背景:股骨头钻孔减压术(core decompression, CD)是治疗早期股骨头缺血性坏死(avascular necorsis of femoral head, ANFH)的有效方法,但保髋失败后是否影响后续的全髋关节置换(total hip arthroplasty, THA)尚存争议.目的:分析THA治疗CD术后失败的非创伤性ANFH患者的中期临床和影像学随访结果.方法:回顾性分析2013年1月至2015年12月收治的CD术后失败待行THA的非创伤性ANFH患者27例(27髋)作为CD组,以及既往未行手术治疗的非创伤性ANFH患者42例(42髋)作为对照组.手术前后采用Harris髋关节评分系统进行评价,并对手术前后的正侧位X线片进行分析.结果:CD组术中自体血回收量为(246±85)ml,显著高于对照组的(176±47)ml(t=3.854, P＜0.001).两组患者均获得随访,CD组随访时间为28~65个月,平均(46.4±9.6)个月;对照组随访时间为27~64个月,平均(49.8±9.2)个月.CD组髋关节Harris评分从术前平均(43.2±11.7)分(18~61分)提高至末次随访的(90.3±5.3)分(82~100分)(t=-21.564, P＜0.001),对照组Harris评分从术前平均(44.4±11.7)分(18~66分)提高至末次随访的(88.0±5.9)分(78~100分)(t=-20.465, P＜0.001),两组术后评分无显著性差异(t=0.542, P=0.589).CD组并发症包括1例医源性坐骨神经损伤,无一例需要翻修.结论:THA治疗CD术后失败的非创伤性ANFH患者的中期临床和影像学结果满意.既往CD治疗使后续THA的术中出血量有所增加,但未对临床和影像学结果以及并发症发生率造成不利影响.%Background: Core decompression (CD) of femoral head is an effective method for early avascular necrosis of femoral head (ANFH), but whether the failure of CD has any influence on following total hip arthroplasty (THA) remains controversial. Objective: To investigate the mid-term clinical and radiographic results of THA in the treatment of the pa-tients with non-traumatic ANFH who failed in CD therapy. Methods: Twenty-seven patients (27 hips) with non-traumatic ANFH failing in CD and preparing for THA were selected as CD group and 42 ANFH patients (42 hips) without surgery were selected as control group from January 2013 to December 2015. All of them received the THA in one hip. Harris hip scores and front and lateral X-ray films before and after surgery were used for evaluation. Results: The volume of autolo-gous blood absorption was (246±85) ml in the CD group and (176±47) ml in the control group (t=3.854, P＜0.001).The aver-age follow up time was (46.4±9.6) months (range, 28-65 months) in the CD group and (49.8±9.2) months (range, 27-64 months) in the control group. The average Harris hip score increased from 43.2±11.7 with a range of 18-61 preoperatively to 90.3±5.3 with a range of 82-100 at the latest follow-up (t=-21.564, P＜0.001) in the CD group and increased from 44.4± 11.7 with a range of 18-66 preoperatively to 88.0±5.9 with a range of 78-100 at the latest follow-up (t=-20.465, P＜0.001) in the control group. However, there was no significant difference in postoperative Harris hip score between the two groups (t=0.542, P=0.589). One patient had iatrogenic sciatic nerve injury. No hip needed revision. Conclusions: The clinical and radiographic outcomes of THA in the treatment of patients with non-traumatic ANFH failing in CD of femoral head are sat-isfactory, which are not adversely affected by previous CD therapy although the volume of intraoperative bleeding increas-es, and nerther is the incidence of complication.
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