Introduction: Osteonecrosis of the femoral head (ONTF) is a debilitating condition. Several treatments have been proposed with controversial results. The aim of our study was to evaluate treatment by surgical drilling...Introduction: Osteonecrosis of the femoral head (ONTF) is a debilitating condition. Several treatments have been proposed with controversial results. The aim of our study was to evaluate treatment by surgical drilling coupled with in situ cancellous grafting. Materials and methods: Our study was a case-control study conducted at Brazzaville University Hospital from 1st January 2018 to 31 December 2023. It compared two groups of patients with ONTF: non-operated (13 patients, 20 hips) and operated (22 patients, 35 hips). We used the visual digital scale (VDS) for pain assessment, the Merle D’Aubigne-Postel (MDP) scoring system for clinical and functional assessment, and the evolution of necrosis. Results: The group of non-operated patients had a mean age of 35.69 ± 3.4 years, no improvement in pain with an EVN above seven at the last recoil and a mean global MDP score falling from 12.7 before offloading to 10.13 at one year. The group of patients operated on had a mean age of 37.86 ± 7.02 years, a significant reduction in pain (p = 0.00004) and a significantly increased MDP score (p = 0.0034). A comparison of the two groups of patients showed significant stabilization of the necrotic lesions in the operated patients (p = 0.00067), with better satisfaction in the same group. Conclusion: Surgical drilling combined with grafting in the treatment of early-stage ONTF has improved progress in our series. The technique is reproducible and less invasive. It has made it possible to delay unfavorable progression and, consequently, hip replacement surgery.展开更多
cases (97 hips) with avascular necrosis of femoral head caused by variors factors treated by the free transferring fibular graft with vascular pedicle in the Second Teaching Hospital of Xi'an Medical University ar...cases (97 hips) with avascular necrosis of femoral head caused by variors factors treated by the free transferring fibular graft with vascular pedicle in the Second Teaching Hospital of Xi'an Medical University are reported. All patients have ben followed up for 2 to 11 years. Excellent and good rate of operative results was 86. 6%. A long observation indicated that this procedure was superior to the other operations for the osteonecrosis of femoral head. Successful interim and final operative results can warrant its continued use in management of this kind of patients.展开更多
AIM: To study a modified porous tantalum technique for the treatment of osteonecrosis of the femoral head.METHODS: The porous tantalum rod was combined with endoscopy,curettage,autologous bone grafting and use of bone...AIM: To study a modified porous tantalum technique for the treatment of osteonecrosis of the femoral head.METHODS: The porous tantalum rod was combined with endoscopy,curettage,autologous bone grafting and use of bone marrow aspirates from iliac crest aspiration in 49 patients(58 hips) with a mean age of 38 years.The majority of the patients had idiopathic osteonecrosis,followed by corticosteroid-induced osteonecrosis.Thirtyeight hips were of Steinberg stage Ⅱ disease and 20 hips were of stage Ⅲ disease.Patients were followed for 5 years and were evaluated clinically with the Merle D'Aubigne and Postel score and radiologically.The primary outcome of the study was survival based on the conversion to total hip arthroplasty(THA).Secondary outcomes included deterioration of the osteonecrosis to a higher disease stage at 5 years compared to the preoperative period and identification of factors that were associated with survival.The Kaplan-Meier survival analysis was performed to evaluate the survivorship ofthe prosthesis,and the Fisher exact test was performed to test associations between various parameters with survival.RESULTS: No patient developed any serious intraoperative or postoperative complication including implant loosening or migration and donor site morbidity.During the 5-year follow up,1 patient died,7 patients had disease progression and 4 hips were converted to THA.The 5-year survival based on conversion to THA was 93.1% and the respective rate based on disease progression was 87.9%.Stage Ⅱ disease was associated with statistically significant better survival rates compared to stage Ⅲ disease(P = 0.04).The comparison between idiopathic and non-idiopathic osteonecrosis and between steroid-induced and non-steroid-induced osteonecrosis did not showed any statistically significant difference in survival rates.The clinical evaluation revealed statistically significantly improved Merle d'Aubigne scores at 12 mo postoperatively compared to the preoperative period(P < 0.001).The mean preoperative Merle d'Aubigne score was 13.0(SD: 1.8).The respective score at 12 mo improved to 17.0(SD: 2.0).The 12-mo mean score was retained at 5 years.CONCLUSION: The modified porous tantalum rod technique presented here showed encouraging outcomes.The survival rates based on conversion to THA are the lowest reported in the published literature.展开更多
Introduction: The therapeutic success of total hip arthroplasty (THA) is unquestionable. However, in young patients, it is still a controversial topic, not because of the results obtained, but because of the presumed ...Introduction: The therapeutic success of total hip arthroplasty (THA) is unquestionable. However, in young patients, it is still a controversial topic, not because of the results obtained, but because of the presumed need for revision of the prosthetics components in the future. Objectives: The present work performs a retrospective study of patients who underwent THA surgery in the past, in which the femoral head was transferred to the iliac for use in future revisions of total hip arthroplasty (autograft), and describes the proposed technique. Methods: The research reviewed 27 patients operated on using the femoral head autograft technique for the ipsilateral iliac in total hip arthroplasty, performed from 1996 to 2005;the study considered medical records, X-rays and CT scan images, and photographs taken at the time of surgery. Results: To date, only two revisions of total hip arthroplasty have been performed, in which the patients have benefited from the technique of autografting of the femoral head. No case evolved with infection or any other type of complication. All inserted grafts are consolidated and integrated with the iliac. Conclusion: The autograft technique is cheap, simple and reproducible, making available large amounts of bone for use in future revisions of total hip arthroplasty in young patients.展开更多
BACKGROUND Osteonecrosis of the femoral head(ONFH)is a destructive condition most commonly affecting young and middle-aged patients.The leading consequence of ONFH is often a significant articular disability.Effective...BACKGROUND Osteonecrosis of the femoral head(ONFH)is a destructive condition most commonly affecting young and middle-aged patients.The leading consequence of ONFH is often a significant articular disability.Effective joint-preserving surgical treatments are urgently needed for patients with early stage ONFH when outcomes of treatment are in general better than the advanced stage disease.AIM To introduce a new surgery procedure called percutaneous expanded core decompression and mixed bone graft technique,which is a new way of jointpreserving surgical treatments.METHODS The clinical data of 6 patients with ONFH diagnosed and treated with the procedure called percutaneous expanded core decompression and mixed bone graft technique at The First Hospital of Qiqihar from March 2013 to August 2019 were retrospectively analyzed;the follow-up ended in December 2019.RESULTS There were 6 male patients with an average age of 43 years in our study.Gratifying results have been obtained from the comparison of Harris hip score,visual analogue scale,and imaging examination before and after operation.CONCLUSION This new modified technique is simple,safe,and reliable.No serious perioperative complications were observed in our cases.Advantages of the single blade expandable reamer are obvious.The adjuvant substance is inexpensive and easy to obtain.Thus,this technique is an effective joint-preserving surgical treatment for patients with early stage of ONFH.展开更多
目的:分析和总结自体股骨头结构植骨重建髋臼辅助全髋关节置换术(total hip arthroplasty,THA)治疗改良Crowe TypeⅣB型成人髋关节发育不良性脱位(developmental dysplasia of the hip,DDH)患者的临床疗效。方法:按照改良Crowe分型,选...目的:分析和总结自体股骨头结构植骨重建髋臼辅助全髋关节置换术(total hip arthroplasty,THA)治疗改良Crowe TypeⅣB型成人髋关节发育不良性脱位(developmental dysplasia of the hip,DDH)患者的临床疗效。方法:按照改良Crowe分型,选取山东大学齐鲁医院德州医院关节外科2015年8月至2023年3月收治的TypeⅣB型DDH患者26例,其中男25例,女1例,采用自体股骨头结构植骨重建髋臼辅助THA,记录患者手术时间、术中失血量、术中术后输血量、术后血红蛋白、手术相关并发症和骨愈合时间等,并行骨盆正位X线片了解假体位置、假体骨长入、假体松动以及骨愈合情况等,采用视觉模拟评分表(visual analogue scale,VAS)评价髋关节的疼痛不适,采用髋关节Harris评分和Western Ontario and McMaster Universities Osteoarthritis Index(WOMAC)来评价髋关节功能及临床疗效。结果:所有患者的平均随访时间(9.73±8.35)个月,术中出血平均为(715.38±143.37) mL,术中平均输血(415.38±282.41) mL,手术时间平均为(118.62±18.27) min,术后平均输血为(192.31±236.51) mL。所有患者转子下骨端、自体股骨头和假臼之间均骨愈合良好。髋关节VAS评分从术前6.73±0.45,至术后末次随访时VAS评分1.73±0.53,差异有统计学意义(P=0.000),髋关节活动度均较术前明显改善,髋关节Harris评分从术前24.27±1.66,至术后末次随访时Harris评分74.77±2.89,差异有统计学意义(P=0.000),WOMAC术前术后评分分别为130.08±5.72和67.85±3.23,差异均有统计学意义(P=0.000)。结论:自体股骨头结构植骨重建髋臼辅助THA治疗改良Crowe TypeⅣB型DDH,具有操作相对简单、固定牢固、手术相对安全和疗效确切的优点。展开更多
Background Quadratus femoris pedicled bone grafting has yielded satisfactory long-term clinical outcome for osteonecrosis of the femoral head （ONFH） in pre-collapse ONFH without extensive lesion. However, for pre-co...Background Quadratus femoris pedicled bone grafting has yielded satisfactory long-term clinical outcome for osteonecrosis of the femoral head （ONFH） in pre-collapse ONFH without extensive lesion. However, for pre-collapse ONFH with extensive necrotic area, it is still challenging to preserve the femoral head. The current study aimed to introduce a new technique of deliquesce strut with titanium mesh containing bone grafting pedicled with the femoral quadratus and to evaluate its short-term outcomes.Methods From January 2008 to December 2008, 10 ONFH patients （12 hips） underwent operations by a new technique of deliquesce strut with titanium mesh containing bone grafting pedicled with the femoral quadratus （group A）.According to the ARCO classification system, there were two hips in stage Ⅱ B and 10 hips in stage Ⅱ C. Also in the same period, 12 ONFH patients （16 hips） underwent operations by the conventional procedure of quadratus femoris pedicled bone grafting （group B）. There were 6 hips in stage Ⅱ B and 10 hips in stage Ⅱ C. All patients were males and suffered from alcohol induced ONFH. For the new technique, the necrotic area was evaluated, and a titanium mesh piece of the same size （range from 2.5 cm×2.8 cm to 2.8 cm×3.4 cm） was obtained and shaped to match the contour of the head. The cancellous bone was first placed underneath the subchondral bone and was densely impacted （about 1 to 2 mm thick）.Then the titanium mesh piece was inserted. The length of the decompressive trough was measured. A titanium cylinder mesh cage with a diameter of 1.6 cm of the same length was obtained, with a ＂U＂ shaped window in the wall being created to make room for the muscle pedicle. The muscle pedicle bone was inserted into the titanium mesh cage to form a bone graft-titanium cage complex and, then the complex was inserted. The hundred percent score method was used for outcome evaluation. Clinical and radiographic outcomes were compared between group A and group B.Results The average operative time was 150 minutes （130 to 185 minutes） in group A, with an average of 130 minutes （120 to 180 minutes） in group B. The mean blood loss was 400 ml （300 to 500 ml） in group Aand 350 ml （250 to 500 ml）in group B. Group A patients were followed up for an average of 19.2 months （14 to 24 months）, with an average of 18.5 months （12 to 24 months） for Group B. Full weight bearing was allowed 5 to 7 months postoperatively. Pain and function were obviously improved. For group A, pain score improved from a mean of 9.8 points preoperatively to an average of 24.6 points postoperatively, and function score improved from a mean of 9.0 points preoperatively to an average of 17.4 points postoperatively. In group B, pain score improved from a mean of 9.5 points preoperatively to an average of 24.2 points postoperatively and function score improved from a mean of 9.2 points preoperatively to an average of 17.2 points postoperatively. The range of motion changed the least, with score improvement from a preoperative mean of 13.9 points to postoperative 16.8 points for group A and from a preoperative mean of 13.7 points to postoperative 16.5 points for group B. Radiographic score improved from preoperative 31 points to postoperative 38 points for group A, in comparison with an improvement from preoperative 31 points to postoperative 37 points for group B. At the latest follow up, 11 hips were rated as excellent and 1 hip was better for group A, with 14 hips being rated as excellent and 2 hips being better in group B. There was no statistically significant difference between groups A and B in clinical and radiographic outcomes.Conclusion For ONFH in stage ARCO llC, satisfactory clinical outcome can be achieved by the new technique in the short-term period while the long-term clinical outcome has yet to be determined.展开更多
目的观察“糖果钢丝”环扎术对股骨距环扎固定联合阿仑膦酸钠对骨质疏松性股骨颈基底部骨折骨转换生化标志物(bone turnover markers,BTMs)及预后的影响。方法筛选2019年5月至2022年5月符合纳入标准的64例骨质疏松性股骨颈基底部骨折患...目的观察“糖果钢丝”环扎术对股骨距环扎固定联合阿仑膦酸钠对骨质疏松性股骨颈基底部骨折骨转换生化标志物(bone turnover markers,BTMs)及预后的影响。方法筛选2019年5月至2022年5月符合纳入标准的64例骨质疏松性股骨颈基底部骨折患者,随机分为观察组和对照组,每组32例。对照组予以股骨头置换术,术后连续服用碳酸钙D3片3个月;观察组在对照组的基础上予以股骨距“糖果钢丝”环扎固定术,术后连续服用阿仑膦酸钠片3个月。比较2组手术时间、术中出血量、手术切口长度、开始下地时间、住院时间,并分别比较治疗前和治疗3个月后2组患者假体周围骨密度(bone mineral density,BMD)、血清Ⅰ型原胶原N-端前肽(serum N-terminal peptide of type Ⅰ collagen,S-PINP)、血清Ⅰ型胶原C-末端肽交联(serum C-terminal telopeptide of type Ⅰ collagen,S-CTX);并随访12个月分析患者术后Harris髋关节功能评分、疼痛视觉模拟评分(visual analogue scale,VAS)、改良Barthel指数(modified Barthel index,MBI)评分改善情况及术后并发症发生情况。结果2组患者手术时间、术中出血量、切口长度比较无显著差异(P>0.05),2组患者术后开始下地时间和住院时间比较观察组显著低于对照组(P<0.05)。2组骨转换生化标志物S-PINP和S-CTX均较术前升高,但观察组骨形成生化标志物S-PINP显著高于对照组,骨吸收生化标志物S-CTX显著低于对照组,差异有统计学意义(P<0.05)。2组假体周围BMD均较治疗前升高,且观察组显著高于对照组,差异有统计学意义(P<0.05)。随访12个月时Harris评分、BMI评分均较术前提高,且观察组显著高于对照组,VAS评分均较术前降低,且观察组显著低于对照组,差异有统计学意义(P<0.05)。术后随访期间观察组并发症发生率低于对照组,但差异无统计学意义(P<0.05)。结论“糖果钢丝”环扎技术联合阿仑膦酸钠可以有效改善骨质疏松性股骨颈骨折术后骨转换状态,促进骨重塑,提供更加稳定的股骨柄骨长入环境,对患者预后恢复疗效显著。展开更多
目的:分析髓芯减压植骨保髋手术对不同坏死病灶位置早期股骨头坏死(osteonecrosis of the femoral head,ONFH)的临床疗效。方法:回顾分析2017年1月至2018年12月骨循环协会(Association Research Circulation Osseous,ARCO)Ⅱ期ONFH患者...目的:分析髓芯减压植骨保髋手术对不同坏死病灶位置早期股骨头坏死(osteonecrosis of the femoral head,ONFH)的临床疗效。方法:回顾分析2017年1月至2018年12月骨循环协会(Association Research Circulation Osseous,ARCO)Ⅱ期ONFH患者105例,男71例,女34例,年龄(55.20±10.98)岁,病程(15.91±9.85)个月。所有患者按日本骨坏死研究会(Japanese Investigation Committee,JIC)分型分为4组:A型17例,B型26例,C1型33例,C2型29例。所有患者行髓芯减压植骨术,术前及术后3、6、12、24个月随访时采用视觉模拟评分(visual analogue scale,VAS)、Harris髋关节评分,复查X线片观察2年内股骨头塌陷情况。结果:105例患者手术成功获得随访,时间(24.45±2.75)个月,无手术并发症发生。Harris评分在术前及术后3、6个月时各组间比较差异均无统计学意义(P>0.05),在术后12、24个月时各组间比较差异有统计学意义(P<0.01),各组术前及术后各时间点间Harris评分比较差异有统计学意义(P<0.01)。VAS在术前及术后3、6个月时各组间比较差异均无统计学意义(P>0.05),在术后12、24个月时各组间比较差异有统计学意义(P<0.01),各组术前及术后各时间点间的VAS比较差异有统计学意义(P<0.01)。4组患者在术前、术后3、6个月时均未发生股骨头塌陷;术后12个月C组发生股骨头塌陷3例,C2组发生4例(P>0.05);术后24个月B组发生股骨头塌陷1例、C1组发生6例、C2组发生8例(P<0.05)。结论:髓芯减压植骨术可提高股骨头坏死保髋疗效,而股骨头坏死保髋疗效与骨坏死病灶位置密切相关,临床治疗中应考虑到病灶位置对保髋疗效的影响,以更好的在术前制定保髋方案。展开更多
文摘Introduction: Osteonecrosis of the femoral head (ONTF) is a debilitating condition. Several treatments have been proposed with controversial results. The aim of our study was to evaluate treatment by surgical drilling coupled with in situ cancellous grafting. Materials and methods: Our study was a case-control study conducted at Brazzaville University Hospital from 1st January 2018 to 31 December 2023. It compared two groups of patients with ONTF: non-operated (13 patients, 20 hips) and operated (22 patients, 35 hips). We used the visual digital scale (VDS) for pain assessment, the Merle D’Aubigne-Postel (MDP) scoring system for clinical and functional assessment, and the evolution of necrosis. Results: The group of non-operated patients had a mean age of 35.69 ± 3.4 years, no improvement in pain with an EVN above seven at the last recoil and a mean global MDP score falling from 12.7 before offloading to 10.13 at one year. The group of patients operated on had a mean age of 37.86 ± 7.02 years, a significant reduction in pain (p = 0.00004) and a significantly increased MDP score (p = 0.0034). A comparison of the two groups of patients showed significant stabilization of the necrotic lesions in the operated patients (p = 0.00067), with better satisfaction in the same group. Conclusion: Surgical drilling combined with grafting in the treatment of early-stage ONTF has improved progress in our series. The technique is reproducible and less invasive. It has made it possible to delay unfavorable progression and, consequently, hip replacement surgery.
文摘cases (97 hips) with avascular necrosis of femoral head caused by variors factors treated by the free transferring fibular graft with vascular pedicle in the Second Teaching Hospital of Xi'an Medical University are reported. All patients have ben followed up for 2 to 11 years. Excellent and good rate of operative results was 86. 6%. A long observation indicated that this procedure was superior to the other operations for the osteonecrosis of femoral head. Successful interim and final operative results can warrant its continued use in management of this kind of patients.
文摘AIM: To study a modified porous tantalum technique for the treatment of osteonecrosis of the femoral head.METHODS: The porous tantalum rod was combined with endoscopy,curettage,autologous bone grafting and use of bone marrow aspirates from iliac crest aspiration in 49 patients(58 hips) with a mean age of 38 years.The majority of the patients had idiopathic osteonecrosis,followed by corticosteroid-induced osteonecrosis.Thirtyeight hips were of Steinberg stage Ⅱ disease and 20 hips were of stage Ⅲ disease.Patients were followed for 5 years and were evaluated clinically with the Merle D'Aubigne and Postel score and radiologically.The primary outcome of the study was survival based on the conversion to total hip arthroplasty(THA).Secondary outcomes included deterioration of the osteonecrosis to a higher disease stage at 5 years compared to the preoperative period and identification of factors that were associated with survival.The Kaplan-Meier survival analysis was performed to evaluate the survivorship ofthe prosthesis,and the Fisher exact test was performed to test associations between various parameters with survival.RESULTS: No patient developed any serious intraoperative or postoperative complication including implant loosening or migration and donor site morbidity.During the 5-year follow up,1 patient died,7 patients had disease progression and 4 hips were converted to THA.The 5-year survival based on conversion to THA was 93.1% and the respective rate based on disease progression was 87.9%.Stage Ⅱ disease was associated with statistically significant better survival rates compared to stage Ⅲ disease(P = 0.04).The comparison between idiopathic and non-idiopathic osteonecrosis and between steroid-induced and non-steroid-induced osteonecrosis did not showed any statistically significant difference in survival rates.The clinical evaluation revealed statistically significantly improved Merle d'Aubigne scores at 12 mo postoperatively compared to the preoperative period(P < 0.001).The mean preoperative Merle d'Aubigne score was 13.0(SD: 1.8).The respective score at 12 mo improved to 17.0(SD: 2.0).The 12-mo mean score was retained at 5 years.CONCLUSION: The modified porous tantalum rod technique presented here showed encouraging outcomes.The survival rates based on conversion to THA are the lowest reported in the published literature.
文摘Introduction: The therapeutic success of total hip arthroplasty (THA) is unquestionable. However, in young patients, it is still a controversial topic, not because of the results obtained, but because of the presumed need for revision of the prosthetics components in the future. Objectives: The present work performs a retrospective study of patients who underwent THA surgery in the past, in which the femoral head was transferred to the iliac for use in future revisions of total hip arthroplasty (autograft), and describes the proposed technique. Methods: The research reviewed 27 patients operated on using the femoral head autograft technique for the ipsilateral iliac in total hip arthroplasty, performed from 1996 to 2005;the study considered medical records, X-rays and CT scan images, and photographs taken at the time of surgery. Results: To date, only two revisions of total hip arthroplasty have been performed, in which the patients have benefited from the technique of autografting of the femoral head. No case evolved with infection or any other type of complication. All inserted grafts are consolidated and integrated with the iliac. Conclusion: The autograft technique is cheap, simple and reproducible, making available large amounts of bone for use in future revisions of total hip arthroplasty in young patients.
基金Supported by The First Hospital of Qiqihar,No.2013-006Department of Veterans Affairs and the Veterans Administration Medical Center in Memphis,No.I01 BX000671.
文摘BACKGROUND Osteonecrosis of the femoral head(ONFH)is a destructive condition most commonly affecting young and middle-aged patients.The leading consequence of ONFH is often a significant articular disability.Effective joint-preserving surgical treatments are urgently needed for patients with early stage ONFH when outcomes of treatment are in general better than the advanced stage disease.AIM To introduce a new surgery procedure called percutaneous expanded core decompression and mixed bone graft technique,which is a new way of jointpreserving surgical treatments.METHODS The clinical data of 6 patients with ONFH diagnosed and treated with the procedure called percutaneous expanded core decompression and mixed bone graft technique at The First Hospital of Qiqihar from March 2013 to August 2019 were retrospectively analyzed;the follow-up ended in December 2019.RESULTS There were 6 male patients with an average age of 43 years in our study.Gratifying results have been obtained from the comparison of Harris hip score,visual analogue scale,and imaging examination before and after operation.CONCLUSION This new modified technique is simple,safe,and reliable.No serious perioperative complications were observed in our cases.Advantages of the single blade expandable reamer are obvious.The adjuvant substance is inexpensive and easy to obtain.Thus,this technique is an effective joint-preserving surgical treatment for patients with early stage of ONFH.
文摘Background Quadratus femoris pedicled bone grafting has yielded satisfactory long-term clinical outcome for osteonecrosis of the femoral head （ONFH） in pre-collapse ONFH without extensive lesion. However, for pre-collapse ONFH with extensive necrotic area, it is still challenging to preserve the femoral head. The current study aimed to introduce a new technique of deliquesce strut with titanium mesh containing bone grafting pedicled with the femoral quadratus and to evaluate its short-term outcomes.Methods From January 2008 to December 2008, 10 ONFH patients （12 hips） underwent operations by a new technique of deliquesce strut with titanium mesh containing bone grafting pedicled with the femoral quadratus （group A）.According to the ARCO classification system, there were two hips in stage Ⅱ B and 10 hips in stage Ⅱ C. Also in the same period, 12 ONFH patients （16 hips） underwent operations by the conventional procedure of quadratus femoris pedicled bone grafting （group B）. There were 6 hips in stage Ⅱ B and 10 hips in stage Ⅱ C. All patients were males and suffered from alcohol induced ONFH. For the new technique, the necrotic area was evaluated, and a titanium mesh piece of the same size （range from 2.5 cm×2.8 cm to 2.8 cm×3.4 cm） was obtained and shaped to match the contour of the head. The cancellous bone was first placed underneath the subchondral bone and was densely impacted （about 1 to 2 mm thick）.Then the titanium mesh piece was inserted. The length of the decompressive trough was measured. A titanium cylinder mesh cage with a diameter of 1.6 cm of the same length was obtained, with a ＂U＂ shaped window in the wall being created to make room for the muscle pedicle. The muscle pedicle bone was inserted into the titanium mesh cage to form a bone graft-titanium cage complex and, then the complex was inserted. The hundred percent score method was used for outcome evaluation. Clinical and radiographic outcomes were compared between group A and group B.Results The average operative time was 150 minutes （130 to 185 minutes） in group A, with an average of 130 minutes （120 to 180 minutes） in group B. The mean blood loss was 400 ml （300 to 500 ml） in group Aand 350 ml （250 to 500 ml）in group B. Group A patients were followed up for an average of 19.2 months （14 to 24 months）, with an average of 18.5 months （12 to 24 months） for Group B. Full weight bearing was allowed 5 to 7 months postoperatively. Pain and function were obviously improved. For group A, pain score improved from a mean of 9.8 points preoperatively to an average of 24.6 points postoperatively, and function score improved from a mean of 9.0 points preoperatively to an average of 17.4 points postoperatively. In group B, pain score improved from a mean of 9.5 points preoperatively to an average of 24.2 points postoperatively and function score improved from a mean of 9.2 points preoperatively to an average of 17.2 points postoperatively. The range of motion changed the least, with score improvement from a preoperative mean of 13.9 points to postoperative 16.8 points for group A and from a preoperative mean of 13.7 points to postoperative 16.5 points for group B. Radiographic score improved from preoperative 31 points to postoperative 38 points for group A, in comparison with an improvement from preoperative 31 points to postoperative 37 points for group B. At the latest follow up, 11 hips were rated as excellent and 1 hip was better for group A, with 14 hips being rated as excellent and 2 hips being better in group B. There was no statistically significant difference between groups A and B in clinical and radiographic outcomes.Conclusion For ONFH in stage ARCO llC, satisfactory clinical outcome can be achieved by the new technique in the short-term period while the long-term clinical outcome has yet to be determined.
文摘目的观察“糖果钢丝”环扎术对股骨距环扎固定联合阿仑膦酸钠对骨质疏松性股骨颈基底部骨折骨转换生化标志物(bone turnover markers,BTMs)及预后的影响。方法筛选2019年5月至2022年5月符合纳入标准的64例骨质疏松性股骨颈基底部骨折患者,随机分为观察组和对照组,每组32例。对照组予以股骨头置换术,术后连续服用碳酸钙D3片3个月;观察组在对照组的基础上予以股骨距“糖果钢丝”环扎固定术,术后连续服用阿仑膦酸钠片3个月。比较2组手术时间、术中出血量、手术切口长度、开始下地时间、住院时间,并分别比较治疗前和治疗3个月后2组患者假体周围骨密度(bone mineral density,BMD)、血清Ⅰ型原胶原N-端前肽(serum N-terminal peptide of type Ⅰ collagen,S-PINP)、血清Ⅰ型胶原C-末端肽交联(serum C-terminal telopeptide of type Ⅰ collagen,S-CTX);并随访12个月分析患者术后Harris髋关节功能评分、疼痛视觉模拟评分(visual analogue scale,VAS)、改良Barthel指数(modified Barthel index,MBI)评分改善情况及术后并发症发生情况。结果2组患者手术时间、术中出血量、切口长度比较无显著差异(P>0.05),2组患者术后开始下地时间和住院时间比较观察组显著低于对照组(P<0.05)。2组骨转换生化标志物S-PINP和S-CTX均较术前升高,但观察组骨形成生化标志物S-PINP显著高于对照组,骨吸收生化标志物S-CTX显著低于对照组,差异有统计学意义(P<0.05)。2组假体周围BMD均较治疗前升高,且观察组显著高于对照组,差异有统计学意义(P<0.05)。随访12个月时Harris评分、BMI评分均较术前提高,且观察组显著高于对照组,VAS评分均较术前降低,且观察组显著低于对照组,差异有统计学意义(P<0.05)。术后随访期间观察组并发症发生率低于对照组,但差异无统计学意义(P<0.05)。结论“糖果钢丝”环扎技术联合阿仑膦酸钠可以有效改善骨质疏松性股骨颈骨折术后骨转换状态,促进骨重塑,提供更加稳定的股骨柄骨长入环境,对患者预后恢复疗效显著。
文摘目的:分析髓芯减压植骨保髋手术对不同坏死病灶位置早期股骨头坏死(osteonecrosis of the femoral head,ONFH)的临床疗效。方法:回顾分析2017年1月至2018年12月骨循环协会(Association Research Circulation Osseous,ARCO)Ⅱ期ONFH患者105例,男71例,女34例,年龄(55.20±10.98)岁,病程(15.91±9.85)个月。所有患者按日本骨坏死研究会(Japanese Investigation Committee,JIC)分型分为4组:A型17例,B型26例,C1型33例,C2型29例。所有患者行髓芯减压植骨术,术前及术后3、6、12、24个月随访时采用视觉模拟评分(visual analogue scale,VAS)、Harris髋关节评分,复查X线片观察2年内股骨头塌陷情况。结果:105例患者手术成功获得随访,时间(24.45±2.75)个月,无手术并发症发生。Harris评分在术前及术后3、6个月时各组间比较差异均无统计学意义(P>0.05),在术后12、24个月时各组间比较差异有统计学意义(P<0.01),各组术前及术后各时间点间Harris评分比较差异有统计学意义(P<0.01)。VAS在术前及术后3、6个月时各组间比较差异均无统计学意义(P>0.05),在术后12、24个月时各组间比较差异有统计学意义(P<0.01),各组术前及术后各时间点间的VAS比较差异有统计学意义(P<0.01)。4组患者在术前、术后3、6个月时均未发生股骨头塌陷;术后12个月C组发生股骨头塌陷3例,C2组发生4例(P>0.05);术后24个月B组发生股骨头塌陷1例、C1组发生6例、C2组发生8例(P<0.05)。结论:髓芯减压植骨术可提高股骨头坏死保髋疗效,而股骨头坏死保髋疗效与骨坏死病灶位置密切相关,临床治疗中应考虑到病灶位置对保髋疗效的影响,以更好的在术前制定保髋方案。
