头颈部开窗减压治疗L1型激素性股骨头坏死:单中心前瞻性临床研究

Type L1 steroid-induced osteonecrosis of the femoral head through femoral head and neck junction decompression by fenestration:a single-center prospective clinical study

背景:股骨头坏死是骨科难治性疾病,尤其激素性骨坏死,发病率高,易进展塌陷,增加对激素性股骨头坏死的认识将有助于早期识别、干预,选择合理的治疗措施,以改善预后。目的:探讨经头颈部开窗减压植骨治疗中日友好医院(CJFH)分型L1型患者中不同类型激素性股骨头坏死的临床效果及其影响因素。方法:临床观察分析采用经头颈部开窗减压治疗的82例(106髋)CJFH分型L1型激素性股骨头坏死患者的临床资料。临床效果评价由两部分组成,包括髋关节Harris评分系统、双髋关节正位及蛙式位片观察,临床失败定义为Harris评分为差(<70分),和/或股骨头进行性塌陷,伴随临床表现加重;单、多因素分析性别、年龄、病因、术前ARCO分期、发病时间及术前Harris评分对预后的影响。结果与结论:①全部患者均获得随访,随访时间3-51个月;②根据末次随访Harris评分结果,优4髋,良33髋,可50髋,差19髋,优良率为34.9%(37/106);末次随访Harris评分(83.1±14.3)分显著高于与术前(64.4±9.8)分,差异有显著性意义(P<0.05);③影像学观察股骨头塌陷进展15髋,单纯影像进展6髋;④临床失败26髋,单、多因素分析显示,术前Harris评分<70分是影响股骨头坏死预后的独立危险因素(P<0.05),不同类型激素性股骨头坏死组间差异无显著性意义;⑤提示经头颈部开窗减压治疗L1型激素性股骨头坏死可获得满意的中短期临床效果,但术前Harris评分<70分是影响保髋预后的危险因素。

BACKGROUND:Osteonecrosis of the femoral head is a refractory disease in department of orthopedics.Especially with steroid-induced osteonecrosis,incidence rate is high,and it is easy to collapse.Increasing knowledge of hormone necrosis will help early identification and intervention,and choose reasonable treatment measures to improve prognosis.OBJECTIVE:To investigate the clinical effects and influencing factors in the treatment of different kinds of steroid-induced osteonecrosis of the femoral head of CJFH type L1 patients through femoral head and neck junction decompression by fenestration and bone grafting.METHODS:Clinical data of 82 patients(106 hips)with CJFH type L1 steroid-induced osteonecrosis of the femoral head,who underwent femoral head and neck junction decompression by fenestration in China-Japan Friendship Hospital,were analyzed.The clinical effect evaluation consisted of two parts:Harris hip score system,the observation of bilateral hip joint and frog position film.Clinical endpoint events were marked by poor Harris hip score<70,progressive collapse of the femoral head with/without obvious clinical manifestation.Univariate and multivariate analyses were used to analyze the influence of gender,age,etiology,preoperative ARCO stage,onset time and preoperative Harris score on prognosis.RESULTS AND CONCLUSION:(1)All patients were followed up,and the mean duration was 3-51 months.(2)Based on Harris hip score of the last follow-up,the results were excellent in 4 hips,good in 33 hips,fair in 50 hips,and poor in 19 hips.The excellent and good rate was 34.9%(37/106).Harris hip score was higher in the final follow-up(83.1±14.3)than that before surgery(64.4±9.8)(P<0.05).(3)Imaging results demonstrated that there were 15 hips with progressive collapse of the femoral head,and 6 hips without obvious clinical symptoms.(4)The 26 hips were classified as clinical failed.Univariate and multivariate analyses showed that preoperative Harris hip score<70 was the independent risk factor for prognosis of osteonecrosis of the femoral head(P<0.05).There was no significant difference among different types of steroid-induced osteonecrosis of the femoral head.(5)The method through femoral head and neck junction decompression by fenestration and bone grafting has a good effectiveness in patients with type L1 steroid-induced osteonecrosis of the femoral head in short and medium terms,but preoperative Harris hip score<70 is a risk factor affecting the prognosis of hip preservation.