围塌陷期股骨头坏死的头颈开窗植骨

Head-neck fenestration bone autografting for pericollapse-stage femur head necrosis

[目的]评价经直前入路(direct anterior approach,DAA)高位头颈开窗植骨治疗“围塌陷期”股骨头坏死的临床疗效。[方法]回顾性分析2015年9月—2018年3月股骨头坏死患者32例(37髋)的临床资料,均采取DAA入路,头颈部带部分软骨高位开窗清除坏死骨并自体骨打压植骨。观察临床与影像结果。[结果]所有患者均顺利完成手术,术中无神经、血管损伤等严重并发症。随访(35.23±10.35)个月,随访过程中,5例(5髋)临床症状加重,其中2髋改行THA,判定为保髋失败,占13.51%;27例(32髋)临床症状持续改善,判定为保髋成功,占86.49%。与术前相比,末次随访时髋关节疼痛VAS评分显著降低(P<0.05)。而Harris评分、髋关节屈曲、内旋、外旋ROM均显著增加(P<0.05)。影像方面,与术前比较,末次随访坏死面积、关节面塌陷情况、关节间隙变窄情况无显著变化(P>0.05)。[结论]经DAA高位头颈开窗植骨治疗“围塌陷期”股骨头坏死仍可取得较好临床效果。

[Objective]To evaluate the clinical efficacy of head-neck fenestration bone autografting through direct anterior approach(DAA)for pericollapse-stage femoral head necrosis.[Methods]A retrospective study was conducted on 32 patients(37 hips)who underwent head-neck fenestration bone autografting through DAA for pericollapse-stage femoral head necrosis from September 2015 to March2018.The clinical and imaging results were observed.[Results]All patients were successfully operated on without neurovascular injury and other serious complications.During follow-up period lasted for(35.23±10.35)months,5 patients(5 hips)who had clinical symptoms worsen,including 2 hips turned to total hip arthroplasty(THA),were judged as hip preservation failure,accounting for 13.51%,while the remaining 27 patients(32 hips)who got continuous improvement in clinical symptoms were marked as successful hip preservation,accounting for 86.49%.The VAS score for hip pain significantly decreased(P<0.05),while Harris score,hip extension-flexion,internal-external rotation range of motions(ROMs)significantly increased at the latest follow up compared with those preoperatively(P<0.05).Radiographically,there were no significant changes in the area of necrosis,head collapse,and articular space at the latest follow-up compared with those before operation(P<0.05).[Conclusion]This head-neck fenestration bone autografting through DAA still achieves acceptable clinical outcomes for the pericollapse-stage femoral head necrosis.