目的 分析髋关节镜导向器引导下精准钻孔减压治疗早期股骨头坏死的近期临床疗效。方法 选取2015-04至2018-08解放军总医院第三医学中心骨科60例(93髋)诊断为股骨头坏死的患者,均接受导向器引导下股骨头坏死区精准钻孔减压治疗。患者18～53岁,平均38.3岁,男44例,女16例。其中激素性股骨头坏死28例,酒精性股骨头坏死11例,8例为武警战士训练后所致,13例不明原因。术前采用Harris评分系统进行患髋评分,术后予以对症治疗,定期随访,拍片复查。结果 60例(93髋)获得随访,失访2例,平均随访13个月。Harris评分由术前[(74.19±12.19)分]提高到末次随访时的[(87.40±5.34)分]。其中2例病情进展股骨头发生塌陷。无感染及术中、术后股骨转子间或股骨颈骨折发生。结论 导向器引导下股骨头坏死区精准钻孔减压能将钻孔位置精准定位到股骨头坏死区域,提高了钻孔减压的准确性,手术效果好。
Abstract
Objective To analyze the efficacy of treating early osteonecrosis of the femoral head (ONFH) via hip arthroscope-guided precise drilling decompression.Methods Between April 2015 and August 2018, 60 patients (93 hips) who had been diagnosed with ONFH underwent arthroscope-guided precise drilling decompression. These patients (44 males and 16 females) were aged 18 to 53, with an average age of 38.3 years. Among these patients, there were 28 cases of hormone-induced ONFH, 11 cases of alcohol-induced ONFH, 8 cases caused by military training, and 13 cases of unknown causes. The Harris hip score was used to score the hips preoperatively. Symptomatic treatment and regular follow-up were offered postoperatively.Results Sixty cases (93 hips) were followed up, and two cases lost contact, so the follow-up averaged 13 months. The Harris hip score rose from (74.19±12.19) points preoperatively to (87.40±5.34) points during the last follow-up. Two cases progressed into femoral head collapse. Neither infection nor preoperative or postoperative femoral intertrochanteric fractures occurred.Conclusions Hip arthroscope-guided precise drilling decompression can help locate ONFH accurately, thus improving both the accuracy of drilling decompression and surgical outcomes.
关键词
股骨头坏死 /
钻孔减压 /
导向器 /
精准
Key words
osteonecrosis of the femoral head /
drilling decompression /
guider /
accurate
{{custom_sec.title}}
{{custom_sec.title}}
{{custom_sec.content}}
参考文献
[1] Hungerford D S. Treatment of osteonecrosis of the femoral head : everything's new [J]. J Arthroplasty,2007,22(4) :91-94.
[2] Garrigues G E,Aldridge J M,Friend J K,et al.Free vascularized fibular grafting for treatment of osteonecrosis of the femoral head secondary to hip dislocation[J].Microsurgery,2009,29(5):342-345.
[3] Takashi N,Nobuhiko S,Kenji O, et al.Progression and cessation of collapse in osteonecrosis of the femoral head[J]. Clin Orthop Relat Res,2002,400:149-157.
[4] Steinberg M E,Larcom P G,Strafford B,et al. Core decompression with bone grafting for osteonecrosis of the femoral head[J]. Clin Orthop Relat Res,2001,386:71-78.
[5] Judet H,Gilbert A. Long-term results of free vascularized fibular grafting for femoral head necrosis[J]. Clin Orthop Relat Res,2001,386:114-119.
[6] Sugioka Y,Hotokebuchi T,Tsutsui H.Transtrochanteric anterior rotational osteotomy for idiopathic and steroid-induced necrosis of the femoral head. Indications and long-term results[J]. Clin Orthop Relat Res,1992, 277:111-120.
[7] Smet K A,Pattyn C,Verdonk R.Early result of primary Birminham hip resurfing using a hybrid metal-on metal couple[J]. Hip Int,2002,12(2):158-162.
[8] Eisenschenk A,Lautenbach M,Schwetlick G,et al. Treatment of femoral head necrosis with vascularized iliac crest transplants[J]. Clin Orthop Relat Res,2001, 386:100-105.
[9] Hungerford D S,Jones L C.Core decompression[J].Technique Orthop,2008,23(1):26-34.
[10] 李鸿帅,张长青.股骨头缺血性坏死保头治疗进展[J].中国修复重建外科杂志,2006,20 (6):655-658.
[11] Mont M A,Jones L C,Hungerford D S.Nontraumatic osteonecrosis of the femoral head :ten years later[J].J Bone Joint Surg Am,2006,88 (5):1117-1132.
[12] Grory B J,York S C,Iorio R,et al.Current practices of AAHKS members in the treatment of adult osteonecrosis of the femoral head[J].J Bone Joint Surg Am,2007,89(6):1194-1204.
[13] Marker D R,Seyler T M,McGrath M S,et al.Treatment of early stage osteonecrosis of the femoral head[J].J Bone Joint Surg Am,2008,90(4):175-187.
[14] Song W S,Yoo J J,Kim Y M,et al.Results of multiple drilling compared with those of conventional methods of core decompression[J].Clin Orthop Relat Res,2007,454:139-146.
[15] Israelite C,Nelson C L,Ziarani C F,et al.Bilateral core decompression for osteonecrosis of the femoral head[J].Clin Orthop Relat Res,2005,441:285-290.
[16] Marker D R,Seyler T M,Ulrich S D,et al.Do mordern techniques improve core decompression outcomes for hip osteonecrosis?[J]. Clin Orthop Relat Res,2008,466:1093-1103.
[17] 康鹏德,裴福兴,沈 彬,等.钻孔减压自体松质骨打压植骨结合同种异体腓骨棒植入治疗早期股骨头坏死的近期疗效观察[J].中华关节外科杂志(电子版),2012,6(2):184-191
[18] Shuler M S,Rooks M D,Roberson J R.Porous tantalum implant in early osteonecrosis of the hip[J].J Arthroplasty,2007,22(1): 26-31.
[19] Bobyn J D,Poggie R A,Krygier J J,et al.Clinical validation of a structural porous tantalum biomaterial for adult reconstruction[J].J Bone Joint Surg Am,2004,86(Suppl 2):123-129.
[20] Christian J H V,Mehdian H.Survivorship analysis and radiographic outcome following tantalum rod insertion for osteonecrosis of the femoral head[J].J Bone Joint Surg Am,2006,88 (Suppl 3):48-55.
[21] Tanzer M,Bobyn J D,Krygier J J,et al.Histopathologic retrieval analysis of clinically failed porous tantalum osteonecrosis implants[J].J Bone Joint Surg Am,2008,90(6):1282-1289.
[22] Nelson L M,Clark C R.Efficacy of phemister bone grafting in non-trau-matic aseptic necrosis of the femoral head[J].J Arthrop Lasty,1993,8(3):253-258.
[23] Wang C J,Wang F S,Huang C C,et al.Treatment for osteonecrosis of the femoral heag :comparison of extracorreal shock waves with core decom-pression and bone-grafting[J].J Bone Joint Surg Am,2005,87 (11): 2380-2387.
[24] Wei B F.Treatment of osteonecrosis of the femoral head with core decompression and bone grafting[J]. Hip Int,2011, 21(2):206-210.
[25] Korompilias A V.Femoral head osteonecrosis: why choose free vascularized fibula grafting[J]. Microsurgery,2011,31(3):223-228.
[26] 王 瑞,唐 杰,王文锦,等.股骨头缺血性坏死的研究进展[J].世界中医药,2013,8(5):586-588.
PDF(647 KB)
