经大粗隆双通道减压植骨加异体腓骨支撑治疗股骨头坏死的近期疗效观察

Short term effect of double channel decompression and bone grafting via greater trochanter combined with allograft fibula propping in the treatment of femoral head necrosis

目的:探讨经大粗隆双通道减压植骨加异体腓骨支撑治疗股骨头坏死的近期临床疗效。方法:自2017年11月至2019年2月纳入股骨头坏死患者22例23髋,根据国际骨循环研究学会(Association Research Circulation Osseous,ARCO)分期:Ⅱ期组13髋,年龄20~48(32.5±8.5)岁;Ⅲ期组10髋,年龄18~45(32.7±8.6)岁。应用经大粗隆的单一入路行双通道下的减压植骨及异体腓骨支撑术。植入前、后均采用Harris评分系统对髋关节功能评估;植入后3、6、12、18个月摄髋关节正侧位X线片,观察股骨头修复以及坏死进展情况并加以分析。结果:所有患者获随访,时间12~18(14.6±2.1)个月。Ⅱ期组和Ⅲ期组的Harris评分分别由术前73.2±5.5和66.5±3.4提高到末次随访时的87.6±8.7(P<0.001)和77.2±14.0(P<0.05)。随访患者12个月时的X线片提示:Ⅱ期组术后改善12髋,Ⅲ期组术后改善7髋。结论:经大粗隆双通道减压植骨加异体腓骨支撑术治疗早中期股骨头坏死效果良好,尤其适用于中青年ARCOⅡ期的股骨头坏死患者。

Objective:To investigate the short-term clinical effect of double channel decompression and bone grafting through the greater trochanter combined with allograft fibula propping in the treatment of osteonecrosis of femoral head(ONFH).Methods:Twenty two patients(23 hips)with osteonecrosis of the femoral head were included from November 2017 to February 2019.According to Association Research Cirulation Osseous(ARCO)staging,there were 13 hips at stageⅡgroup,aged from 20 to 48 years old with an average of(32.5±8.5)years old;10 hips at stageⅢgroup,aged from 18 to 45 years old with an average of(32.7±8.6)years old.A single approach through the greater trochanter was used for decompression,bone grafting and fibula support.Harris scoring system was used to evaluate the function of hip joint before and after implantation,and the anteroposterior and lateral X-ray films of hip joint were taken at 3,6,12 and 18 months after implantation to observe and analyze the progress of femoral head necrosis and regeneration.Results:All patients were followed up,and the duration ranged from 12 to 18 months with an average of(14.6±2.1)months.Harris score of stageⅡand stageⅢpatients increased from 73.2±5.5 and 66.5±3.4 to 87.6±8.7(P<0.001)and 77.2±14.0(P<0.05)respectively.After 12 months,the X-ray film of all patients showed that 12 hips were improved at stageⅡgroup and 7 hips were improved at stageⅢgroup.Conclusion:The effect of double trochanteric decompression and bone grafting combined with fibular allograft propping in the treatment of early and middle-stage avascular necrosis of the femoral head is good,especially suitable for young and middle-aged patients with ARCOⅡstage avascular necrosis of the femoral head.