摘要
目的探讨打压支撑植骨术治疗股骨头坏死的中长期疗效与影响因素。方法采用打压支撑植骨治疗股骨头坏死54例（64髋），男44例，女10例；年龄20-55岁，平均（35．44±8．86）岁。股骨头坏死的病因包括：创伤性5髋、激素性23髋、酒精性28髋、酒精＋激素型4髋、特发性4髋；国际骨循环研究会（Association Research Circulation Osseous，ARCO）分期Ⅱ期14髋、Ⅲ期50髋；日本骨坏死调查委员会（Japanese Osteonecrosis Investigation Committee，JIC）分型B型6髋、C1型23髋、C2型35髋。术后采用Harris髋关节评分评价临床疗效，分析年龄、疼痛时间、ARCO分期、JIC分型对疗效的影响。手术失败定义为术后患髋改行其他手术或Harris髋关节评分为差（C70分），股骨头生存时间定义为患者接受打压支撑植骨术至手术失败的时间。结果全部病例随访5．13-10．84年，平均（8．61±1．45）年。末次随访时Harris髋关节评分优良率为81．3％（52／64）、术后8年优良率为76．0％（38／50）。手术失败10例（12髋），失败率为18．8％（12／64），股骨头8年生存率为92％。不同年龄、病因、疼痛时间、ARCO分期、JIC分型患者术前Harris髋关节评分的组间差异均无统计学意义。末次随访时20-30岁组、31-40岁组Harris评分及优良率均高于〉40岁组，差异有统计学意义；不同病因组Harris评分及优良率的差异无统计学意义；疼痛发生时间≤6个月组、7-12个月组Harris评分及优良率高于〉12个月组，差异有统计学意义；Ⅲa期Harris评分及优良率高于IUC期，差异有统计学意义；JICC1型Harris评分及优良率高于c2型，差异有统计学意义。多因素Logistic回归分析显示疼痛时间、ARCO分期、JIC分型与股骨头坏死打压支撑植骨术后Harris评分优良率相关。结论打压支撑植骨术治疗股骨头坏死中长期疗效满意，尤其对初次疼痛发生在12个月以
Objective To investigate the long and mid-term clinical outcomes of the impacting bone graft and impact factors in treating osteonecrosis of femoral head （ONFH）. Methods Impacting bone graft was utilized to treat 54 patients （64 hips） with ONFH. There were 44 cases male and 10 female with an average age of 35.44±8.86 （range, 20-55） years. There were 5 hips caused by trauma, 23 hips by glucocorticoid administration, 28 hips by intake of alcohol, 4 hips by alcohol and glucocorticoid induced, and 4 hips by idiopathic factors. There were 14 hips at ARCO （Association Research Circulation Osseous） stage , Ⅱ50 hips at stage Ⅲ and 6 hips at JIC （Japanese Osteonecrosis Investigation Committee） type B, 23 hips at type C1, 35 hips at C2 type. Har- ris hip score （HHS） was used to evaluate the clinical effects. Potential factors, including age, etiologies, pain duration, ARCO stage and JIC type, were evaluated to investigate their impacts on clinical outcomes. Surgery failure was defined as diverting to other surgeries, or poor HHS score evaluation （〈70 points）. The survival time of femoral head was defined as the interval between time of impacting bone graft and the failure of surgery. Results The mean follow-up duration was 8.61＋1.45 （range, 5.13-10.84） years. The proportion of patients with excellent or good Harris score was 81.3% （52/64）. The excellent or good rate was 76.0% （38/50） at 8 years follow-up. Furthermore, the total survival rate of femoral head was 92% at 8 years follow-up. The number of surgical failure was 10 （12 hips） and the failure rate was 18.8% （12/64）. There were no significant differences in ages, etiologies, pain dura- tion, ARCO stage and JIC type among these patients before surgery （P 〈 0.05）. There were significant differences in the post-operational Harris score and excellent or good rate among the 20-30 years group, 31-40 years group and over 40 years group （P 〈 0.05）. No significant difference for both two indexes was observed
作者
陈雷雷
洪志楠
洪郭驹
张庆文
陈镇秋
何伟
Chen Leilei, Hong Zhinan, Hong Guoju, Zhang Qingwen, Chen Zhenqiu, He Wei(Third Department of Orthopaedics, First Affiliated Hospital, Guangzhou University of Chinese Medicine, Guangzhou 510405, China （Chen LL Zhang QW, Chen ZQ, He W）; The Lab of Orthopaedics and Traumatology of Lingnan Medical Research Center, Guangzhou University of Chinese Medicine, Guangzhou 510405, China （Hong ZN, Hong G J）)
出处
《中华骨科杂志》
CAS
CSCD
北大核心
2018年第7期403-410,共8页
Chinese Journal of Orthopaedics
基金
国家自然科学基金（81473697、81673999）
广东省杰出青年科学基金（2015A030306037）
广东省科技计划项目（2014A020221114）
广东省优势病种突破项目（粤中医函[2015]19号）
关键词
股骨头坏死
骨移植
影响因素分析
随访研究
Femur head necrosis
Bone transplantation
Root cause analysis
Follow-up studies
