两种入路“电灯泡”术治疗股骨头坏死比较△

Comparison of two approaches for lightbulb procedure in the treatment of femoral head necrosis

摘要:

［目的］比较经直接前入路（direct anterior approach, DAA）与传统 Watson-Jones 入路“电灯泡”术股骨头颈部开窗减压植骨治疗早期非创伤性股骨头坏死的疗效。［方法］回顾分析 2014 年 6 月—2018 年 6 月采用“电灯泡”术治疗的 89 例（116 髋）早期非创伤性股骨头坏死患者的临床资料。其中，40 例（54 髋）采用 DAA 入路，49 例（62 髋）采用传统 Watson-Jones 入路。比较两组围手术期、随访及影像资料。［结果］所有患者均顺利完成手术，术中无严重并发症。两组手术时间和术中放射线暴露时间的差异均无统计学意义 （P>0.05）。DAA 组切口长度、术中出血量显著优于传统组 （P<0.05）。随访 24~45 个月，平均 （32.09±14.08）个月，两组下地活动时间和完全负重活动时间的差异均无统计学意义（P>0.05）。随术后时间推移，两组 VAS 评分均显著降低（P<0.05），而髋内-外旋 ROM 和 Harris 评分均显著增加（P<0.05）；术后 6 个月，DAA 组 VAS 评分和 Harris 评分均显著优于传统组 （P<0.05）。至末次随访时，保髋成功率方面差异无统计学意义 （P>0.05），DAA 组为 81.48%，传统组为 72.58%。影像方面，术后 6 个月及末次随访时，两组关节间隙、股骨头塌陷、病灶面积的差异均无统计学意义（P>0.05）。［结论］相较于传统 Watson-Jones 入路，DAA 入路“电灯泡”技术治疗早期股骨头坏死的创伤更小，早期功能更好。

Abstract:

[Objective] To compare the clinical outcomes of direct anterior approach (DAA) versus conventional Watson- Jones ap- proach for lightbulb procedures, involving femoral neck-head fenestration, debridement and bone autografting, for treatment of early-stage non-traumatic femoral head necrosis. [Methods] A retrospective study was done on total of 116 patients who received lightbulb procedures for early-stage nontraumatic femoral head necrosis from June 2014 to June 2018. Among them, 40 patients (54 hips) had the operation per- formed through DAA approach, while the other 49 patients (62 hips) had lightbulb procedure conducted through the conventional WatsonJones approach. The perioperative, follow-up and radiographic documents were compared between the two groups. [Results] All patients in both groups were successfully operated on without serious complications. Although there were no significant differences in the operative time and intraoperative radiation exposure time between the two groups (P＞0.05) , the DAA group had significantly less intraoperative blood loss than that in the conventional group (P＜0.05) . The follow- up lasted for 24 to 45 months, with an average of (32.09± 14.08) months. There were no significant differences in the time to return walking and time to full weight-bearing activity between the two groups (P＞0.05) . The VAS scores decreased significantly (P＜0.05) , whereas the hip internal-external rotation range of motion (ROM) and Harris score significantly increased in both groups over time (P＜0.05) . At 6 months after operation, the DAA group was significantly superior to the conventional group in terms of VAS score and Harris score (P＜0.05) . By the time of the latest follow-up, successful rate of hip preserva- tion was 81.48% in the DAA group, whereas 72.58% in the conventional group. Radiographically, there were no statistically significant dif- ferences in terms of joint space, femoral head collapse or lesion area between the two groups at 6 months after surgery or at the latest followup (P＞0.05) . [Conclusion] Compared with the conventional Watson-Jones approach, DAA approach takes benefits of less trauma and bet- ter early functional recovery for treatment of early-stage femoral head necrosis.