围塌陷期股骨头坏死的头颈开窗植骨△

Head-neck fenestration bone autografting for pericollapse-stage femur head necrosis

摘要:

［目的］ 评价经直前入路 （direct anterior approach, DAA） 高位头颈开窗植骨治疗“围塌陷期”股骨头坏死的临床疗效。［方法］ 回顾性分析 2015 年 9 月—2018 年 3 月股骨头坏死患者 32 例 （37 髋） 的临床资料，均采取 DAA 入路，头颈部带部分软骨高位开窗清除坏死骨并自体骨打压植骨。观察临床与影像结果。［结果］所有患者均顺利完成手术，术中无神经、血管损伤等严重并发症。随访（35.23±10.35）个月，随访过程中，5 例（5 髋）临床症状加重，其中 2 髋改行 THA，判定为保髋失败，占 13.51%；27 例 （32 髋） 临床症状持续改善，判定为保髋成功，占 86.49%。与术前相比，末次随访时髋关节疼痛 VAS 评分显著降低 （P<0.05）。而 Harris 评分、髋关节屈曲、内旋、外旋 ROM 均显著增加 （P<0.05）。 影像方面，与术前比较，末次随访坏死面积、关节面塌陷情况、关节间隙变窄情况无显著变化 （P>0.05）。［结论］ 经 DAA 高位头颈开窗植骨治疗 “围塌陷期”股骨头坏死仍可取得较好临床效果。

Abstract:

[Objective] To evaluate the clinical efficacy of head-neck fenestration bone autografting through direct anterior approach (DAA) for pericollapse-stage femoral head necrosis. [Methods] A retrospective study was conducted on 32 patients (37 hips) who under- went head-neck fenestration bone autografting through DAA for pericollapse-stage femoral head necrosis from September 2015 to March 2018. The clinical and imaging results were observed. [Results] All patients were successfully operated on without neurovascular injury and other serious complications. During follow-up period lasted for (35.23±10.35) months, 5 patients (5 hips) who had clinical symptoms worsen, including 2 hips turned to total hip arthroplasty (THA) , were judged as hip preservation failure, accounting for 13.51%, while the remaining 27 patients (32 hips) who got continuous improvement in clinical symptoms were marked as successful hip preservation, account- ing for 86.49%. The VAS score for hip pain significantly decreased (P＜0.05) , while Harris score, hip extension-flexion, internal-external rotation range of motions (ROMs) significantly increased at the latest follow up compared with those preoperatively (P＜0.05) . Radiographi- cally, there were no significant changes in the area of necrosis, head collapse, and articular space at the latest follow-up compared with those before operation (P＜0.05) . [Conclusion] This head-neck fenestration bone autografting through DAA still achieves acceptable clini- cal outcomes for the pericollapse-stage femoral head necrosis