股骨头坏死外科脱位入路打压植骨支撑术后超早期康复介入的保髋效果
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摘要
背景:研究发现股骨头坏死术后康复可促进恢复髋关节功能。目的:探讨股骨头坏死外科脱位入路打压植骨支撑术后超早期康复介入的保髋效果。方法:纳入中青年ARCOⅢ期股骨头缺血性坏死患者32例,随机分入试验组与对照组,每组16例。所有患者对治疗方案均知情同意,且得到医院伦理委员会批准(批件号:中医一附伦审科[2015]010号)。2组均接受常规的袁氏生脉成骨片药物治疗,联合采用经髋关节外科脱位入路打压植骨支撑术。对照组介入常规术后康复训练,试验组给予术后超早期康复训练流程。以疼痛目测类比评分和髋关节功能Harris评分评价关节恢复情况,以股骨头塌陷超过4 mm为终点事件,观察2组患者术后3,7,14 d的目测类比疼痛评分以及术后1,3,6个月的髋关节功能Harris评分。结果与结论:①目测类比评分:组内比较,术后3,7,14 d试验组目测类比评分逐渐降低(P <0.01),对照组目测类比评分也逐渐降低(P<0.01);组间比较,2组随着康复训练时间的增加术后疼痛减轻,术后7,14 d试验组目测类比评分均低于对照组(P <0.05);②髋关节功能Harris评分:组内比较,术后1,3,6个月试验组的Harris评分逐渐升高(P<0.01);组间比较,术后3,6个月试验组的Harris评分均高于对照组(P<0.01);③提示超早期康复介入能够在一定程度上改善股骨头坏死保髋术后的功能恢复速度和程度,术后标准化康复流程有助于促进股骨头坏死患者术后功能恢复。
BACKGROUND: Postoperative rehabilitation of osteonecrosis of the femoral head has been shown to promote the recovery of hip joint function.OBJECTIVE: To explore the effect of ultra-early rehabilitation after bone grafting through surgical dislocation approach in osteonecrosis of the femoral head.METHODS: Thirty-two cases of young and middle-aged ARCOIII patients with avascular necrosis of femoral head were included, and randomly divided into the trial and control groups(n=16/group). All patients signed the informed consents and the study was approved by the Ethics Committee of the hospital, approval number:[2015]010. Two groups were treated with Yuan's Shengmai Chenggu tablets and bone grafting via surgical hip dislocation. The control group received routine postoperative rehabilitation training, and the trial group was treated with ultra-early rehabilitation training. Joint recovery was evaluated with Visual Analogue Scale score, and Harris hip score. Femoral head collapse over 4 mm was the end event. The Visual Analogue Scale score at postoperative 3, 7 and 14 days, and Harris hip score at postoperative 1, 3 and 6 months were recorded.RESULTS AND CONCLUSION:(1) The Visual Analogue Scale score at postoperative 3, 7 and 14 days in the trial and control groups was decreased(both P < 0.01). The postoperative pain was alleviated with rehabilitation time in the two groups and the Visual Analogue Scale score at postoperative 7 and 14 days in the trial group was significantly lower than that in the control group(P < 0.05).(2) The Harris hip score at postoperative 1, 3 and 6 months in the trial group was gradually increased(P < 0.01). The Harris hip score at postoperative 3 and 6 months in the trial group was significantly higher than that in the control group(P < 0.01).(3) To conclude, ultra-early rehabilitation can improve the functional recovery after hip-preserving surgery of osteonecrosis of the femoral head to some extent, and standardized rehabilitation process can promote the postoperative functional recovery in patients with osteonecrosis of the femoral head.
BACKGROUND: Postoperative rehabilitation of osteonecrosis of the femoral head has been shown to promote the recovery of hip joint function.OBJECTIVE: To explore the effect of ultra-early rehabilitation after bone grafting through surgical dislocation approach in osteonecrosis of the femoral head.METHODS: Thirty-two cases of young and middle-aged ARCOIII patients with avascular necrosis of femoral head were included, and randomly divided into the trial and control groups(n=16/group). All patients signed the informed consents and the study was approved by the Ethics Committee of the hospital, approval number:[2015]010. Two groups were treated with Yuan's Shengmai Chenggu tablets and bone grafting via surgical hip dislocation. The control group received routine postoperative rehabilitation training, and the trial group was treated with ultra-early rehabilitation training. Joint recovery was evaluated with Visual Analogue Scale score, and Harris hip score. Femoral head collapse over 4 mm was the end event. The Visual Analogue Scale score at postoperative 3, 7 and 14 days, and Harris hip score at postoperative 1, 3 and 6 months were recorded.RESULTS AND CONCLUSION:(1) The Visual Analogue Scale score at postoperative 3, 7 and 14 days in the trial and control groups was decreased(both P < 0.01). The postoperative pain was alleviated with rehabilitation time in the two groups and the Visual Analogue Scale score at postoperative 7 and 14 days in the trial group was significantly lower than that in the control group(P < 0.05).(2) The Harris hip score at postoperative 1, 3 and 6 months in the trial group was gradually increased(P < 0.01). The Harris hip score at postoperative 3 and 6 months in the trial group was significantly higher than that in the control group(P < 0.01).(3) To conclude, ultra-early rehabilitation can improve the functional recovery after hip-preserving surgery of osteonecrosis of the femoral head to some extent, and standardized rehabilitation process can promote the postoperative functional recovery in patients with osteonecrosis of the femoral head.
引文
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[2]徐福东,庄至坤,吴昭克,等.带旋股外侧血管横支大转子骨瓣移植术治疗股骨头坏死的近期疗效[J].中国中医骨伤科杂志,2015,23(12):65-66.
[3]何伟.如何把握股骨头坏死患者的保髋治疗时机[J].中国骨与关节杂志,2016,5(2):82-86.
[4]李子荣.股骨头坏死的早期诊断治疗及合理治疗[J].中华关节外科杂志(电子版),2008,2(1):1-2.
[5]Frost HM.Why do long-distance runners not have more bone?a vital biomechnical explanation and an estrogen effect.JBone Miner Metab.1997;15:9-16.
[6]蒋协远,王大伟.骨科临床疗效评价标准[M].北京:人民卫生出版社,2005:123-124.
[7]Ganz R,Gil TJ,Gautier E,et al.Surgical dislocation of the adult hip a technique with ful aces to the femoral head and acetabulum without therisk of avascular necrosis.J Bone Joint Surg Br.2001;83(8):1119-1124.
[8]庄至坤,吴昭克,谢庆华,等.中药联合经髋关节外科脱位入路打压植骨支撑术治疗中青年ARCOⅢ期股骨头坏死22例[J].中国中医骨伤科杂志,2017,25(11):46-47.
[9]黄红拾,敖英芳,周谋望,等.持续被动活动对兔重建前交叉韧带组织学研究的影响[J].中国康复医学杂志,2007,2(7):1059-1061.
[10]洗祖新,杨延砚,周谋望,等.关节镜下前交叉韧带重建术后股四头肌肌力训练方式的选择--开链还是闭链[J].中国康复医学杂志,2012,27(12):1174-1177.
[11]吴鸣,尚希福,崔俊才,等.超早期规范化物理治疗对缩短全膝关节置换术平均住院日的影响[J].中国康复医学杂志,2017,32(7):802-807.
[12]Afoke NY,Byers PD,Hutton WC.Contact pressures in the human hip joint.J Bone Joint Surg(Br).1987;69(4):536-541.
[13]Chen ZP,Xu Y,Qi ZX,et al.The formation and function of the sclerosis rim in the femoral head:A biomechanical point of view.Med Eng Phys.2015;37(12):1125-1132.
[14]Van Houcke J,Schouten A,Steenackers G,et al.Computerbased estimation of the hip joint reaction force and hip flexion angle in three different sitting configurations.Appl Ergon.2017;63:99-105.
[15]杨鹏.微观辨证下非创伤性股骨头坏死内侧间隙与塌陷的相关性及生物力学研究[D].广州:广州中医药大学,2017:42-45.
[16]Neumann DA.Kinesiology of the Musculoskeletal System Foundations of Rehabilitation[M].北京:人民军医出版社,2015:498-510.
[17]李鹏飞,孙楠,樊粤光,等.袁氏生脉成骨片对激素干预后大鼠成骨细胞的差异表达miRNA的实验研究[J].中华中医药学刊,2017,35(1):91-94.
[18]饶根云,王永刚,王哲军,等.骨质疏松性骨折愈合的细胞学观察[J].中国骨质疏松杂志,2005,5,11(2),230-233.
[19]孙仁贵,陈冠群.实验性骨折愈合的扫描电镜观察[J].中华骨科杂志,1993,13(2):114-116.
[20]饶根云,陈一鸣,谢乐屏,等,应力刺激对骨质疏松性骨折愈合的影响--扫描电镜观察[J].医用生物力学,1998,13(4):233-237.
[2]徐福东,庄至坤,吴昭克,等.带旋股外侧血管横支大转子骨瓣移植术治疗股骨头坏死的近期疗效[J].中国中医骨伤科杂志,2015,23(12):65-66.
[3]何伟.如何把握股骨头坏死患者的保髋治疗时机[J].中国骨与关节杂志,2016,5(2):82-86.
[4]李子荣.股骨头坏死的早期诊断治疗及合理治疗[J].中华关节外科杂志(电子版),2008,2(1):1-2.
[5]Frost HM.Why do long-distance runners not have more bone?a vital biomechnical explanation and an estrogen effect.JBone Miner Metab.1997;15:9-16.
[6]蒋协远,王大伟.骨科临床疗效评价标准[M].北京:人民卫生出版社,2005:123-124.
[7]Ganz R,Gil TJ,Gautier E,et al.Surgical dislocation of the adult hip a technique with ful aces to the femoral head and acetabulum without therisk of avascular necrosis.J Bone Joint Surg Br.2001;83(8):1119-1124.
[8]庄至坤,吴昭克,谢庆华,等.中药联合经髋关节外科脱位入路打压植骨支撑术治疗中青年ARCOⅢ期股骨头坏死22例[J].中国中医骨伤科杂志,2017,25(11):46-47.
[9]黄红拾,敖英芳,周谋望,等.持续被动活动对兔重建前交叉韧带组织学研究的影响[J].中国康复医学杂志,2007,2(7):1059-1061.
[10]洗祖新,杨延砚,周谋望,等.关节镜下前交叉韧带重建术后股四头肌肌力训练方式的选择--开链还是闭链[J].中国康复医学杂志,2012,27(12):1174-1177.
[11]吴鸣,尚希福,崔俊才,等.超早期规范化物理治疗对缩短全膝关节置换术平均住院日的影响[J].中国康复医学杂志,2017,32(7):802-807.
[12]Afoke NY,Byers PD,Hutton WC.Contact pressures in the human hip joint.J Bone Joint Surg(Br).1987;69(4):536-541.
[13]Chen ZP,Xu Y,Qi ZX,et al.The formation and function of the sclerosis rim in the femoral head:A biomechanical point of view.Med Eng Phys.2015;37(12):1125-1132.
[14]Van Houcke J,Schouten A,Steenackers G,et al.Computerbased estimation of the hip joint reaction force and hip flexion angle in three different sitting configurations.Appl Ergon.2017;63:99-105.
[15]杨鹏.微观辨证下非创伤性股骨头坏死内侧间隙与塌陷的相关性及生物力学研究[D].广州:广州中医药大学,2017:42-45.
[16]Neumann DA.Kinesiology of the Musculoskeletal System Foundations of Rehabilitation[M].北京:人民军医出版社,2015:498-510.
[17]李鹏飞,孙楠,樊粤光,等.袁氏生脉成骨片对激素干预后大鼠成骨细胞的差异表达miRNA的实验研究[J].中华中医药学刊,2017,35(1):91-94.
[18]饶根云,王永刚,王哲军,等.骨质疏松性骨折愈合的细胞学观察[J].中国骨质疏松杂志,2005,5,11(2),230-233.
[19]孙仁贵,陈冠群.实验性骨折愈合的扫描电镜观察[J].中华骨科杂志,1993,13(2):114-116.
[20]饶根云,陈一鸣,谢乐屏,等,应力刺激对骨质疏松性骨折愈合的影响--扫描电镜观察[J].医用生物力学,1998,13(4):233-237.