单一入路微创法在股骨头坏死中的应用价值

Application value of single approach minimally invasive method in femoral head necrosis

目的探讨单一入路微创法在股骨头坏死(ONFH)中的应用价值。方法回顾性分析本院2014年1月至2018年3月收治的符合纳入标准的Ⅱb~Ⅲc期69例ONFH患者的临床资料,所有患者均采用单一入路微创法进行治疗,随访时间1年,采用Harris髋关节评分、NRS疼痛评分、生活质量量表36项健康调查简表(SF-36)评分和放射学结果进行评价。结果本组69例(87髋)随访过程中共有4例(5髋)因术后地址变更失访,失访率为5.74%。随访的65例(82髋)患者中62例(79髋)术后恢复良好,髋关节临床症状明显改善,患者未出现感染、股骨粗隆下骨折、深血管血栓形成、血管神经损伤及排异现象,成功率为96.34%;在术后1年的X线分析中3例(3髋)患者的髋关节出现逐渐塌陷,患者保髋失败;患者术后1年Harris、SF-36评分分别为(86.51±12.67)分、(86.23±11.19)分,均高于术前,NRS评分为(25.52±9.42)分,低于术前,差异均有统计学意义(均P<0.05)。结论单一入路微创法治疗早中期股骨头坏死具有良好的临床疗效及安全性,手术损伤小、关节功能恢复快。

Objective To explore the application value of single approach minimally invasive method in femoral head necrosis(ONFH).Methods The clinical data of 69 patients with ONFH treated at our hospital from January,2014 to March,2018 in accordance with the inclusion criteria were retrospectively analyzed.All the patients were treated with single approach minimally invasive surgery and followed up 1 Year.The Harris score,NRS pain score,Quality of Life Scale 36 Health Survey Summary(SF-36)scores,and radiological findings were evaluated.Results In this group of 69 patients with 87 hips,4 patients(5 hips)were out of follow-up,with a loss rate of 5.74%.Of the 65 patients(82 hips)who were followed up,62(79 hips)recovered well,the hip pain symptoms were relieved or disappeared,and the internal and external rotation and flexion and extension functions were significantly improved.The patients had no infection,femoral subtrochanteric fracture,and deep blood vessel thrombosis,vascular nerve injury,and rejection.The success rate was 96.34%.One year the operation,the X-ray analysis showed that the hip joints of 3 patients(3 hips)gradually collapsed,and they failed to protect their hips.The scores of Harris and SF-36 were(86.51±12.67)and(86.23±11.19)and the NRS score was(25.52±9.42)one year after the operation,which were better than those before the operation(P<0.05).Conclusions Single approach minimally invasive treatment for early and middle femoral head necrosis has good clinical efficacy and safety,small surgical damage,and rapid recovery of joint function.