髓芯减压术治疗不同类型股骨头坏死的疗效分析
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摘要
背景:髓芯减压术是治疗早期股骨头坏死的简单且行之有效的保髋治疗手术方法,但不同研究表明,其治疗效果差异很大,这可能与股骨头坏死的病因不同有关。目的:观察采用髓芯减压术分别治疗早期创伤性、酒精性及激素性股骨头坏死的临床疗效。方法:对2010年9月至2013年9月采用细针多孔髓芯减压术分别治疗创伤性、激素性及酒精性早期(ARCOⅠ、Ⅱa期)股骨头坏死患者进行回顾性分析。其中,创伤性股骨头坏死32例(32髋):男20例(20髋),女12例(12髋);平均年龄(43.4±9.9)岁;受伤至出现症状时间为(23.9±17.6)个月。激素性股骨头坏死67例(97髋):男18例(32髋),女49例(65髋);平均年龄(38.5±10.8)岁;服用激素至出现症状时间为(27.2±16.8)个月。酒精性股骨头坏死38例(66髋):均为男性;平均年龄(46.4±11.8)岁;饮酒至出现症状时间为(118.7±65.4)个月。术前及术后12、24个月采用Harris评分评价髋关节功能恢复情况;术后24个月比较3组塌陷情况:未塌陷为优,塌陷<2 mm为良,塌陷>2 mm为差。结果:创伤组优良率为59.3%,激素组优良率为81.4%,酒精组优良率为84.8%,创伤组与其他两组比较,差异有统计学意义(P<0.05),激素组与酒精组比较,差异无统计学意义(P>0.05);3组患者术前Harris评分差异无统计学意义(P>0.05),3组术后均较术前显著提高(P<0.05),术后12个月、24个月Harris评分,创伤组与其他两组相比,差异有统计学意义(P<0.05)。结论:髓芯减压术对早期激素性及酒精性股骨头坏死的治疗效果要明显优于创伤性股骨头坏死。
Background: Core decompression is an easy and effective surgical method for early femoral head osteonecrosis with hip remained, but the effect is quite different due to the causes of femoral head osteonecrosis. Objective: To analyze the outcomes of core decompression in treatment of femoral head osteonecrosis of early-stage traumatic, corticosteroid and alcoholic types. Methods: From September 2010 to September 2013, a retrospective analysis was performed on the patients with earlystage(ARCO Ⅰ and Ⅱa) traumatic, corticosteroid and alcoholic femoral head necrosis treated by multiple drilling core decompression. In traumatic group, there were 32 patients(32 hips), including 20 males(20 hips) and 12 females(12 hips), with an average age of(43.4±9.9) years and the time since injury to the onset of pain as(23.9± 17.6) months. In corticosteroid group,there were 67 patients(97 hips), including 18 males(32 hips) and 49 females(65 hips), with an average age of(38.5 ±10.8)years and the time since taking corticosteroid to the onset of pain as(27.2± 16.8) months. In alcoholic group, there were 38 patients(66 hips), all males, with an average age of(46.4± 11.8) years and the time since taking alcohol to the onset of pain as(118.7±65.4) months. The functions of hips were measured with Harris score before the operation and 12, 24 months after the operation, and the collapse of the femoral head was evaluated 24 months after the operation with non-collapse as excellent, collapse less than 2 mm as good and collapse more than 2 mm as poor. Results: The ratio of excellent and good reached 59.3% in traumatic group, 81.4% in corticosteroid group and 84.8% in alcoholic group. There was significant differences between traumatic group and the other two groups(P<0.05). There was no significant difference between the corticosteroid group and alcoholic group(P>0.05). Harris scores before the operation were not significantly different among the three groups(P>0.05) and were significantly better after the operation(P<0.05). Harris score was less at 12 and 24 months after the operation in traumatic group than in the other two groups(P<0.05). Conclusions: The effects of core decompression in treatment of both early-stage corticosteroid and alcoholic femoral head necrosis are superior to the traumatic femoral head necrosis.
Background: Core decompression is an easy and effective surgical method for early femoral head osteonecrosis with hip remained, but the effect is quite different due to the causes of femoral head osteonecrosis. Objective: To analyze the outcomes of core decompression in treatment of femoral head osteonecrosis of early-stage traumatic, corticosteroid and alcoholic types. Methods: From September 2010 to September 2013, a retrospective analysis was performed on the patients with earlystage(ARCO Ⅰ and Ⅱa) traumatic, corticosteroid and alcoholic femoral head necrosis treated by multiple drilling core decompression. In traumatic group, there were 32 patients(32 hips), including 20 males(20 hips) and 12 females(12 hips), with an average age of(43.4±9.9) years and the time since injury to the onset of pain as(23.9± 17.6) months. In corticosteroid group,there were 67 patients(97 hips), including 18 males(32 hips) and 49 females(65 hips), with an average age of(38.5 ±10.8)years and the time since taking corticosteroid to the onset of pain as(27.2± 16.8) months. In alcoholic group, there were 38 patients(66 hips), all males, with an average age of(46.4± 11.8) years and the time since taking alcohol to the onset of pain as(118.7±65.4) months. The functions of hips were measured with Harris score before the operation and 12, 24 months after the operation, and the collapse of the femoral head was evaluated 24 months after the operation with non-collapse as excellent, collapse less than 2 mm as good and collapse more than 2 mm as poor. Results: The ratio of excellent and good reached 59.3% in traumatic group, 81.4% in corticosteroid group and 84.8% in alcoholic group. There was significant differences between traumatic group and the other two groups(P<0.05). There was no significant difference between the corticosteroid group and alcoholic group(P>0.05). Harris scores before the operation were not significantly different among the three groups(P>0.05) and were significantly better after the operation(P<0.05). Harris score was less at 12 and 24 months after the operation in traumatic group than in the other two groups(P<0.05). Conclusions: The effects of core decompression in treatment of both early-stage corticosteroid and alcoholic femoral head necrosis are superior to the traumatic femoral head necrosis.
引文
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[2] Moya-Angeler J, Gianakos AL, Villa JC, et al. Current concepts on osteonecrosis of the femoral head. World J Orthop,2015, 6(8):590-601.
[3] Agarwala S, Shah S, Joshi VR. The use of alendronate in the treatment of avascular necrosis of the femoral head followup to eight years. J Bone Joint Surg Br, 2009, 91(8):1013-1018.
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[6] Kang P, Pei F, Shen B, et al. Are the results of multiple drilling and alendronate for osteonecrosis of the femoral head better than those of multiple drilling? A pilot study. Joint Bone Spine, 2012, 79(1):67-72.
[7]王荣田,陈卫衡,林娜,等.股骨头坏死的病因构成及发病特征分析.中国骨与关节损伤杂志,2009,24(9):792-795.
[8] Pepke W, Kasten P, Beckmann NA, et al. Core decompression and autologous bone marrow concentrate for treatment of femoral head osteonecrosis:A randomized prospective study. Orthop Rev(Pavia), 2016, 8(1):61-62.
[9] Pierce TP, Jauregui JJ, Elmallah RK, et al. A current review of core decompression in the treatment of osteonecrosis of the femoral head. Curr Rev Musculoskelet Med, 2015, 8(3):228-232.
[10] Song WS, Yoo JJ, Kim YM, et al. Results of multiple drilling compared with those of conventional methods of core decompression. Clin Orthop Relat Res, 2007, 454:139-146.
[11] Larson E, Jones LC, Goodman SB, et al. Early-stage osteonecrosis of the femoral head:where are we and where are we going in year 2018? Int Orthop, 2018, 42(7):1723-1728.
[12] Liu Y, Zhao D, Wang W, et al. Efficacy of core decompression for treatment of canine femoral head osteonecrosis induced by arterial ischaemia and venous congestion. Hip Int,2017, 27(4):406-411.
[13] Wang W, Hu W, Yang P, et al. Patient-specific core decompression surgery for early-stage ischemic necrosis of the femoral head. PLoS One, 2017, 12(5):e0175366.
[14] Ren X, Fan W, Shao Z, et al. A metabolomic study on early detection of steroid-induced avascular necrosis of the femoral head. Oncotarget, 2018,9(8):7984-7995.
[15] Bai R, Feng W, Liu WL, et al. Roles of osteocyte apoptosis in steroid-induced avascular necrosis of the femoral head. Genet Mol Res, 2016,15(1).
[16] Wu B, Dong Z, Li S, et al. Steroid-induced ischemic bone necrosis of femoral head:Treatment strategies. Pak J Med Sci,2015, 31(2):471-476.
[17] Hernigou P, Beaujean F, Lambotte JC. Decrease in the mesenchymal stem-cell pool in the proximal femur in corticosteroid-induced osteonecrosis. J Bone Joint surg, 1999, 81(2):349-355.
[18] Sadile F, Bernasconi A, Carbone F, et al. Histological fibrosis may predict the failure of core decompression in the treatment of osteonecrosis of the femoral head. Int J Surg, 2017,44:303-308.
[19] Bachiller FG, Caballer AP, Portal LF. Avascular necrosis of the femoral head after femoral neck fracture. Clin Orthop Relat Res, 2002,(399):87-109.
[20] Carulli C, Nistri L, Bracco L, et al. A steroid-induced bilateral avascular necrosis of the femoral head in an underage patient affected by multiple sclerosis. Clin Cases Miner Bone Metab, 2015,12(3):257-259.
[21]周龙涛,韦标方,任金钊,等.酒精性股骨头坏死发病机制的研究进展.风湿病与关节炎,2015,4(4):67-71.
[22] Qin X, Jin P, Jiang T, et al. A human chondrocyte-derived in vitro model of alcohol-induced and steroid-induced femoral head necrosis. Med Sci Monit, 2018, 24:539-547.
[23] Liu Y, Zhao D, Wang W, et al. Efficacy of core decompression for treatment of canine femoral head osteonecrosis induced by arterial ischaemia and venous congestion. Hip Int,2017,27(4):406-411.
[24] Zhao DW, Yu XB. Core decompression treatment of earlystage osteonecrosis of femoral head resulted from venous stasis or artery blood supply insufficiency. J Surg Res, 2015,194(2):614-621.
[25] Luo RB, Lin T, Zhong HM, et al. Evidence for using alendronate to treat adult avascular necrosis of the femoral head:a systematic review. Med Sci Monit, 2014, 20:2439-2447.
[26] Landgraeber S, Warwas S, Claβen T, et al. Modifications to advanced core decompression for treatment of avascular necrosis of the femoral head. BMC Musculoskelet Disord, 2017,18(1):479.
[2] Moya-Angeler J, Gianakos AL, Villa JC, et al. Current concepts on osteonecrosis of the femoral head. World J Orthop,2015, 6(8):590-601.
[3] Agarwala S, Shah S, Joshi VR. The use of alendronate in the treatment of avascular necrosis of the femoral head followup to eight years. J Bone Joint Surg Br, 2009, 91(8):1013-1018.
[4]中华老年骨科与康复电子杂志编辑委员会.股骨头坏死保髋治疗指南(2016版).中华老年骨科与康复杂志,2016,2(2):65-70.
[5]阎亮,王上增,孙永强,等.不同类型股骨头坏死保头治疗效果的对比研究.中国中医骨伤科杂志,2016, 24(6):13-15.
[6] Kang P, Pei F, Shen B, et al. Are the results of multiple drilling and alendronate for osteonecrosis of the femoral head better than those of multiple drilling? A pilot study. Joint Bone Spine, 2012, 79(1):67-72.
[7]王荣田,陈卫衡,林娜,等.股骨头坏死的病因构成及发病特征分析.中国骨与关节损伤杂志,2009,24(9):792-795.
[8] Pepke W, Kasten P, Beckmann NA, et al. Core decompression and autologous bone marrow concentrate for treatment of femoral head osteonecrosis:A randomized prospective study. Orthop Rev(Pavia), 2016, 8(1):61-62.
[9] Pierce TP, Jauregui JJ, Elmallah RK, et al. A current review of core decompression in the treatment of osteonecrosis of the femoral head. Curr Rev Musculoskelet Med, 2015, 8(3):228-232.
[10] Song WS, Yoo JJ, Kim YM, et al. Results of multiple drilling compared with those of conventional methods of core decompression. Clin Orthop Relat Res, 2007, 454:139-146.
[11] Larson E, Jones LC, Goodman SB, et al. Early-stage osteonecrosis of the femoral head:where are we and where are we going in year 2018? Int Orthop, 2018, 42(7):1723-1728.
[12] Liu Y, Zhao D, Wang W, et al. Efficacy of core decompression for treatment of canine femoral head osteonecrosis induced by arterial ischaemia and venous congestion. Hip Int,2017, 27(4):406-411.
[13] Wang W, Hu W, Yang P, et al. Patient-specific core decompression surgery for early-stage ischemic necrosis of the femoral head. PLoS One, 2017, 12(5):e0175366.
[14] Ren X, Fan W, Shao Z, et al. A metabolomic study on early detection of steroid-induced avascular necrosis of the femoral head. Oncotarget, 2018,9(8):7984-7995.
[15] Bai R, Feng W, Liu WL, et al. Roles of osteocyte apoptosis in steroid-induced avascular necrosis of the femoral head. Genet Mol Res, 2016,15(1).
[16] Wu B, Dong Z, Li S, et al. Steroid-induced ischemic bone necrosis of femoral head:Treatment strategies. Pak J Med Sci,2015, 31(2):471-476.
[17] Hernigou P, Beaujean F, Lambotte JC. Decrease in the mesenchymal stem-cell pool in the proximal femur in corticosteroid-induced osteonecrosis. J Bone Joint surg, 1999, 81(2):349-355.
[18] Sadile F, Bernasconi A, Carbone F, et al. Histological fibrosis may predict the failure of core decompression in the treatment of osteonecrosis of the femoral head. Int J Surg, 2017,44:303-308.
[19] Bachiller FG, Caballer AP, Portal LF. Avascular necrosis of the femoral head after femoral neck fracture. Clin Orthop Relat Res, 2002,(399):87-109.
[20] Carulli C, Nistri L, Bracco L, et al. A steroid-induced bilateral avascular necrosis of the femoral head in an underage patient affected by multiple sclerosis. Clin Cases Miner Bone Metab, 2015,12(3):257-259.
[21]周龙涛,韦标方,任金钊,等.酒精性股骨头坏死发病机制的研究进展.风湿病与关节炎,2015,4(4):67-71.
[22] Qin X, Jin P, Jiang T, et al. A human chondrocyte-derived in vitro model of alcohol-induced and steroid-induced femoral head necrosis. Med Sci Monit, 2018, 24:539-547.
[23] Liu Y, Zhao D, Wang W, et al. Efficacy of core decompression for treatment of canine femoral head osteonecrosis induced by arterial ischaemia and venous congestion. Hip Int,2017,27(4):406-411.
[24] Zhao DW, Yu XB. Core decompression treatment of earlystage osteonecrosis of femoral head resulted from venous stasis or artery blood supply insufficiency. J Surg Res, 2015,194(2):614-621.
[25] Luo RB, Lin T, Zhong HM, et al. Evidence for using alendronate to treat adult avascular necrosis of the femoral head:a systematic review. Med Sci Monit, 2014, 20:2439-2447.
[26] Landgraeber S, Warwas S, Claβen T, et al. Modifications to advanced core decompression for treatment of avascular necrosis of the femoral head. BMC Musculoskelet Disord, 2017,18(1):479.