[1]毕红宾,杨亚丽,李岩,等.直接前侧入路小切口病灶清除打压植骨治疗股骨头坏死的疗效[J].中国中医骨伤科杂志,2023,31(03):67-71.[doi:10.20085/j.cnki.issn1005-0205.230313]
　BI Hongbin,YANG Yali,LI Yan,et al.Efficacy of Direct Anterior Approach of Small Incision by Debridement and Bone Grafting on the Treatment of the Femoral Head Necrosis[J].Chinese Journal of Traditional Medical Traumatology & Orthopedics,2023,31(03):67-71.[doi:10.20085/j.cnki.issn1005-0205.230313]
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直接前侧入路小切口病灶清除打压植骨治疗股骨头坏死的疗效()
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《中国中医骨伤科杂志》[ISSN:1005-0205/CN:42-1340/R]

卷:
第31卷
期数:
2023年03期
页码:
67-71
栏目:
临床报道
出版日期:
2023-03-15

文章信息/Info

Title:
Efficacy of Direct Anterior Approach of Small Incision by Debridement and Bone Grafting on the Treatment of the Femoral Head Necrosis
文章编号:
1005-0205(2023)03-0067-05
作者:
毕红宾1; 杨亚丽1; 李岩1; 邢庆胜1△
1河南省洛阳正骨医院(河南省骨科医院)(郑州,450008)
Author(s):
BI Hongbin1; YANG Yali1; LI Yan1; XING Qingsheng1△
1Luoyang Orthopedic-Traumatological Hospital of Henan Province(Henan Provincial Orthopedic Hospital), Zhengzhou 450008, China.
关键词:
股骨头坏死;  病灶清除;  打压植骨
Keywords:
ostoenecrosis of the femoral head;  debridement;  impact bone graft
分类号:
R681.8
DOI:
10.20085/j.cnki.issn1005-0205.230313
文献标志码:
B
摘要:
目的:直接前侧入路(DAA)小切口病灶清除打压植骨治疗股骨头坏死(ONFH)的疗效。方法:2017年5月至2021年5月,采用直接前侧入路小切口病灶清除打压植骨治疗股骨头坏死患者50例(60髋),其中男32例,女18例; 年龄为21～60岁,平均年龄为(41.76±8.62)岁; 病程为3～25个月,平均为(12.6±9.5)个月; 均诊断为股骨头无菌性坏死。按病因分型:酒精型32例,激素型18例。按照国际骨循环研究协会(ARCO)股骨头坏死分期Ⅱ期40髋、Ⅲa期10髋。结果:术后所有患者均得到随访,切口均一期愈合,无切口感染、取骨区疼痛不适、人工骨排异反应、股外侧皮神经损伤、下肢深静脉血栓等术后并发症。术后随访时间为2～4年,平均为(2.8±1.6)年。术后复查X线片显示植骨区均骨性融合,融合时间为为6～18个月。末次随访时Harris评分为(90.64±3.90)分,与术前(69.88±4.24)分比较差异有统计学意义(t=65.56,P<0.001)。优31髋,良14髋,可4髋,差1髋,优良率为90.0%。结论:直接前侧入路小切口经股骨头颈结合部开窗病灶清除打压植骨术治疗ARCO分期Ⅱ期及Ⅲa期患者,坏死病灶清除彻底,可实现充分植骨和骨融合,恢复头颈部生物力学性能,创伤小,临床疗效显著,是治疗早中期股骨头坏死的良好保髋方式。
Abstract:
Objective:To investigate the efficacy and application of direct anterior approach(DAA)on the treatment of osteonecrosis of the femoral head(ONFH)by small incision debridement and bone grafting. Methods:From May 2017 to May 2021, 50 patients(60 hips)with the femoral head necrosis were treated by small incision debridement and bone grafting with DAA, including 32 males and 18 females. The aged from 21 to 60 years old with(41.76±8.62)years old on average. All patients had aseptic necrosis of the femoral head. The duration of the disease was 3 to 25 months, with an average of(12.6±9.5)months. According to the etiology, 32 cases were alcohol type and 18 cases were hormone type. According to Association Research Circulation Osseus(ARCO), 40 hips were rated as stage Ⅱ, and 10 hips as stage Ⅲa. Results:All patients were followed up after surgery. All the patients' incisions were healed in one stage, and there were no incision infection, pain and discomfort in the bone extraction area, artificial bone rejection, lateral femoral cutaneous nerve damaged, deep venous thrombosis of lower limbs and other early postoperative complications. All patients were followed up for 2 to 4 years, with an average of(2.8±1.6)years. Postoperative radiographs showed that all bone grafts were fused, and the fusion time was 16 to 18 months. The Harris score at the last follow-up was 90.64±3.90, which was significantly different from the preoperative score(69.88±4.24)(t=65.56,P<0.001). 31 hips were excellent, 14 hips were good, 4 hips were acceptable, 1 hip was poor, the rate of excellent and good was 90.0%. Conclusion:The treatment of ARCO stage Ⅱ and Ⅲa patients by small incision of DAA through fenestration of femoral head and neck junction is complete. The necrotic lesions can be completely removed, and full bone grafting and bone fusion can be achieved, the biological performance of head and neck can be restored, and the trauma is small, obtaining significant clinical efficacy. It is a good way in protecting hip on the treatment of mid-early ostoenecrosis of the femoral head.

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备注/Memo

备注/Memo:
△通信作者 E-mail: abinbhb@126.com
更新日期/Last Update: 2023-03-10