Surgical Treatment of Osteonecrosis of the Femoral Head Using Minimally Invasive Surgical Drilling and Cancellous Grafting at Brazzaville University Hospital

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.

TREATMENT OF ISCHEMIC NECROSIS OF FEMORAL HEAD BY THE FREE TRANSFERRING FIBULAR BONE GRAFT WITH VASCULAR PEDICLE IN ADULTS: A REPORT ON 95 CASES

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.

Treatment of Non-union Femoral Neck Fractures with Vascularized Fibula Grafting

Objective: To investigate the value of transplantation of vascularized fibula in treating non-union femoral neck fractures and preventing ischemic necrosis of the femoral head. Methods : Vascularized heterotopic fibula was transplanted to the anterior-lateral part of the femoral neck. The fibula artery and vein were anastomosised with lateral circumflex artery and vein. Results : One hundred and twenty-nine cases of non-union femoral neck fracture were treated with vascularized fibula graft in our hospital from 1982 to 2002. Eighty-seven cases of them were followed up for 3 to 19 years with functional and X-ray examination. The percentage of fracture healing and effect were 94. 3 and 81. 6, respectively. Conclusion:The fibula with blood supply has a synergistic fixation impact on the non-union femoral neck fractures. The fibula is solid enough for supporting the femoral head and preventing it from collapse. The vascularized fibula grafting, by providing blood supply to the affected femoral head and neck, could promote the femoral head restoration and reconstruction. In addition, the periosteum of fibula plays a role in fracture healing.

Modified porous tantalum rod technique for the treatment of femoral head osteonecrosis

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.

Femoral Head Autograft to the Iliac for Use in Future Revisions of Total Hip Arthroplasty: 15-Year Follow-Up

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.

Modified technique of advanced core decompression for treatment of femoral head osteonecrosis

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.

自体股骨头结构植骨重建髋臼辅助THA在改良CROWE Type ⅣB型DDH中的临床疗效分析

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。

A modified technique of bone grafting pedicled with femoral quadratus for alcohol-induced osteonecrosis of the femoral head

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.

组织工程技术在股骨头坏死治疗中的应用及前景

背景:股骨头坏死早期多采用植骨类保髋手术治疗,其中自体骨与异体骨是常用的植骨材料,但自体骨移植创伤性大且供骨来源有限,异体骨虽来源丰富,但存在严重的免疫排斥反应和吸收风险。近年来,以间充质干细胞为基础的组织工程技术是治疗股骨头坏死的新方法,经过基础实验和临床应用的检验,正逐渐得到广泛应用。目的:综述组织工程技术在股骨头坏死治疗中的应用及前景,为临床治疗股骨头坏死提供新的选择。方法:由第一作者检索2013-2023年的PubMed数据库和中国知网,英文检索词为“tissue engineering,mesenchymal stem cells,biological scaffolds,cytokines,osteonecrosis of the femoral head,bone graft,hip preservation”,中文检索词为“组织工程,间充质干细胞,生物支架,细胞因子,股骨头坏死,植骨,保髋”,选择运用组织工程技术治疗股骨头坏死方面的文献,根据纳入与排除标准对所有文章进行初筛后,共纳入55篇代表性文献进行综述。结果与结论:①随着生物技术与材料学的不断发展,骨组织工程技术治疗股骨头坏死己取得较大进展,例如基因修饰的间充质干细胞修复骨坏死、基因重组技术及表面改性技术与骨组织工程的结合在股骨头坏死治疗中的应用等;②组织工程技术应用于坏死股骨头时可促进坏死骨组织再生和血管系统的修复,同时为坏死区域提供生物力学稳定性,并且利用生物活性因子促进种子细胞的修复作用,完成坏死区新生骨的再生;③但目前这些研究大多数尚处于动物实验阶段,骨组织工程研究仍存在许多未解决的问题和挑战,随着纳米技术、组织工程学和临床医学的快速发展,性能完善的仿生替代植骨材料将有望诞生;④在未来应用骨组织工程技术治疗股骨头坏死有望成为一种令人满意的治疗方式,给保髋患者带来福音。

股骨距环扎固定联合阿仑膦酸钠对骨质疏松性股骨颈骨折BTMs及预后的影响

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。

早期股骨头坏死采用改良髓芯减压植骨术结合多孔钽棒材料治疗的可行性分析

目的探讨对早期股骨头坏死(ONFH)患者采用改良髓芯减压植骨术结合多孔钽棒材料治疗的可行性。方法选取2021年1月至2022年10月空军军医大学第一附属医院收治的72例(72髋)早期ONFH患者作为研究对象。采用随机数字表法分为对照组和观察组,各36例。对照组给予常规髓芯减压植骨术治疗,观察组给予改良髓芯减压植骨术结合多孔钽棒材料治疗。对比2组围手术期指标,术前及术后6个月疼痛视觉模拟量表(VAS)评分、Fugl-Meyer平衡量表(FMA)评分、Harris髋关节功能评分,髋关节活动度,临床疗效,以及术后并发症发生情况。结果观察组手术时间、术中出血量、骨折愈合时间短于/少于对照组[(51±17)min比(62±15)min、(103±26)ml比(135±36)ml、(11.5±1.6)周比(13.2±2.6)周],差异均有统计学意义(均P<0.05)。术后6个月观察组VAS评分低于对照组,FMA评分、Harris髋关节功能评分均高于对照组,差异均有统计学意义(均P<0.001)。术后6个月2组髋关节外旋、内旋、外展、内收、后伸、前屈角度均大于术前,且观察组均大于对照组,差异均有统计学意义(均P<0.05)。观察组临床疗效优良率高于对照组[97.2%(35/36)比80.6%(29/36)],差异有统计学意义(χ^(2)=5.063,P=0.024)。观察组和对照组并发症总发生率差异无统计学意义(P>0.05)。结论改良髓芯减压植骨术结合多孔钽棒材料治疗早期ONFH可行。该方法安全性高且操作简便,能够有效减轻早期ONFH患者髋膝部疼痛,改善髋关节活动度与平衡能力。

股骨颈骨折患者术前骨代谢水平与内固定术后发生股骨头坏死的关系

目的探讨术前骨代谢指标水平与股骨颈骨折患者内固定术后发生股骨头坏死的关系,为优化治疗方案提供依据。方法选取河南省洛阳正骨医院于2021年1月至2022年6月收治的96例股骨颈骨折患者为研究对象,所有患者明确诊断后均接受内固定术治疗。设计调查表,收集并对比所有患者一般资料;记录入院当天测定的骨代谢指标[骨钙素(OST)、Ⅰ型前胶原氨基端延长肽(PⅠNP)、Ⅰ型胶原羧基端肽β特殊序列(β-CTX)、骨特异性碱性磷酸酶(BAP)];统计所有患者术后3个月内股骨头坏死情况。采用点二列相关性分析术前骨代谢指标与股骨颈骨折患者内固定术后股骨头坏死发生的关系。结果术后3个月内,96例股骨颈骨折患者中发生股骨头坏死17例,占比17.71%;股骨头坏死发生组术前OST、PⅠNP、BAP水平低于未发生组,β-CTX水平高于未发生组,Garden类型Ⅲ型占比高于未发生组,差异有统计学意义(P<0.05);经点二列相关结果显示,术前OST、PⅠNP、BAP、β-CTX水平与股骨颈骨折术后患者股骨头坏死有关(P<0.05)。结论患者术前骨代谢指标水平与股骨颈骨折术后发生股骨头坏死有关,且OST、PⅠNP、BAP水平越低,β-CTX水平越高,股骨头坏死发生可能性越大。

经皮扩张式铰刀髓芯减压联合PRO-DENSE可再生骨植骨治疗股骨头坏死的疗效及安全性分析

目的探究经皮扩张式铰刀髓芯减压联合PRO-DENSE可再生骨植骨术在股骨头坏死(ONFH)治疗中的应用价值。方法回顾性选取2020年1月1日—2022年1月1日100例ONFH,根据手术方法分为2组各50例。对照组行髓芯减压自体骨植骨术,观察组行经皮扩张式铰刀髓芯减压联合PRO-DENSE可再生骨植骨术。比较2组手术观察指标、手术疗效、并发症发生情况,以及手术前后神经源性炎症指标[神经生长因子(NGF)、前列腺素E_(2)(PGE_(2))]、血清生化指标[缺氧诱导因子-1α(HIF-1α)、血管内皮生长因子A(VEGF-A)、Ⅰ型前胶原氨基酸前肽(PⅠNP)、骨钙素(BGP)]、视觉模拟量表(VAS)评分、Harris髋关节功能评分。结果观察组术中出血量(24.25±4.78)mL少于对照组(50.29±8.94)mL,住院时间(12.50±2.24)d短于对照组(15.12±3.37)d(P<0.01)。观察组术后1、3及7 d血清NGF、PGE_(2)低于对照组(P<0.05)。观察组术后1、3及6个月血清HIF-1α、VEGF-A、BGP及Harris髋关节功能评分较对照组高,血清PⅠNP及VAS评分较对照组低(P<0.05)。2组手术优良率、并发症总发生率比较,差异无统计学意义(P>0.05)。结论经皮扩张式铰刀髓芯减压联合PRO-DENSE可再生骨植骨术是ONFH患者安全可靠的治疗方式,能降低炎性因子水平,促进术后早期恢复,加速骨代谢,促进髋关节功能恢复,减轻患者疼痛。

青少年股骨头软骨母细胞瘤1例

患者,男,15岁,因跌倒后右髋疼痛13 d于2022年3月28日至我院就诊。查体:右髋压痛,自主内旋稍受限。DR及CT检查显示:右股骨头外上部骨密度不均匀增高,多个斑片状低密度灶,边缘骨质硬化(见图1A)。初步诊断为右股骨头软骨母细胞瘤。排除手术禁忌证后在腰硬联合麻醉下手术治疗。

扩大髓芯减压植骨术和肌骨瓣植入术治疗股骨头坏死的疗效比较

目的比较扩大髓芯减压植骨术和肌骨瓣植入术治疗股骨头坏死的临床疗效。方法将27例股骨头坏死患者按照手术方式不同分为扩大髓芯减压植骨组(10例)和肌骨瓣植入组(17例)。记录两组手术情况,采用疼痛VAS评分评价患者疼痛缓解情况,采用Harris评分评价髋关节功能恢复情况。结果患者均获得随访,时间12~48个月。手术时间、术中出血量、切口长度、住院时间扩大髓芯减压植骨组均短(少)于肌骨瓣植入组(P<0.01)。两组术后1、3、12个月疼痛VAS评分均低于术前(P<0.05),术后各时间点两组比较差异均无统计学意义(P>0.05)。两组术后1、3、12个月Harris评分均高于术前(P<0.05),术后各时间点两组比较差异均无统计学意义(P>0.05)。末次随访时,两组X线片均未见股骨头坏死区域进展;患者均能正常行走,除肌骨瓣植入组2例轻度跛行步态外,其余患者均为正常步态。结论扩大髓芯减压植骨术和肌骨瓣植入术治疗股骨头坏死均能获得满意的临床效果,扩大髓芯减压植骨术的手术创伤更小,出血更少,患者恢复更快。

直接前方入路和经上关节囊通道辅助入路全髋关节置换术治疗髋关节疾病的短期疗效

目的探讨直接前方入路(DAA)及经上关节囊通道辅助入路(SuperPATH)全髋关节置换术(THA)治疗髋关节疾病的短期疗效。方法回顾性分析2016年7月至2017年12月因髋关节疾病在苏北人民医院关节外科行初次全髋关节置换手术的41例患者,其中DAA组19例,SuperPATH组22例。比较两组术前、出院前及术后6个月的Harris评分、手术时间、第一次下床时间、住院时间、VAS评分、术中失血量、第3天的血红蛋白变化值和白蛋白变化值以及围手术期并发症的发生情况。结果DAA组及SuperPATH组患者一般资料比较差异无统计学意义(P>0.05)。DAA组患者手术时间长于SuperPATH组(P<0.05),两组患者第一次下床时间、住院时间、出院前VAS评分、出院前及术后6个月的Harris评分差异无统计学意义(P>0.05)。DAA组患者术中出血量、第3天血红蛋白及白蛋白的变化量明显高于SuperPATH组(P<0.01)。两组都有4例患者进行了输血治疗,差异无统计学意义(P>0.05)。两组患者围手术期并发症发生率差异无统计学意义(P>0.05)。结论DAA入路与SuperPATH入路均是全髋关节置换术治疗髋关节疾病的有效手术入路,均具有恢复快创伤小的优点。

FVFG术与髓芯干细胞植入术治疗股骨头坏死的临床价值比较

目的对比分析吻合血管游离腓骨移植(FVFG)术、髓芯干细胞植入术治疗股骨头坏死(ONFH)的临床价值。方法收集南阳文和骨科医院2021年3月至2023年5月103例ONFH患者临床资料,依照手术方案差异分为两组,对照组(51例)行髓芯干细胞植入术治疗,研究组(52例)行FVFG术治疗,比较两组围术期情况、术后并发症发生率以及术前、术后3个月Harris髋关节功能评分、血液流变学指标、骨代谢指标。结果研究组手术时间为(98.41±10.37)min,长于对照组(47.62±5.19)min(P<0.05);术后3个月,研究组血清25羟基维生素D3[25-(OH)D3]、Harris髋关节功能评分、血清骨碱性磷酸酶(BAP)分别为(24.16±2.55)ng/mL、(91.28±4.57)分、(0.75±0.12)pg/mL,均高于对照组(20.38±2.14)ng/mL、(88.51±6.02)分、(0.64±0.09)pg/mL,全血高切黏度、血清Ⅱ型胶原C端肽(CTX-Ⅱ)、血浆黏度、全血低切黏度分别为(4.27±0.65)mPa·s、(132.71±18.69)ng/L、(1.84±0.52)mPa·s、(7.36±1.80)mPa·s,均低于对照组(4.80±0.71)mPa·s、(161.80±21.43)ng/L、(2.16±0.47)mPa·s、(8.94±1.72)mPa·s(P<0.05);研究组术后并发症发生率5.77%较对照组19.61%低(P<0.05)。结论与髓芯干细胞植入术比较,FVFG术治疗ONFH的手术时间较长,但对患者髋关节功能、血液流变学指标、骨代谢指标水平的改善效果更好。

机器人辅助髓芯减压植骨治疗ARCOⅡ期股骨头坏死

背景:髓芯减压植骨是ARCOⅡ期股骨头坏死的主要保髋术式之一,但传统手术方式存在透视时间长、出血量大等缺点。目的:分析机器人辅助下进行髓芯减压植骨术治疗ARCOⅡ期股骨头坏死的临床治疗特点,为股骨头坏死保髋治疗提供新思路。方法:回顾性分析2017年6月到2019年12月于西安交通大学附属红会医院骨坏死与关节重建科因股骨头坏死行髓芯减压植骨治疗的100例患者资料,其中骨科机器人导航辅助下髓芯减压植骨患者50例,男性36例,女性14例,年龄30-74(47.52±12.50)岁,设为机器人导航组;常规髓芯减压植骨患者50例,男性37例,女性13例,年龄28-77(50.68±13.60)岁,设为常规手术组;所有手术均为同一名术者操作完成。记录两组患者术前、末次随访Harris评分、术后目测类比疼痛评分、股骨头塌陷情况、术中各操作透视次数、术中出血量和手术时间。结果与结论:①所有患者获得随访,随访时间为20-38(28.53±0.50)个月;②机器人导航组患者术中X射线透视总次数、导针置入透视次数、植骨操作透视次数、植骨通道确定时间、手术时间分别为(13.84±1.52)次、(5.64±1.14)次、(8.20±1.70)次、(20.39±1.46)min和(39.37±1.96)min,均少于常规手术组上述各项指标的相应值[(18.94±1.32)次、(8.64±1.27)次、(10.30±1.79)次、(41.57±1.63)min和(62.53±3.44)min,均P<0.05];③两组在末次Harris评分、术后目测类比疼痛评分、股骨头塌陷情况和术中出血量之间比较差异无显著性意义(P>0.05);④结果说明,骨科机器人导航辅助下进行髓芯减压植骨治疗ARCOⅡ期股骨头坏死可明显提高髓芯减压植骨操作的精准度,减少术中透视次数,缩短手术时间,降低术后并发症出现的概率。

消炎止痛膏联合钻孔减压自体髂骨松质骨打压植骨治疗早期股骨头坏死的效果观察

目的分析消炎止痛膏联合钻孔减压自体髂骨松质骨打压植骨治疗早期股骨头坏死的效果。方法前瞻性选取2019年1月至2020年12月唐山市第二医院收治的86例早期股骨头坏死患者作为研究对象。按随机数字表法分为两组,每组各43例。对照组采用钻孔减压自体髂骨松质骨打压植骨治疗,观察组采用消炎止痛膏联合钻孔减压自体髂骨松质骨打压植骨治疗。观察并比较两组股骨头坏死的治疗效果、治疗前后Harris髋关节功能评分、血浆中枢神经特异性蛋白S-100B及神经元特异性烯醇化酶(NSE)水平及不良反应发生情况,并进行统计学分析。结果治疗后3、6、12个月,两组Harris髋关节功能评分均较治疗前显著升高,且观察组治疗后的Harris髋关节功能评分分别为(77.23±7.65)、(83.84±6.69)、(86.71±6.15)分,均高于对照组[(72.91±8.12)、(79.31±6.25)、(83.22±6.33)分],差异均有统计意义(P<0.05)。治疗后4、8、12周,两组血浆S-100B及NSE水平均较治疗前降低,且观察组治疗后血浆S-100B分别为(75.21±6.66)、(72.85±6.05)、(70.55±5.93)ng/mL,NSE水平分别为(15.41±3.96)、(13.73±3.31)、(12.35±2.87)ng/mL,显著低于对照组[S-100B:(78.94±7.11)、(76.33±6.31)、(74.44±6.22)ng/mL;NSE:(17.19±4.13)、(15.86±3.97)、(14.03±3.61)ng/mL],差异均有统计意义(P<0.05)。观察组总有效率为95.34%,明显高于对照组(65.12%),差异有统计学意义(P<0.05)。两组均无明显不良反应,或不良反应耐受。结论消炎止痛膏联合钻孔减压自体髂骨松质骨打压植骨有利于改善早期股骨头坏死患者神经系统功能及髋关节功能,值得临床予以推广应用。

血管介入联合髓芯减压植骨术治疗早中期股骨头缺血性坏死的疗效观察

目的探究血管介入联合髓芯减压植骨术治疗早中期股骨头缺血性坏死(ANFH)患者的临床疗效。方法前瞻性选取2015年6月至2022年6月在北京中医药大学孙思邈医院周围血管病科就诊的113例早中期ANFH患者作为研究对象,采用随机数表法分为观察组56例和对照组57例,比较两组患者术后6个月的治疗效果及并发症、两组术前及术后6个月的Harris评分(疼痛、功能、畸形、关节活动)、骨代谢标志物[骨钙素(OC)、骨形态发生蛋白-2(BMP-2)、胰岛素样生长因子-1(IGF-1)]和血液流变学指标[全血高切黏度(WBHS)、全血低切黏度(WBLS)、血浆黏度(PV)]。结果术后6个月,观察组患者的优良率为94.64%,明显高于对照组的78.95%,差异有统计学意义(P<0.05);术后6个月,观察组患者的Harris量表疼痛、功能、畸形、关节活动各项评分分别为(37.82±5.82)分、(41.67±5.96)分、(3.27±0.52)分、(3.85±0.59)分,明显高于对照组的(34.68±5.19)分、(37.09±5.39)分、(2.82±0.46)分、(3.35±0.52)分,差异均有统计学意义(P<0.05);术后6个月,观察组患者的OC、BMP-2及IGF-1水平分别为(6.85±0.89)μg/L、(17.74±2.31)μg/L、(88.35±10.93)ng/mL,明显高于对照组的(5.54±0.78)μg/L、(13.47±1.79)μg/L、(81.36±10.96)ng/mL,差异均有统计学意义(P<0.05);术后6个月,观察组患者的WBHS、WBLS及PV分别为(5.32±0.74)mPa·s、(6.82±0.87)mPa·s、(1.74±0.21)mPa·s,明显低于对照组的(6.27±0.81)mPa·s、(8.14±1.23)mPa·s、(2.15±0.29)mPa·s,差异均有统计学意义(P<0.05);治疗期间,观察组患者的不良反应总发生率为3.57%,略低于对照组的7.02%,但差异无统计学意义(P>0.05)。结论血管介入联合髓芯减压植骨术有助于改善ANFH患者的髋关节功能、骨代谢及血液流变学指标,提高生活质量,且安全性较高。