外科脱位联合高位头颈开窗病灶清除打压植骨支撑术治疗早期股骨头坏死

Effects of Surgical Dislocation Combined with Debridement and Bone Graft through a High Location Window of Femoral Head-Neck Junction for Osteonecrosis of Femoral Head

摘要: 目的：探讨髋关节外科脱位联合股骨高位头颈开窗病灶清除打压植骨支撑术治疗早期非创伤性股骨头坏死的近期疗效。方法：对2014年6月至2015年10月入住临沂市人民医院股骨头专科接受治疗的120例(140髋)ARCOⅡ期、ⅢA期非创伤性股骨头坏死患者进行回顾性分析。病例组：60例(70髋)，采用外科脱位联合高位头颈开窗病灶清除打压植骨支撑术治疗。对照组：60例(70髋)，接受单纯高位头颈开窗病灶清除打压植骨支撑术治疗。术后第1、3、6个月及以后每6个月定期随访复查，随访时间不少于12个月。根据髋关节Harris评分及优良率进行临床评价，根据ARCO分期、髋关节正蛙位片股骨头密度及高度的改变进行影像学评价。结果：120例患者均获得随访，随访时间为13~30个月，平均20.5个月。病例组较对照组手术切口长，手术时间长，且失血量大。末次随访时，两组患者各分期Harris评分和优良率均较术前明显提高，病例组各分期Harris评分和优良率显著高于对照组(P < 0.05)。除病例组2髋由IIIA期进展至IIIC期，对照组3髋由IIC期进展至IV期外，其余患者疼痛较之前明显减轻或消失，髋关节活动良好，步态基本正常，X线检查示股骨头内密度改善，股骨大转子截骨处全部愈合。结论：两种术式均能有效治疗早期非创伤性股骨头坏死。外科脱位联合高位头颈开窗病灶清除打压植骨支撑术过程相对复杂，创伤大，近期疗效要优于单纯高位头颈开窗病灶清除打压植骨支撑术，但中、远期效果需要进一步随访观察。

Abstract: Objective: To study the short-term efficacy of surgical dislocation combined with debridement and bone graft through a high location window of femoral head-neck junction for osteonecrosis of femoral head. Methods: A retrospective study was carried out to analyze the cases of 120 patients (140 hips) who with ARCO phase II, IIIA non traumatic osteonecrosis of the femoral head during June 2014 to Oct. 2015 in Linyi City People’s Hospital. Case group: 60 cases (70 hips), they are treated by surgical dislocation combined with debridement and bone graft through a high location window of femoral head-neck junction. Control group: 60 cases (70 hips), they are treated by simple debridement and bone graft through a high location window of femoral head-neck junction. The follow-up period was 1, 3, 6 months and 6 months after operation. The follow-up time was not less than 12 months. The clinical effects was evaluated by the changes in the Harris hip score and excellent and good rate, and the radiographic effects was determined according to the system of the ARCO and density and height changes of the femoral head. Results: All cases were followed-up for an average of 20.5 months (range 13 - 30 months). The length of incision, operation time and amount of bleeding were much more in case group than those in control group. At the latest follow-up, both of stage Harris score and excellent and good rate of two groups significantly increased compared with the ones before surgery. Overall and stage Harris score and excellent and good rate of case group were higher, and the difference were statistical significant (p < 0.05). 2 hips of the case group aggravated from stage IIIA to IIIC. In the control group, 3 hips aggravated from stage IIC to IV. The pain of the remaining patients significantly relieved or disappeared, the range of hip activity and gait closed to normal. X-ray examination shows that the density of femoral heads altered for the better, and the trochanters healed. Conclusion: Two kinds of operation can be effective in the treatment of early non traumatic osteonecrosis of the femoral head. Although surgical dislocation combined with debridement and bone graft through a high location window of femoral head-neck junction is relatively complex and more traumatic, short-term effect is better than simple debridement and bone graft through a high location window of femoral head-neck junction, the long-term effect needs further follow-up and observation.