髋关节镜联合多次小直径钻孔减压与单独钻孔减压治疗股骨头早期缺血性坏死的效果比较
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摘要
目的比较髋关节镜联合多次小直径钻孔减压与单独钻孔减压治疗股骨头早期缺血性坏死的临床效果。方法回顾性分析2014年2月至2017年8月于我院因股骨头早期缺血性坏死行髋关节镜联合减压的患者(83例,116髋),根据减压方法分为多孔组(37例,51髋)和单孔组(46例,65髋),比较两组患者手术相关指标及术后住院时间,比较两组术前和术后3个月、1年的髋关节Harris评分,采用Kaplan-Meier生存曲线分析比两组患者出现股骨头塌陷的情况。结果多孔组患者其术中出血量显著少于单孔组,差异具有统计学意义(t=5.545,P <0.001),两组患者术后3个月和1年的髋关节Harris评分均较术前显著升高(P <0.05),术后1年多孔组患者其Harris评分显著高于单孔组,差异具有统计学意义(t=2.052,P=0.043)。结论髋关节镜联合多次小直径钻孔减压对比单独钻孔减压治疗股骨头早期缺血性坏死,其手术创伤更小,能进一步改善髋关节功能,其临床效果优于单独钻孔减压。
Objective To compare the clinical effects of hip arthroscopy combined with multiple small diameter drilling decompression and single hole decompression for early avascular necrosis of the femoral head.Methods A total of 83 patients(116 hips)with total hip arthroscopic decompression due to early avascular necrosis of the femoral head from February 2014 to August 2017 were retrospectively analyzed. They were divided into porous groups(37 cases,51 hips)and single-hole group(46 cases,65 hips)according to the decompression method. The indexes of surgery and postoperative hospital stay were compared between the two groups. The hips of the two groups were compared. The Harris scores of the hips were analyzed before and 3 months and 1 year after surgery and Kaplan-Meier survival curves were adopted to analyze femoral head collapse in these two groups of patients. Results The amount of intraoperative blood loss was significantly lower in the porous group than that in the single-hole group(t = 5.545,P < 0.001). The hip Harris scores at 3 months and 1 year after the surgery were significantly higher than those before the operation in both two groups(P < 0.05). The Harris score of the porous group was significantly higher than that of the single-hole group at 1 year after the surgery. The difference was statistically significant(t = 2.052,P = 0.043). Conclusions Compared with single hole decompression for early avascular necrosis of the femoral head, hip arthroscopy combined with multiple small diameter drilling decompression is demonstrated smaller surgical,which can be further improved hip function,and its clinical effect is better than separate drilling stress reliever.
Objective To compare the clinical effects of hip arthroscopy combined with multiple small diameter drilling decompression and single hole decompression for early avascular necrosis of the femoral head.Methods A total of 83 patients(116 hips)with total hip arthroscopic decompression due to early avascular necrosis of the femoral head from February 2014 to August 2017 were retrospectively analyzed. They were divided into porous groups(37 cases,51 hips)and single-hole group(46 cases,65 hips)according to the decompression method. The indexes of surgery and postoperative hospital stay were compared between the two groups. The hips of the two groups were compared. The Harris scores of the hips were analyzed before and 3 months and 1 year after surgery and Kaplan-Meier survival curves were adopted to analyze femoral head collapse in these two groups of patients. Results The amount of intraoperative blood loss was significantly lower in the porous group than that in the single-hole group(t = 5.545,P < 0.001). The hip Harris scores at 3 months and 1 year after the surgery were significantly higher than those before the operation in both two groups(P < 0.05). The Harris score of the porous group was significantly higher than that of the single-hole group at 1 year after the surgery. The difference was statistically significant(t = 2.052,P = 0.043). Conclusions Compared with single hole decompression for early avascular necrosis of the femoral head, hip arthroscopy combined with multiple small diameter drilling decompression is demonstrated smaller surgical,which can be further improved hip function,and its clinical effect is better than separate drilling stress reliever.
引文
[1]何晓铭,龚水帝,庞凤祥,等.抵抗素水平与股骨头坏死塌陷进程的相关性[J].实用医学杂志,2019,35(4):579-583.
[2]姚依村,曹良国,叶冬平,等.股骨颈骨折加压螺钉取出术后继发股骨头缺血坏死的原因分析[J].实用医学杂志,2018,34(23):3913-3916.
[3] AL OMARAN A. Multiple drilling compared with standard core decompression for avascular necrosis of the femoral head in sickle cell disease patients[J]. Arch Orthop Trauma Surg,2013,133(5):609-613.
[4] YIN H,YUAN Z,WANG D. Multiple drilling combined with simvastatin versus multiple drilling alone for the treatment of avascular osteonecrosis of the femoral head:3-year follow-up study[J]. BMC Musculoskelet Disord,2016,17(1):344.
[5]刘予豪,周驰,陈雷雷,等.基于股骨头坏死围塌陷期理论的保髋术式总结[J].中国修复重建外科杂志,2017,31(8):1010-1015.
[6]张长青.股骨头坏死保髋治疗指南(2016版)[J].中华老年骨科与康复电子杂志,2016,2(2):65-70.
[7]何敏聪,魏秋实,何伟.非创伤性股骨头坏死血清标志物临床应用的研究进展[J].实用医学杂志,2017,33(1):154-156.
[8] MOHANTY S P,SINGH K A,KUNDANGAR R,et al. Management of nontraumatic avascular necrosis of the femoral heada comparative analysis of the outcome of multiple small diameter drilling and core decompression with fibular grafting[J]. Musculoskeletal Surgery,2017,10(1):59-66.
[9] LI J,ZHANG H,SU X Z,et al. Long-term outcome of multiple smalldiameter drilling decompression combined with hip arthroscopy versus drilling alone for early avascular necrosis of the femoral head[J]. Chin Med J(Engl),2017,130(12):1435-1440.
[10] MANENTI G,ALTOBELLI S,PUGLIESE L,et al. The role of imaging in diagnosis and management of femoral head avascular necrosis[J]. Clin Cases Miner Bone Metab,2015,12(Suppl1):31-38.
[11] VLAMIS J,KARAMPINAS P,KAVROUDAKIS E,et al. The use of core track endoscopy to document accurate decompression of the femoral head[J]. Hip Int,2014,24(3):284-289.
[2]姚依村,曹良国,叶冬平,等.股骨颈骨折加压螺钉取出术后继发股骨头缺血坏死的原因分析[J].实用医学杂志,2018,34(23):3913-3916.
[3] AL OMARAN A. Multiple drilling compared with standard core decompression for avascular necrosis of the femoral head in sickle cell disease patients[J]. Arch Orthop Trauma Surg,2013,133(5):609-613.
[4] YIN H,YUAN Z,WANG D. Multiple drilling combined with simvastatin versus multiple drilling alone for the treatment of avascular osteonecrosis of the femoral head:3-year follow-up study[J]. BMC Musculoskelet Disord,2016,17(1):344.
[5]刘予豪,周驰,陈雷雷,等.基于股骨头坏死围塌陷期理论的保髋术式总结[J].中国修复重建外科杂志,2017,31(8):1010-1015.
[6]张长青.股骨头坏死保髋治疗指南(2016版)[J].中华老年骨科与康复电子杂志,2016,2(2):65-70.
[7]何敏聪,魏秋实,何伟.非创伤性股骨头坏死血清标志物临床应用的研究进展[J].实用医学杂志,2017,33(1):154-156.
[8] MOHANTY S P,SINGH K A,KUNDANGAR R,et al. Management of nontraumatic avascular necrosis of the femoral heada comparative analysis of the outcome of multiple small diameter drilling and core decompression with fibular grafting[J]. Musculoskeletal Surgery,2017,10(1):59-66.
[9] LI J,ZHANG H,SU X Z,et al. Long-term outcome of multiple smalldiameter drilling decompression combined with hip arthroscopy versus drilling alone for early avascular necrosis of the femoral head[J]. Chin Med J(Engl),2017,130(12):1435-1440.
[10] MANENTI G,ALTOBELLI S,PUGLIESE L,et al. The role of imaging in diagnosis and management of femoral head avascular necrosis[J]. Clin Cases Miner Bone Metab,2015,12(Suppl1):31-38.
[11] VLAMIS J,KARAMPINAS P,KAVROUDAKIS E,et al. The use of core track endoscopy to document accurate decompression of the femoral head[J]. Hip Int,2014,24(3):284-289.