摘要
目的探讨经髋关节外科脱位入路(surgical hip dislocation,SHD)髂骨瓣打压植骨治疗非创伤性股骨头坏死(non-traumaticosteo necrosis of the femoral head,NONFH)的中短期临床疗效及影响因素。方法回顾分析自2014年1月至2017年12月在我院骨科诊治的56例(62髋)NONFH患者,日本骨坏死研究会(Japanese Investigation Committee,JIC)分型均为C型,其中C1型47髋,C2型15髋,均经SHD行股骨大转子截骨、股骨头坏死骨清除、松质骨及自体髂骨块植骨治疗。所有患者均采用Harris评分评估术前及术后髋关节功能,以髋关节功能优良率和X线影像学评估作为疗效评定指标。数据比较采用t检验和秩和检验,采用单因素和多因素Logistic回归分析影响临床结局的危险因素。结果56例均获得随访,随访时间(59.58±15.06)个月。末次随访时Harris评分为(87.50±11.84)分,较术前(55.58±8.43)明显提高,差异有统计学意义。其中优34髋、良14髋、中1髋、差9髋,保髋优良率83.87%,9例在4年内行全髋关节置换术(total hip arthroplasty,THA)。X线塌陷好转14髋(22.58%),无进展5髋(8.06%),进展39髋(62.90%);JIC C1型和疼痛时间≤12个月为避免THA的保护因素。JIC分型的C1和C2两组生存曲线差异有统计学意义(P<0.001),疼痛持续时间为≤6个月、7~12个月、>12个月的3组生存曲线差异有统计学意义(P<0.001),72个月时,JIC分类C1型、C2型患者的总生存率分别为97.9%、46.5%,疼痛持续时间≤6个月、7~12个月、>12个月患者的总生存率分别为97.5%、92.9%、12.5%。结论经SHD自体髂骨瓣打压植骨治疗NONFH的中短期疗效满意,尤其是外侧柱保留完好和疼痛时间短于1年的患者。
Objective To investigate the medium-term outcomes of surgical hip dislocation(SHD)combined with impacted bone grafts and iliac bone flap implantation in the treatment of non-traumatic osteonecrosis of the femoral head(NONFH)and to define the indications for this treatment.Methods A total of 56 cases(62 hips)with non-traumatic osteonecrosis of the femoral head from January 2014 to December 2017 were included in this study.According to the JIC classification,47 hips were classified as JIC type C1,and 15 hips were classified as JIC type C2 at initial diagnosis.All patients underwent SHD surgery combined with impacted bone grafts and iliac bone flap implantation.Preoperative and postoperative clinical outcomes were assessed using the Harris hip score(HHS)to evaluate hip function before and after the operation in all patients.The excellent and good hip function ratio and X-ray imaging evaluation were used as the evaluation indexes of curative effect.Univariate and multivariate logistic regression analyses were performed to identify risk factors affecting the clinical outcome.Kaplan-Meier(K-M)analysis was applied to calculate the survival rate of the femoral head.Results At the last follow-up(59.58±15.06 months),the HHS was 87.50±11.84,which was significantly higher than that before the operation 55.58±8.43.The HHS was excellent for 34 hips,good for 14 hips,fair for 1 hip,and poor for 9 hips.The rate of excellent and good hip function was 83.87%.All nine hips with poor HHS underwent total hip arthroplasty(THA)within 4 years.The collapse situation,according to X-ray,recovered in 14 hips(22.58%),did not progress in 5 hips(8.06%),and developed in 39 hips(62.90%).JIC type C1 and pain duration≤12 months were found to protect patients from THA.There were statistical differences in the survival curves of the C1 and C2 groups of JIC classification(P<0.001),and there were statistical differences in the survival curves of the three groups with pain duration≤6 months,7-12 months,and>12 months(P<0.001).The overall survival
作者
高张
凡一诺
陈志文
方汉军
黄泽青
刘予豪
周驰
陈镇秋
GAO Zhang;FAN Yi-nuo;CHEN Zhi-wen;FANG Han-jun;HUANG Ze-qing;LIU Yu-hao;ZHOU Chi;CHEN Zhen-qiu(The First Clincal Medical School of Guangzhou University of Chinese Medicine,Guangzhou,Guangdong,510405,China)
出处
《中国骨与关节杂志》
CAS
2024年第10期787-794,共8页
Chinese Journal of Bone and Joint
基金
广州市卫生健康委员会项目(09002428001)
广州市科技计划项目(2023A04J1171)。
关键词
股骨头坏死
髋关节
矫形外科手术
Femur head necrosis
Hip joint
Orthopedic procedures
