镜下清理减压术结合冲击波治疗早期股骨头坏死△

Arthroscopic debridement and drilling decompression combined with extracorporeal shockwave therapy for early- stage femoral head necrosis

摘要:

[目的]探讨关节镜下清理结合术后冲击波治疗股骨头坏死的临床疗效。[方法]回顾性分析 2010 年 1 月—2018 年 1 月，本院收治的成人股骨头坏死 422 例 (642 髋) 患者的临床资料，所有患者均接受髋关节镜探查清理，股骨头钻孔减压手术治疗，术后早期开始冲击波治疗。[结果] 422 例患者 (642 髋) 均顺利手术，术中无严重并发症。ESW 治疗期无明显不良反应。422 例患者随访 24 个月以上。随访过程中，16 例(18 髋)于术后 8~24 个月，平均(14.33±6.21)个月，因股骨头塌陷行全髋关节置换术，占 2.84%。术前至术后 12 个月，患者静息状态 VAS 评分、行走时 VAS 评分均显著下降 (P＜0.05)，而屈伸 ROM、内旋-外旋 ROM、内收-外展 ROM 以及 Harris 评分均显著增加 (P＜0.05)；但是，与术后 12 个月相比，末次随访时上述指标的改善均有所丢失，各指标两时间点间差异均无统计学意义 (P＞0.05)。影像方面，术前至术后 12 个月，642 髋的 ARCO 分级、股骨头骨水肿和关节积液均显著改善 (P＜0.05)，而髋关节 T?nnis 分期无显著变化 (P＞0.05)。与术后 12 个月相比，末次随访时上述各影像指标无显著变化(P＞0.05)。[结论]关节镜下清理结合术后冲击波治疗能够在一定程度上逆转或延缓股骨头坏死的进展，临床疗效满意。

Abstract:

[Objective] To explore the clinical efficacy of arthroscopic debridement and drilling decompression combined with postop- erative extracorporeal shock wave therapy for early- stage femoral head necrosis. [Methods] A retrospective study was done on a total of 422 adult patients (642 hips) who received treatment for early-stage femoral head necrosis in our hospital from January 2010 to January 2018. All the patients underwent hip arthroscopic debridement and drilling decompression of the femoral head, and then extracorporeal shockwave therapy postoperatively. [Results] All the 422 patients (642 hips) were successfully operated on without serious complications during perioperative period, and with no obvious adverse reactions during ESW treatment. The follow-up period lasted for more than 24 months. Of them, 16 patients (18 hips) turned to receive total hip arthroplasty due to femoral head collapse in 8~24 months after primary op- eration, with an average of (14.33±6.21) months, accounting for 2.84%. From time point preoperatively to 12 months postoperatively, the VAS scores in resting state and during walking were significantly decreased (P＜0.05) , while flexion-extension ROM, internal-external rota- tion ROM and adduction- abduction ROM, as well as Harris score significantly increased (P＜0.05) . However, the improvements in the above item had slight loss at the latest follow-up compared with those at 12 months postoperatively, whereas which were not statistically sig- nificant (P＞0.05) . Radiographically, significant improvements were noticed in terms of ARCO classification, femoral head bone edema, and intraarticular effusion from the time preoperatively to 12 months postoperatively (P＜0.05) , whereas the T?nnis classification remained un- changed (P＞0.05) . However, there were no significant changes in these imaging parameters at the latest follow-up compared with those at 12 months postoperatively (P＞0.05) . [Conclusion] The arthroscopic debridement and drilling decompression combined with postoperative shock wave therapy might reverse in some extent, or delay the progression of femoral head necrosis, do achieve satisfactory clinical out- comes.