髓芯减压术与直接前入路病灶清除自体骨移植治疗早期股骨头缺血性坏死疗效比较

Comparison of therapeutic effects between core decompression and autologous bone grafts with direct anterior approach lesion removal for early avascular necrosis of femoral head

目的比较单纯髓芯减压术与直接前入路病灶清除联合自体骨移植治疗早期股骨头缺血性坏死的临床疗效。方法回顾性分析自2013-10—2018-12诊治的42例(52髋)ARCOⅠ、Ⅱ期股骨头缺血性坏死,其中观察组18例(23髋)行直接前入路病灶清除联合自体骨移植治疗,对照组24例(29髋)行单纯髓芯减压术治疗。比较两组手术时间、术中出血量、保头成功率,以及末次随访时髋关节功能Harris评分。结果观察组随访时间为(25.9±12.8)个月,对照组随访时间为(26.8±13.1)个月。观察组手术时间较对照组长,术中出血量较对照组多,差异有统计学意义(P<0.05)。观察组末次随访时ARCOⅠ期、ARCOⅡ期患者保头成功率、髋关节功能Harris评分均高于对照组,差异有统计学意义(P<0.05)。结论直接前入路病灶清除联合自体骨移植治疗早期股骨头缺血性坏死较单纯髓芯减压术可取得更好的临床疗效,能有效缓解患者髋部疼痛症状,改善髋关节功能,延缓股骨头坏死进展。

ObjectiveTo investigate the clinical effectiveness of simple core decompression and direct anterior lesion debridement combined with autogenous bone transplantation in the treatment of early-stage avascular necrosis of femoral head.MethodsA retrospective analysis was performed on 42 patients(52 hips)with ARCO stage Ⅰ and Ⅱ avascular necrosis of the femoral bone from October 2013 to December 2018. Eighteen patients(23 hips)received direct anterior approach for lesion removal combined with autologous bone graft(observation group), while 24 patients(29 hips)received simple core decompression(control group). The operative time, intraoperative blood loss, the success rate of head preservation, and the Harris score of hip function at the last follow-up were compared between the two groups.Results(25.9±12.8)months, and the control group was followed up for(26.8±13.1)months. The operation time of the observation group was longer than that of the control group, and the amount of intraoperative blood loss was more than that of the control group, the difference was statistically significant(P<0.05). At the last follow-up, the success rate of head preservation and the Harris score of hip joint function in ARCO Ⅰ stage and ARCO Ⅱ stage patients in the observation group were higher than those in the control group, and the differences were statistically significant(P<0.05).ConclusionDirect anterior approach combined with autogenous bone transplantation is more effective in the management of early-stage avascular necrosis of femoral head than the simple core decompression surgery, which can effectively relieve the symptoms of hip pain, improve the function of the hip joint and delay the progression of avascular necrosis of the femoral head.