery, and it was 80.4±5.9(59-90) at postoperative 10 years follow-up. In all hips, 197 hips(69.1%) achieved excellent outcome(Harris score >80), patients were competent for daily work with no pain or mild pain, and their X-ray results showed no collapse obviously;Sixty-one hips(21.4%) were evaluated as good(Harris score, 70-79), patients could take care of themselves, with mild to moderate pain, and their X-ray results showed femoral head collapse less than 2 mm;Twenty-seven hips(9.5%) had poor outcome(Harris score < 69), and patients could not take care of themselves and felt severe pain, their X-ray results showed collapse of femoral head. During follow up, 23 hips accepted total hip replacement. Conclusion The multiple small-diameter drilling can treat the early ANFH effectively, reduce bone destruction of the femoral head, delay the collapse, and prevent hip replacement.