髓芯减压异体腓骨支撑移植治疗股骨头坏死△

Core decompression with or without allogenic fibula support grafting for femoral head necrosis

摘要:

[目的] 探讨采用髓芯减压异体腓骨支撑移植治疗股骨头坏死（osteonecrosis of the femoral head, ONFH） 的临床疗效。[方法] 回顾性分析2018 年6 月—2020 年6 月本院就诊的ONFH 患者的临床资料，根据医患沟通结果，43 例采用髓芯减压+同种异体骨植入结合异体腓骨支撑术（支撑组），27 例采用髓芯减压术（未支撑组）。比较两组围手术期、随访及影像结果。[结果] 支撑组手术时间[(55.1±9.2) min vs (40.3±10.3) min, P＜0.001]、切口总长度[(5.5±0.6) cm vs (3.1±0.7) cm, P＜0.001]、术中失血量[(33.7±5.0) ml vs (30.9±4.6) ml, P=0.022]、术中透视次数[(4.2±1.0) 次vs (3.6±1.0) 次, P=0.017] 均显著多于未支撑组（P＜0.05），但前者切口愈合情况[例, 甲/乙/丙, (30/10/3) vs (10/9/8), P=0.010]，下地行走时间[(3.4±0.4) d vs (4.6±0.7) d, P＜0.001] 和住院天数[(4.8±0.9) d vs (7.1±1.3) d, P＜0.001] 均显著优于后者。两组均随访24 个月，术后支撑组的ARCO 分级、骨水肿和关节积液征的程度均显著改善（P＜0.05），但T?nnis 分期无显著变化（P＞0.05）。术后未支撑组的上述指标均无显著变化（P＞0.05）。两组术前、术后6 个月上述指标的差异均无统计学意义（P＞0.05），术后24 个月时，支撑组的ARCO 分级[例, I/II/III/IV, (29/12/2/0) vs(11/10/6/0),P=0.030]、骨水肿[(例, ＜15%/15%~30%/≥30%), (34/8/1) vs (14/10/3), P=0.044] 和关节积液征[例, 0/1/2/3, (30/11/2/0) vs(10/14/3/0), P=0.026] 均显著优于未支撑组。[结论] 在治疗ONFH 方面，通过髓芯减压+同种异体骨植入结合异体腓骨支撑术，具有明显的优势，并取得较理想的临床效果。

Abstract:

[Objective] To compare the clinical outcome of core decompression with or without fibula allograft in the treatment of osteo-necrosis of the femoral head (ONFH). [Methods] A retrospective study was done on the patients who received hip preservation treatment forONFH in our hospital from June 2018 to June 2020. According to the results of doctor-patient communication, 43 cases were treated withcore decompression with fibular allograft support (supported group), while other 27 cases were treated with core decompression only (unsup-ported group). The data of perioperative period, follow-up and imaging were compared between the two groups. [Results] Although the sup-ported group was significantly inferior to the unsupported group in terms of operating time [(55.1±9.2) min vs (40.3±10.3) min, P＜0.001), to-tal length of incision [(5.5±0.6) cm vs (3.1±0.7) cm, P＜0.001], intraoperative blood loss [(33.7±5.0) ml vs (30.9±4.6) ml, P=0.022], and intra-operative fluoroscopy times [(4.2±1.0) vs (3.6±1.0), P=0.017], the former was significantly superior to the latter in terms of incision healinggrade [case, A/B/C, (30/10/3) vs (10/9/8), P=0.010], ambulation time postoperatively [(3.4±0.4) days vs (4.6±0.7) days, P＜0.001] and hospital-ization [(4.8±0.9) days vs (7.1±1.3) days, P＜0.001]. As time went in the follow-up period lasted for 24 months, the ARCO grade, bone edemaand joint effusion signs significantly improved (P＜0.05), while the Tonnis stage remained unchanged (P＞0.05) in the supported group. How-ever, there were no significant changes in the abovesaid items in the unsupported group (P＞0.05). There was no significant difference in theabove indexes before and 6 months after surgery between the two groups (P＞0.05). At 24 months after surgery, the supported group provedsignificantly superior to the unsupported group in terms of ARCO classification [case, I/II/III/IV, (29/12/2/0) vs (11/10/6/0), P= 0.030], boneedema [case, ＜15%/15%~30%/≥30%, (34/8/1) vs (14/10/3), P=0.044] and joint effusion [case, 0/1/2/3, (30/11/2/0) vs (10/14/3/0), P=0.026].[Conclusion] For hip preservation treatment of ONFH, core decompression combined with allogenic fibula support has obvious advantagesand achieves satisfactory clinical results.