目的比较经髋关节外科脱位打压植骨术与髓芯减压支撑植骨术治疗国际骨循环研究会(ARCO Ⅲ期股骨头缺血性坏死(avascular necrosis of the femoral head,ANFH)的疗效。方法回顾性分析2013年10月—2016年4月收治并符合选择标准的60例(69髋...目的比较经髋关节外科脱位打压植骨术与髓芯减压支撑植骨术治疗国际骨循环研究会(ARCO Ⅲ期股骨头缺血性坏死(avascular necrosis of the femoral head,ANFH)的疗效。方法回顾性分析2013年10月—2016年4月收治并符合选择标准的60例(69髋)ARCO Ⅲ期非创伤性ANFH患者临床资料。其中,24例(28髋)行经髋关节外科脱位打压植骨支撑术治疗(A组),36例(41髋)行髓芯减压、坏死病灶清除,并打压植骨、同种异体腓骨支撑术治疗(B组)。两组患者性别构成、年龄、侧别、ANFH类型及分期、病程以及术前髋关节Harris评分、疼痛视觉模拟评分(VAS)等一般资料比较,差异均无统计学意义(P>0.05)。术后采用Harris评分评价髋关节功能,X线片复查观察股骨头形态改变情况,评价患者保髋临床是否成功。结果术后两组切口均Ⅰ期愈合。两组患者均获随访,A组随访时间为12～48个月,平均25.8个月;B组为12～54个月,平均26.4个月。A组5髋保髋临床失败,股骨头生存率为82.1%,中位生存时间为43个月;B组19髋保髋临床失败,股骨头生存率为53.7%,中位生存时间为42个月;两组生存曲线分布差异有统计学意义(χ~2=4.123,P=0.042),A组优于B组。末次随访时A、B组保髋成功患者髋关节Harris评分明显高于术前,VAS评分明显低于术前(P<0.05),两组间各评分比较差异无统计学意义(P>0.05)。X线片复查示,两组植骨均融合,融合时间组间比较差异无统计学意义(t=0.752,P=0.456)。A组大转子截骨处均愈合良好,1例髋关节周围出现异位骨化。结论对于股骨头轻度塌陷的ARCO ⅢA期患者,两种术式疗效确切;对于股骨头塌陷较严重的ARCO ⅢB期患者,经髋关节外科脱位打压植骨术后股骨头生存率优于髓芯减压支撑植骨术。展开更多
Objective: We constructed 3D-model of ONFH in computer according to three-dimensional computerized tomography (3D-CT) data. We determined the location and volume of necrosis to investigate its clinical efficacy. Metho...Objective: We constructed 3D-model of ONFH in computer according to three-dimensional computerized tomography (3D-CT) data. We determined the location and volume of necrosis to investigate its clinical efficacy. Method: Totally 92 hips (59 cases) with ONFH (44 males, 15 females) were included, with mean age of 37.5 years (range from 26 to 58). Totally 20 cases (35 hips) were induced by corticosteroid (CTSs), 31 (49 hips) induced by alcohol, 4 (4 hips) induced by trauma and 4 (4 hips) idiopathic. All the hips were categorized into stage ARCO II. Finally diagnosed by MRI, all hips were scanned by CT to acquire data in DICOM format. The images were imported into software to extract 3D-shape of femoral heads, necrotic foci, their volumes and distribution in each quadrant. Deviation of volumes between digital image and biopsy specimen was analyzed by SAS9.1 package. Correlativity between collapse and volume of necrosis under specific pathogeneses was also analyzed. Among the cases necessitating total hip arthroplasty (THA) due to advancing to ARCO III, we randomly selected 8 of them to perform 3D-CT scanning thrice prior to surgical operation. Total femoral heads harvested were torn asunder. Cubic capacity of femoral heads and necrotic foci were hereby measured and compared with those acquired from digital models. Result: Through the digital model, necrotic foci were found mainly locating within the super lateral portion of femoral head, coinciding with those observed in biopsy specimen. Average volumetric ratio of digitally acquired necrosis focus/femoral head in 58 collapsed hips was 36.8%. The ratio of the 34 hips without collapse was 17.3%. In collapsed femoral heads, the distribution of necrosis focus was 23.4% in quadrant 1 (q1), 23.6% in q2, 12.1% in q3, 14.4% in q4, 9.0% in q5, 11.8% in q6, 1.6% in q7 and 3.9% in q8. In femoral heads without collapse, the distribution was 34.2% in q1, 29.6% in q2, 11.8% in q3, 11.3% in q4, 6.0% in q5, 6.0% in q6, 0.5% in q7 and 0.4% in q8. As for the average cubic capacities o展开更多
文摘目的比较经髋关节外科脱位打压植骨术与髓芯减压支撑植骨术治疗国际骨循环研究会(ARCO Ⅲ期股骨头缺血性坏死(avascular necrosis of the femoral head,ANFH)的疗效。方法回顾性分析2013年10月—2016年4月收治并符合选择标准的60例(69髋)ARCO Ⅲ期非创伤性ANFH患者临床资料。其中,24例(28髋)行经髋关节外科脱位打压植骨支撑术治疗(A组),36例(41髋)行髓芯减压、坏死病灶清除,并打压植骨、同种异体腓骨支撑术治疗(B组)。两组患者性别构成、年龄、侧别、ANFH类型及分期、病程以及术前髋关节Harris评分、疼痛视觉模拟评分(VAS)等一般资料比较,差异均无统计学意义(P>0.05)。术后采用Harris评分评价髋关节功能,X线片复查观察股骨头形态改变情况,评价患者保髋临床是否成功。结果术后两组切口均Ⅰ期愈合。两组患者均获随访,A组随访时间为12～48个月,平均25.8个月;B组为12～54个月,平均26.4个月。A组5髋保髋临床失败,股骨头生存率为82.1%,中位生存时间为43个月;B组19髋保髋临床失败,股骨头生存率为53.7%,中位生存时间为42个月;两组生存曲线分布差异有统计学意义(χ~2=4.123,P=0.042),A组优于B组。末次随访时A、B组保髋成功患者髋关节Harris评分明显高于术前,VAS评分明显低于术前(P<0.05),两组间各评分比较差异无统计学意义(P>0.05)。X线片复查示,两组植骨均融合,融合时间组间比较差异无统计学意义(t=0.752,P=0.456)。A组大转子截骨处均愈合良好,1例髋关节周围出现异位骨化。结论对于股骨头轻度塌陷的ARCO ⅢA期患者,两种术式疗效确切;对于股骨头塌陷较严重的ARCO ⅢB期患者,经髋关节外科脱位打压植骨术后股骨头生存率优于髓芯减压支撑植骨术。
文摘Objective: We constructed 3D-model of ONFH in computer according to three-dimensional computerized tomography (3D-CT) data. We determined the location and volume of necrosis to investigate its clinical efficacy. Method: Totally 92 hips (59 cases) with ONFH (44 males, 15 females) were included, with mean age of 37.5 years (range from 26 to 58). Totally 20 cases (35 hips) were induced by corticosteroid (CTSs), 31 (49 hips) induced by alcohol, 4 (4 hips) induced by trauma and 4 (4 hips) idiopathic. All the hips were categorized into stage ARCO II. Finally diagnosed by MRI, all hips were scanned by CT to acquire data in DICOM format. The images were imported into software to extract 3D-shape of femoral heads, necrotic foci, their volumes and distribution in each quadrant. Deviation of volumes between digital image and biopsy specimen was analyzed by SAS9.1 package. Correlativity between collapse and volume of necrosis under specific pathogeneses was also analyzed. Among the cases necessitating total hip arthroplasty (THA) due to advancing to ARCO III, we randomly selected 8 of them to perform 3D-CT scanning thrice prior to surgical operation. Total femoral heads harvested were torn asunder. Cubic capacity of femoral heads and necrotic foci were hereby measured and compared with those acquired from digital models. Result: Through the digital model, necrotic foci were found mainly locating within the super lateral portion of femoral head, coinciding with those observed in biopsy specimen. Average volumetric ratio of digitally acquired necrosis focus/femoral head in 58 collapsed hips was 36.8%. The ratio of the 34 hips without collapse was 17.3%. In collapsed femoral heads, the distribution of necrosis focus was 23.4% in quadrant 1 (q1), 23.6% in q2, 12.1% in q3, 14.4% in q4, 9.0% in q5, 11.8% in q6, 1.6% in q7 and 3.9% in q8. In femoral heads without collapse, the distribution was 34.2% in q1, 29.6% in q2, 11.8% in q3, 11.3% in q4, 6.0% in q5, 6.0% in q6, 0.5% in q7 and 0.4% in q8. As for the average cubic capacities o
