高位股骨头颈开窗植骨支撑术治疗早期股骨头坏死

摘要

Objective To evaluate the effect of the bone grafting through a femoral neck window at high location in the treatment of osteonecrosis of the femoral head (ONFH).Methods From January 2009 to December 2011,26 patient (35 hips,11 males and 15 females) with ONFH were treated with bone grafting through fenestration at high level of femoral head and neck,and then they were followed up for average of 24 months,with the mean age of 37.4 years (range,18-65 years).According to the Association Research Circulation Osseous (ARCO) classification,there were 6 hips,13 hips,and 16 hips on stage Ⅱ A,Ⅱ B,Ⅱ C respectively.The patients were treated with the bone grafting through fenestration at high level of femoral head and neck.The fenestrated area was located in the junction of the femoral head and neck,involved part of the femoral head cartilage.The effectiveness was evaluated according to Harris Scoring system and excellent and good rate.Results All the cases were followed up in outpatient department for 24 months,and 1 was lost to follow-up.After the treatments with the bone grafting through fenestration at high level of femoral head and neck,no infections,nerve damage and other complications were found in all patients.Harris score of overall patients before and after treatment increased from 73.42±7.30 points to 85.85±11.63 points; Harris score of patients with ARCO Ⅱ A before and after treatment increased from 74.50± 1.76 points to 91.17± 1.60 points; Harris score of patients with ARCO Ⅱ B before and after treatment the average score increased from 73.92±8.03 points to 86.00±10.49 points.Harris score of patients with ARCO Ⅱ C before and after treatment increased from 72.60±8.29 points to 83.60± 14.29 points.The overall excellent and good rate before and after treatment in patients with preoperative 36.4％ up to 84.9％.The rate of patients with ARCO Ⅱ A increased from 33.3％ to 100.0％ after treatment.The rate of patients with ARCO Ⅱ B increased from 41.7％ to 91.7％ after treatment.The rate of patients with ARCO Ⅱ C increased from 33.3％ to 73.3％ after treatment.The difference in Harris scores and excellent and good rate between untreatment and treatment were statistical significant.Conclusion Bone grafting through a femoral neck window at high location in the treatment of osteonecrosis of the femoral head were proved to have good short-terms effects which can promote the restoration of osteonecrosis and improve the clinical symptoms of hip.%目的 探讨高位股骨头颈开窗植骨支撑术治疗早期股骨头坏死的近期疗效.方法 2009年1月至2011年12月采用高位股骨头颈开窗植骨支撑术治疗早期股骨头坏死26例(35髋),男11例,女15例;年龄18～65岁,平均37.4岁.股骨头坏死ARCO分期ⅡA期6髋、ⅡB期13髋、ⅡC期16髋.采用高位股骨头颈开窗植骨支撑术治疗,开窗位置位于股骨头颈交界处靠近股骨头方向,累及部分股骨头软骨.术后第1个月及以后每3个月定期门诊随访,依据Harris髋关节评分及优良率评估疗效.结果 25例33髋获得随访,失访1例2髋.随访时间18～32个月,平均24个月.随访期间未出现感染及神经损伤等并发症.总体Harris髋关节评分由术前(73.42±7.30)分提高至末次随访的(85.85±11.63)分;其中ⅡA期患者由(74.50±1.76)分提高至(91.17±1.60)分;ⅡB期患者由(73.92±8.03)分提高至(86.00±10.49)分;ⅡC期患者由(72.60±8.29)分提高至(83.60±14.29)分.总体优良率由术前36.4％提高至84.9％;ⅡA期患者由33.3％提高至100.0％;ⅡB期患者由41.7％提高至91.7％;ⅡC期患者由33.3％提高至73.3％.手术前后Harris髋关节评分及优良率的差异均有统计学意义.结论 高位股骨头颈开窗植骨支撑术治疗早期股骨头坏死近期疗效好,能促进坏死修复,改善髋关节症状.