不同手术方式治疗早期股骨头坏死的疗效分析

Therapeutic effects of different surgical methods on early femoral head necrosis

目的探讨不同手术方式治疗早期股骨头缺血性坏死的临床疗效。方法回顾性分析2015年12月至2018年12月早期股骨头缺血性坏死患者,并选取获得完整随访的112例患者,其中56例实施髓心减压+自体髂骨移植术(A组)治疗,56例实施经皮扩张式铰刀髓心减压+注射型可再生人工骨植骨(B组)治疗,于治疗前后行功能评定(VAS评分、Harris评分、JOA评分),比较2组患者手术指征、临床疗效、并发症。结果2组患者治疗后VAS评分较治疗前显著降低(P<0.05)。2组患者治疗后Harris评分、JOA评分较治疗前显著增加(P<0.05)。B组患者治疗后VAS评分低于A组(P<0.05)。B组患者治疗后Harris评分、JOA评分高于A组(P<0.05)。B组患者充分刮出死骨者所占比例、充分减压者所占比例、优良率高于A组(P<0.05)。B组患者术后软骨表面的应力值、破坏极限点载荷低于A组(P<0.05)。2组患者并发症(迟发性感染、下肢深静脉血栓、股骨头塌陷)比较,差异无统计学意义(P>0.05)。结论经皮扩张式铰刀髓心减压+注射型可再生人工骨植骨治疗早期股骨头缺血性坏死的疗效显著,值得临床推广使用。

Objective To investigate the therapeutic effects of different surgical methods on early femoral head necrosis.Methods The clinical data about 112 patients with early femoral head avascular necrosis who were treated in our hospital from December 2015 to December 2018 were retrospectively analyzed,of whom,56 patients underwent core decompressionn+autogenous sacrum transplantation(group A),and the other 56 patients were treated by percutaneous dilatation reamer and decompression+injection of renewable bone graft(group B).The functional evaluation including VAS score,Harris score and JOA score before and after treatment,and the operation indication,clinical curative effects,the incidence rate of complications were observed and compared between the two groups.Results After treatment the VAS scores were decreased significantly in both groups(P<0.05),however,the Harris scores and JOA scores were increased significantly in both groups(P<0.05).The VAS scores in group B were significantly lower than those in group A(P<0.05),and the Harris scores and JOA scores in group B were significantly hihger than those in group A(P<0.05).The proportion of patients whose dead bones were fully scraped out,and the proportion of patients who were fully decompressed as well as the good/excellent rate in group B were significantly higher than those in group A(P<0.05).Moreover the stress value of cartilage surface after operation and failure limit point load in group B were significantly lower than those in group A(P<0.05).However there were no significant differences in the incidence rates of complications including delayed infection,lower extremity deep vein thrombosis and femoral head collapse between the two groups(P>0.05).Conclusion The percutaneous reamer decompression+injection type renewable artificial bone graft have significant effects in treatment of early femoral head avascular necrosis,which is worthy of clinical application.