双侧股骨头坏死一期换髋与保髋治疗△

One- stage hip replacement and hip preservation for bilateral femoral head necrosis with different head collapse

摘要:

［目的］探讨双侧不同质塌陷股骨头坏死一期换髋与保髋治疗的临床疗效。［方法］2018 年 10 月—2019 年 6 月，对 28 例双侧非同质股骨头坏死患者，均实施一期换髋与保髋治疗，比较两侧围手术期、随访和影像资料。［结果］所有患者顺利完成手术。随时间推移，两侧术后 VAS 评分均显著降低（P<0.05），而髋屈-伸 ROM、内-外旋 ROM、Harris 评分显著增加（P< 0.05）。术后 6 个月及末次随访时两侧 VAS 评分及 Harris 评分差异无统计学意义（P>0.05），换髋侧髋屈-伸 ROM、内-外旋 ROM 优于保髋侧（P<0.05）。影像方面，末次随访时，与术前相比，换髋侧 PDIT、FO 显著增加（P<0.05），保髋侧无显著变化（P> 0.05），术后两侧 PDIT、FO 差异均无统计学意义（P>0.05）。［结论］ 一期换髋与保髋治疗双侧不同质塌陷股骨头坏死，保髋侧可以获得与换髋侧相当的近期临床效果，能够延缓甚至避免关节置换。

Abstract:

[Objective] To investigate the clinical efficacy of one-stage hip replacement and hip preservation for bilateral femoral head necrosis with different heal collapse. [Methods] From October 2018 to June 2019, 28 patients underwent one-stage hip replacement for the severe collapse side and hip preservation by neck-head fenestration and bone grafting for the slight collapse side for bilateral femoral head necrosis in our hospital. The perioperative period, follow-up and imaging data of both sides were compared. [Results] All patients had opera- tion completed successfully. The VAS scores decreased significantly (P＜0.05) , while the hip flexor-extension range of motion (ROM) , inter- nal-external rotation ROM and Harris scores significantly increased on both sides over time (P＜0.05) . Although there was no significant dif- ference in VAS scores and Harris scores between the two sides at 6 months after surgery and the latest follow-up (P＞0.05) , the replacement side was significantly superior to the preservation side in terms of flexor-extension ROM and the internal-external rotation ROM postopera- tively (P＜0.05) . Radiographically, the perpendicular distance between ischial tuberosity connecting line and the tip of the lesser trochanter (PDIT) and femoral offset (FO) significantly increased in the hip replacement side (P＜0.05) at the latest follow-up, while which remained un- changed in the preservation side postoperatively compared with those preoperatively (P＞0.05) . There were no significant differences in PDIT and FO between the two sides at the latest follow-up (P＞0.05) . [Conclusion] One-stage hip replacement and hip preservation in the treat- ment of bilateral femoral head necrosis with different head collapse does achieve the comparable clinical outcomes on both side, which might delay or even avoid joint replacement on the side with slight head collapes.