开窗与髓芯减压植骨治疗中期股骨头坏死△（开放获取）

(Open Access) Fenestration versus core decompression and bone grafting for medium-term femoral head necrosis

摘要:

[目的]比较股骨头-颈交界开窗减压打压植骨术与股骨头髓芯减压打压植骨重建棒置入术治疗中期股骨头缺血性坏死（osteonecrosisof thefemoralhead,ONFH）的临床疗效。[方法]回顾性分析本院2014年6月—2022年4月收治的100例 ONFH患者的临床资料，按照术前医患沟通结果，行开窗（开窗组）与髓芯（髓芯组）减压植骨治疗各50例。比较两组围手术期、随访及影像资料。[结果]开窗组手术时间[(54.4±7.2)minvs(46.3±6.8)min,P＜0.001]、切口总长度[(4.2±0.8)cmvs(3.5±0.6) cm,P＜0.001]、术中失血量[(100.5±12.0)mlvs(50.8±7.4)ml,P＜0.001]均显著多于髓芯组，但前者的植骨量[(2.5±0.5)gvs(4.3±0.6) g,P＜0.001]、下地行走时间[(96.0±5.2)dvs(106.3±10.6)d,P＜0.001]、住院天数[(5.5±0.7)dvs(7.0±1.2)d,P＜0.001]均显著少于髓芯组。随访时间平均（30.0±3.5）个月，开窗组完全负重活动时间显著早于髓芯组[(180.8±26.5)dvs(200.0±35.0)d,P=0.003]。随时间推移，两组术后VAS评分、HHS评分、iHOT-33评分及髋伸-屈、髋内-外旋ROM均显著改善（P＜0.05）。开窗组术后3个月 VAS评分[(2.8±0.6)vs(3.1±0.8),P=0.036]、HHS评分[(76.7±5.6)vs(72.4±6.5),P＜0.001]、iHOT-33评分[(64.8±6.0)vs(60.5±5.6),P＜ 0.001]均显著优于髓芯组。末次随访时开窗组股骨头生存率的差异无统计学意义[42/50(84.0%)vs37/50(74.0%),P=0.220]。21例保髋失败患者中，行翻修髋关节置换术10例（47.6%）。影像方面，与术前相比，术后6个月及末次随访时，两组ARCO分级、 T?nnis分期无显著变化（P＞0.05），但是，两组病灶、关节积液征象显著改善（P＜0.05）。相应时间点，两组上述指标比较的差异均无统计学意义（P＞0.05）。[结论]开窗减压植骨治疗中期ONFH在完全负重活动时间及术后3个月髋关节功能改善上优于髓芯减压植骨。

Abstract:

[Objective] To compare the clinical efficacy of fenstration at femoral head-neck interface for decompression and impacting

bone grafting (the FDBG) versus core decompression, and impacting bone grafting with a strut graft (the CDBG) for medium-term osteonecro-

sis of the femoral head (ONFH). [Methods] A retrospective study was conduted on 100 patients who underwent surgical treatment for medi-

um-term ONFH in our hospital from June 2014 to April 2022. According to the preoperative doctor-patient communication, 50 patients re-

ceived the FDBG, while other 50 patients underwent the CDBG. The perioperative, follow-up and imaging data of the two groups were com-

pared. [Results] The FDBG group proved significantly greater than the CDBG group in term of operation time [(54.4±7.2) min vs (46.3±6.8)

min, P<0.001], total length of incision [(4.2±0.8) cm vs (3.5±0.6) cm, P<0.001], intraoperative blood loss [(100.5±12.0) ml vs (50.8±7.4) ml,

P<0.001], whereas the former was significantly less than the latter regarding volume of bone graft [(2.5±0.5) g vs (4.3±0.6) g, P<0.001], ambu-

lation time [(96.0±5.2) days vs (106.3±10.6) days, P<0.001] and hospitalization days [(5.5±0.7) days vs (7.0±1.2) days, P<0.001]. All patients

in both groups were followed up for a mean of (30.0±3.5) months, and the FDBG group resumed full weight-bearing activity significantly ear-

lier than the CDBG group [(180.8±26.5) days vs (200.0±35.0) days, P=0.003]. The VAS score, HHS score, iHOT-33 score, hip extensionflexion

range of motion (ROM) and hip internal-external rotation ROM significantly improved in both groups over time (P<0.05). The FDBG

group was significantly superior to the CDBG group in terms of VAS score [(2.8±0.6) vs (3.1± 0.8), P=0.036], HHS score [(76.7±5.6) vs (72.4±6.5), P<0.001] and iHOT-33 score [(64.8±6.0) vs (60.5±5.6), P<0.001] 3 months postoperatively. At the last follow-up, there was no statisti-

cally significant difference in the survival rate of the femoral head between the FDBG and CDBG groups [42/50 (84.0%) vs 37/50 (74.0%),

P=0.220]. Among the 21 patients who failed hip preservation, 10 patients (47.6%) underwent revision hip arthroplasty. As for imaging, there

were no significant changes in ARCO grade and Tonnis stage in both groups 6 months after surgery and at the last follow-up, compared with

those before operation (P>0.05), but the signs of lesions and joint effusion significantly improved in the two groups over time (P<0.05). At cor-

responding time points, there were no statistically significant differences in the abovesaid imaging indicators between the two groups (P>

0.05). [Conclusion] The fenstration decompression and impacting bone grafting for ONFH is superior to the core decompression bone graft-

ing in time to regain full weight-bearing activity and hip function 3 months after surgery.