摘要
目的:直接前侧入路(DAA)小切口病灶清除打压植骨治疗股骨头坏死(ONFH)的疗效。方法:2017年5月至2021年5月,采用直接前侧入路小切口病灶清除打压植骨治疗股骨头坏死患者50例(60髋),其中男32例,女18例;年龄为21~60岁,平均年龄为(41.76±8.62)岁;病程为3~25个月,平均为(12.6±9.5)个月;均诊断为股骨头无菌性坏死。按病因分型:酒精型32例,激素型18例。按照国际骨循环研究协会(ARCO)股骨头坏死分期Ⅱ期40髋、Ⅲa期10髋。结果:术后所有患者均得到随访,切口均一期愈合,无切口感染、取骨区疼痛不适、人工骨排异反应、股外侧皮神经损伤、下肢深静脉血栓等术后并发症。术后随访时间为2~4年,平均为(2.8±1.6)年。术后复查X线片显示植骨区均骨性融合,融合时间为为6~18个月。末次随访时Harris评分为(90.64±3.90)分,与术前(69.88±4.24)分比较差异有统计学意义(t=65.56,P<0.001)。优31髋,良14髋,可4髋,差1髋,优良率为90.0%。结论:直接前侧入路小切口经股骨头颈结合部开窗病灶清除打压植骨术治疗ARCO分期Ⅱ期及Ⅲa期患者,坏死病灶清除彻底,可实现充分植骨和骨融合,恢复头颈部生物力学性能,创伤小,临床疗效显著,是治疗早中期股骨头坏死的良好保髋方式。
Objective:To investigate the efficacy and application of direct anterior approach(DAA)on the treatment of osteonecrosis of the femoral head(ONFH)by small incision debridement and bone grafting.Methods:From May 2017 to May 2021,50 patients(60 hips)with the femoral head necrosis were treated by small incision debridement and bone grafting with DAA,including 32 males and 18 females.The aged from 21 to 60 years old with(41.76±8.62)years old on average.All patients had aseptic necrosis of the femoral head.The duration of the disease was 3 to 25 months,with an average of(12.6±9.5)months.According to the etiology,32 cases were alcohol type and 18 cases were hormone type.According to Association Research Circulation Osseus(ARCO),40 hips were rated as stageⅡ,and 10 hips as stageⅢa.Results:All patients were followed up after surgery.All the patients’incisions were healed in one stage,and there were no incision infection,pain and discomfort in the bone extraction area,artificial bone rejection,lateral femoral cutaneous nerve damaged,deep venous thrombosis of lower limbs and other early postoperative complications.All patients were followed up for 2 to 4 years,with an average of(2.8±1.6)years.Postoperative radiographs showed that all bone grafts were fused,and the fusion time was 16 to 18 months.The Harris score at the last follow-up was 90.64±3.90,which was significantly different from the preoperative score(69.88±4.24)(t=65.56,P<0.001).31 hips were excellent,14 hips were good,4 hips were acceptable,1 hip was poor,the rate of excellent and good was 90.0%.Conclusion:The treatment of ARCO stageⅡandⅢa patients by small incision of DAA through fenestration of femoral head and neck junction is complete.The necrotic lesions can be completely removed,and full bone grafting and bone fusion can be achieved,the biological performance of head and neck can be restored,and the trauma is small,obtaining significant clinical efficacy.It is a good way in protecting hip on the treatment of mid-early ostoenecrosis of the femor
作者
毕红宾
杨亚丽
李岩
邢庆胜
BI Hongbin;YANG Yali;LI Yan;XING Qingsheng(Luoyang Orthopedic-Traumatological Hospital of Henan Province(Henan Provincial Orthopedic Hospital),Zhengzhou 450008,China.)
出处
《中国中医骨伤科杂志》
CAS
2023年第3期67-71,共5页
Chinese Journal of Traditional Medical Traumatology & Orthopedics
关键词
股骨头坏死
病灶清除
打压植骨
ostoenecrosis of the femoral head
debridement
impact bone graft
