Background： Avascular necrosis of femoral head （AVNFH） typically presents in the young adults and progresses quickly without proper treatments. However, the optimum treatments for early stage of AVNFH are still con...Background： Avascular necrosis of femoral head （AVNFH） typically presents in the young adults and progresses quickly without proper treatments. However, the optimum treatments for early stage of AVNFH are still controversial. This study was conducted to evaluate the therapeutic effects of multiple small-diameter drilling decompression combined with hip arthroscopy for early AVNFH compared to drilling alone. Methods： This is a nonrandomized retrospective case series study. Between April 2006 and November 2010, 60 patients （98 hips） with early stage AVNFH participated in this study. The patients underwent multiple small-diameter drilling decompression combined with hip arthroscopy in 26 cases/43 hips （Group A） or drilling decompression alone in 34 cases/55 hips （Group B）. Patients were followed up at 6, 12, and 24 weeks, and every 6 months thereafter. Radiographs were taken at every follow-up, Harris scores were recorded at the last follow-up, the paired t-test was used to compare the postoperative Harris scores. Surgery effective rate of the two groups was compared using the Chi-square test. Results： All patients were followed up for an average of 57.6 months （range： 17-108 months）. Pain relief and improvement of hip function were assessed in all patients at 6 months after the surgery. At the last follow-up, Group A had better outcome with mean Harris＇ scores improved from 68.23 ± 11.37 to 82.07 ± 2.92 （t = -7.21, P = 0.001） than Group B with mean Harris＇ scores improved from 69.46 ± 9.71 to 75.79± 4.13 （t = -9.47, P = 0.037） （significantly different： t = -2.54, P = 0.017）. The total surgery effective rate was also significantly different between Groups A and B （86.0% vs. 74.5%; Z2 = 3.69, P = 0.02）. Conclusion： For early stage of AVNFH, multiple small-diameter drilling decompression combined with hip arthroscopy is more effective than drilling decompression alone.展开更多
目的对ARCOⅡa期至Ⅲa期股骨头坏死(osteonecrosis of the femoral head,ONFH)且接受大通道钻孔减压、病灶清除,并经减压通道行股骨头内自体松质骨、同种异体颗粒骨打压植骨、同种异体腓骨条植骨治疗的患者进行短期临床疗效分析。方法2...目的对ARCOⅡa期至Ⅲa期股骨头坏死(osteonecrosis of the femoral head,ONFH)且接受大通道钻孔减压、病灶清除,并经减压通道行股骨头内自体松质骨、同种异体颗粒骨打压植骨、同种异体腓骨条植骨治疗的患者进行短期临床疗效分析。方法2018年1月至2020年12月,四川省骨科医院纳入47例(59髋)股骨头坏死患者。其中,男39例,女8例;年龄29~51岁,平均37.2岁;ARCOⅡa期16髋,ARCOⅡb期21髋,ARCOⅡc期13髋,ARCOⅢa期9髋;酒精性ONFH 46髋(酒精组),激素性ONFH 13髋(激素组)。术后门诊随访,复查X线片(双髋正位及蛙式位片),观察股骨头形态及骨整合情况,记录患髋Harris评分。结果本组47例(59髋)随访24~36个月,平均随访30个月。术后所有患者疼痛明显缓解,部分患者疼痛消失(包括Ⅱa期14髋,Ⅱb期13髋,Ⅱc期4髋)。6例(9髋)患者病情进展股骨头发生塌陷,其中Ⅱb期1髋,Ⅱc期3髋,Ⅲa期5髋。按病因分,酒精性坏死塌陷6髋,塌陷率13%;激素性坏死塌陷3髋,塌陷率23.1%。酒精组和激素组末次随访时Harris评分与术前比较,差异均有统计学意义(P<0.05);酒精组术后Harris评分(82.7±5.6)分显著高于激素组(78.3±8.3)分,差异具有统计学意义(P<0.05)。不同ARCO分期患者术后髋关节功能均得到一定程度改善,其中Ⅱa及Ⅱb期优良率78.4%,Ⅱc、Ⅲa期优良率50%(P<0.05)。结论针对ARCOⅡa期至Ⅲa期股骨头坏死的患者,采用大直径通道减压、清除死骨,同时植入自体松质骨和同种异体颗粒骨混合物,最后配合同种异体腓骨条加强支撑,短期可有效防止坏死股骨头的塌陷并减轻疼痛、改善患功能。展开更多
文摘Background： Avascular necrosis of femoral head （AVNFH） typically presents in the young adults and progresses quickly without proper treatments. However, the optimum treatments for early stage of AVNFH are still controversial. This study was conducted to evaluate the therapeutic effects of multiple small-diameter drilling decompression combined with hip arthroscopy for early AVNFH compared to drilling alone. Methods： This is a nonrandomized retrospective case series study. Between April 2006 and November 2010, 60 patients （98 hips） with early stage AVNFH participated in this study. The patients underwent multiple small-diameter drilling decompression combined with hip arthroscopy in 26 cases/43 hips （Group A） or drilling decompression alone in 34 cases/55 hips （Group B）. Patients were followed up at 6, 12, and 24 weeks, and every 6 months thereafter. Radiographs were taken at every follow-up, Harris scores were recorded at the last follow-up, the paired t-test was used to compare the postoperative Harris scores. Surgery effective rate of the two groups was compared using the Chi-square test. Results： All patients were followed up for an average of 57.6 months （range： 17-108 months）. Pain relief and improvement of hip function were assessed in all patients at 6 months after the surgery. At the last follow-up, Group A had better outcome with mean Harris＇ scores improved from 68.23 ± 11.37 to 82.07 ± 2.92 （t = -7.21, P = 0.001） than Group B with mean Harris＇ scores improved from 69.46 ± 9.71 to 75.79± 4.13 （t = -9.47, P = 0.037） （significantly different： t = -2.54, P = 0.017）. The total surgery effective rate was also significantly different between Groups A and B （86.0% vs. 74.5%; Z2 = 3.69, P = 0.02）. Conclusion： For early stage of AVNFH, multiple small-diameter drilling decompression combined with hip arthroscopy is more effective than drilling decompression alone.
文摘目的对ARCOⅡa期至Ⅲa期股骨头坏死(osteonecrosis of the femoral head,ONFH)且接受大通道钻孔减压、病灶清除,并经减压通道行股骨头内自体松质骨、同种异体颗粒骨打压植骨、同种异体腓骨条植骨治疗的患者进行短期临床疗效分析。方法2018年1月至2020年12月,四川省骨科医院纳入47例(59髋)股骨头坏死患者。其中,男39例,女8例;年龄29~51岁,平均37.2岁;ARCOⅡa期16髋,ARCOⅡb期21髋,ARCOⅡc期13髋,ARCOⅢa期9髋;酒精性ONFH 46髋(酒精组),激素性ONFH 13髋(激素组)。术后门诊随访,复查X线片(双髋正位及蛙式位片),观察股骨头形态及骨整合情况,记录患髋Harris评分。结果本组47例(59髋)随访24~36个月,平均随访30个月。术后所有患者疼痛明显缓解,部分患者疼痛消失(包括Ⅱa期14髋,Ⅱb期13髋,Ⅱc期4髋)。6例(9髋)患者病情进展股骨头发生塌陷,其中Ⅱb期1髋,Ⅱc期3髋,Ⅲa期5髋。按病因分,酒精性坏死塌陷6髋,塌陷率13%;激素性坏死塌陷3髋,塌陷率23.1%。酒精组和激素组末次随访时Harris评分与术前比较,差异均有统计学意义(P<0.05);酒精组术后Harris评分(82.7±5.6)分显著高于激素组(78.3±8.3)分,差异具有统计学意义(P<0.05)。不同ARCO分期患者术后髋关节功能均得到一定程度改善,其中Ⅱa及Ⅱb期优良率78.4%,Ⅱc、Ⅲa期优良率50%(P<0.05)。结论针对ARCOⅡa期至Ⅲa期股骨头坏死的患者,采用大直径通道减压、清除死骨,同时植入自体松质骨和同种异体颗粒骨混合物,最后配合同种异体腓骨条加强支撑,短期可有效防止坏死股骨头的塌陷并减轻疼痛、改善患功能。
