摘要
背景:髓芯减压术是治疗早期股骨头坏死的简单且行之有效的保髋治疗手术方法,但不同研究表明,其治疗效果差异很大,这可能与股骨头坏死的病因不同有关。目的:观察采用髓芯减压术分别治疗早期创伤性、酒精性及激素性股骨头坏死的临床疗效。方法:对2010年9月至2013年9月采用细针多孔髓芯减压术分别治疗创伤性、激素性及酒精性早期(ARCOⅠ、Ⅱa期)股骨头坏死患者进行回顾性分析。其中,创伤性股骨头坏死32例(32髋):男20例(20髋),女12例(12髋);平均年龄(43.4±9.9)岁;受伤至出现症状时间为(23.9±17.6)个月。激素性股骨头坏死67例(97髋):男18例(32髋),女49例(65髋);平均年龄(38.5±10.8)岁;服用激素至出现症状时间为(27.2±16.8)个月。酒精性股骨头坏死38例(66髋):均为男性;平均年龄(46.4±11.8)岁;饮酒至出现症状时间为(118.7±65.4)个月。术前及术后12、24个月采用Harris评分评价髋关节功能恢复情况;术后24个月比较3组塌陷情况:未塌陷为优,塌陷<2 mm为良,塌陷>2 mm为差。结果:创伤组优良率为59.3%,激素组优良率为81.4%,酒精组优良率为84.8%,创伤组与其他两组比较,差异有统计学意义(P<0.05),激素组与酒精组比较,差异无统计学意义(P>0.05);3组患者术前Harris评分差异无统计学意义(P>0.05),3组术后均较术前显著提高(P<0.05),术后12个月、24个月Harris评分,创伤组与其他两组相比,差异有统计学意义(P<0.05)。结论:髓芯减压术对早期激素性及酒精性股骨头坏死的治疗效果要明显优于创伤性股骨头坏死。
Background: Core decompression is an easy and effective surgical method for early femoral head osteonecrosis with hip remained, but the effect is quite different due to the causes of femoral head osteonecrosis. Objective: To analyze the outcomes of core decompression in treatment of femoral head osteonecrosis of early-stage traumatic, corticosteroid and alcoholic types. Methods: From September 2010 to September 2013, a retrospective analysis was performed on the patients with earlystage(ARCO Ⅰ and Ⅱa) traumatic, corticosteroid and alcoholic femoral head necrosis treated by multiple drilling core decompression. In traumatic group, there were 32 patients(32 hips), including 20 males(20 hips) and 12 females(12 hips), with an average age of(43.4±9.9) years and the time since injury to the onset of pain as(23.9± 17.6) months. In corticosteroid group,there were 67 patients(97 hips), including 18 males(32 hips) and 49 females(65 hips), with an average age of(38.5 ±10.8)years and the time since taking corticosteroid to the onset of pain as(27.2± 16.8) months. In alcoholic group, there were 38 patients(66 hips), all males, with an average age of(46.4± 11.8) years and the time since taking alcohol to the onset of pain as(118.7±65.4) months. The functions of hips were measured with Harris score before the operation and 12, 24 months after the operation, and the collapse of the femoral head was evaluated 24 months after the operation with non-collapse as excellent, collapse less than 2 mm as good and collapse more than 2 mm as poor. Results: The ratio of excellent and good reached 59.3% in traumatic group, 81.4% in corticosteroid group and 84.8% in alcoholic group. There was significant differences between traumatic group and the other two groups(P<0.05). There was no significant difference between the corticosteroid group and alcoholic group(P>0.05). Harris scores before the operation were not significantly different among the three groups(P>0.05) and were significantly better after the operation(P<0.05). Harris score was less at 12 and 24 months after the operation in traumatic group than in the other two groups(P<0.05). Conclusions: The effects of core decompression in treatment of both early-stage corticosteroid and alcoholic femoral head necrosis are superior to the traumatic femoral head necrosis.
作者
许珂
蔡元真
杨治
鲁超
侯卫坤
许鹏
XU ke;CAI Yuanzhen;YANG Zhi;LU Chao;HOU Weikun;XU Peng(Department of Joint Surgery,Honghui Hospital,Xi'an Jiaotong University,Xi'an 710054,China)
出处
《中华骨与关节外科杂志》
2019年第4期258-262,共5页
Chinese Journal of Bone and Joint Surgery
基金
国家自然科学基金(81601877)
关键词
创伤性股骨头坏死
激素性股骨头坏死
酒精性股骨头坏死
髓芯减压术
Traumatic Femoral Head Necrosis
Corticosteroid Femoral Head Necrosis
Alcoholic Femoral Head Necrosis
Core Decompression
