经股骨颈打压植骨治疗ARCOⅡ/Ⅲ期非创伤性股骨头坏死——一项10年以上的随访研究

Surgical treatment of non-traumatic osteonecrosis of the femoral head in ARCOⅡ/Ⅲstage with impaction bone grafting via femoral neck:a follow-up study over 10 years

目的探讨经股骨颈打压植骨治疗年轻患者国际骨循环研究会(Association Research Circulation Osseous,ARCO)Ⅱ/Ⅲ期非创伤性股骨头坏死(osteonecrosis of the femoral head,ONFH)的长期疗效,并分析影响该术式远期临床疗效的主要因素。方法纳入2006年1月至2012年6月于我院接受治疗的53例ARCOⅡ和Ⅲ期的ONFH患者(55髋),其中男49髋,女6髋;年龄18~59岁,平均34.5岁。所有患者均接受经股骨颈打压植骨手术,比较术前和末次随访的Harris髋关节评分(Harris hip score,HHS)和疼痛视觉模拟评分(visual analogue scale,VAS),并记录影像学改变情况以及所有患者全髋关节置换术(total hip arthroplasty,THA)的转换率,分析不同的分期和分型特点与远期失败后全髋置换的关系。结果本组随访时间10.0~14.3年,平均12.2年;末次随访与术前相比,HHS功能评分分别从71.7±13.8提高到82.4±17.0(P=0.000);而VAS疼痛评分则从4.5±0.9降到2.4±1.3(P=0.000)。THA转化率为25.5%(14髋)。日本骨坏死研究会(Japanese Investigation Committee,JIC)分型的C2型和Kerboul分类中联合坏死角≥240°与远期失败后转化为THA密切相关(P=0.000)。结论经股骨颈打压植骨治疗ARCOⅡ和Ⅲ期的ONFH长期临床疗效尚可,具有较高的保髋成功率。手术成功的关键在于恰当的病例选择和准确的手术技术,而对于股骨头塌陷较重、外侧柱严重受累、联合坏死角较大的患者保髋成功率较低,远期效果不佳,应谨慎选择经股骨颈打压植骨手术。

Objective To investigate the long-term efficacy of femoral neck compression grafting for the treatment of young patients with ARCO stageⅡ/Ⅲnon-traumatic osteonecrosis of the femoral head(ONFH),and to analyze the main factors influencing the long-term clinical outcomes of this procedure.Methods A total of53 patients(55 hips)with ARCO stageⅡandⅢONFH who received treatment at our hospital from January 2006 to June 2012 were included in the study,comprising 49 hips in males and 6 hips in females.The age range was18 to 59 years,with an average age of 34.5 years.All patients underwent compression grafting surgery via the femoral neck.Harris hip scores(HHS)and visual analogue scale(VAS)pain scores were compared preoperatively and at the last follow-up.Radiological changes were recorded,and the conversion rate to total hip arthroplasty(THA)was analyzed in relation to different stages and types of ONFH.Results The average follow-up duration was 12.2 years(range:10.0-14.3 years).At the last follow-up compared to preoperatively,the HHS functional score improved from(71.7±13.8)to(82.4±17.0)(P=0.000),while the VAS score decreased from(4.5±0.9)to(2.4±1.3)(P=0.000).The THA conversion rate was 25.5%(14 hips).The C2 type in the JIC classification and a combined necrotic angle of≥240°in the Kerboul classification were closely associated with the conversion to total hip arthroplasty after long-term failure(P=0.000).Conclusions Compression grafting via the femoral neck for ARCO stageⅡandⅢONFH shows acceptable long-term clinical outcomes with a high success rate for hip preservation.The key to surgical success lies in appropriate case selection and accurate surgical technique.However,for patients with severe femoral head collapse,significant involvement of the lateral column,and larger combined necrotic angles,the success rate for hip preservation is lower,and long-term outcomes are poor,thus warranting caution when selecting femoral neck compression grafting surgery.