摘要
目的:评价直接前方入路头颈交界开窗减压植骨术治疗早中期股骨头坏死(osteonecrosis of the femoral head,ONFH)的中期临床疗效。方法:回顾性分析2015年1月至2022年5月符合中日友好医院(China-Japan Friendship Hospital,CJFH)分型的L1、L2型,国际骨循环学会(Association Research Circulation Osseous,ARCO)分期Ⅱ、ⅢA、ⅢB期接受直接前方入路头颈交界开窗减压植骨术且获得3年完整随访的ONFH患者40例(40髋),年龄35~69(49.13±6.14)岁;身体质量指数(body mass index,BMI)为20.02~27.94(23.65±1.69)kg·m^(-2);病程13~36(24.55±4.14)个月。分别于术前及术后3年记录并比较前侧保留角(anterior preserved angle,APA)、外侧保留角(lateral preserved angle,LPA)、联合保留角(combined preserved angle,CPA)的变化情况,并比较髋关节残疾与骨关节炎结果评分(hip disability and osteoarthritis outcome score,HOOS)、Harris髋关节评分(Harris hip score,HHS)。结果:40例患者获得随访,时间36~59(47.18±6.18)个月,术后3年无一例行髋关节置换术。术后3年APA(73.15±19.35)°、LPA(75.35±21.48)°、CPA(136.25±26.78)°,较术前(61.93±20.54)°、(59.46±22.67)°、(116.58±32.47)°均明显改善,差异有统计学意义(P<0.05)。术后3年HOOS、HHS分别为(20.37±1.39)、(89.74±3.28)分,均较术前(12.36±1.58)、(50.27±6.15)分明显改善,差异有统计学意义(P<0.05)。结论:直接前方入路头颈交界开窗减压植骨术能够减轻关节疼痛,改善关节功能,提高X线片保留角,有效避免股骨头塌陷,是治疗CJFH分型L1、L2型及ARCO分期Ⅱ、ⅢA、ⅢB期ONFH的有效手术方法。
Objective To assess the mid-term clinical efficacy of the direct anterior approach for window decompression and bone grafting surgery in the treatment of early to mid-stage osteonecrosis of the femoral head(ONFH).Methods A retrospective analysis was performed on 40 patients(40 hips)diagnosed with osteonecrosis of the femoral head(ONFH),classified as types L1 and L2 according to the China-Japan Friendship Hospital(CJFH)classification system,and at stagesⅡ,ⅢA,andⅢB based on the Association Research Circulation Osseous(ARCO)staging system.All patients underwent head-neck junction fenestration decompression and bone grafting via the direct anterior approach between January 2015 and May 2022,with complete follow-up data available for a minimum of three years.The ages of the patients ranged from 35 to 69 years old,with a mean of(49.13±6.14)years old;their body mass index(BMI)ranged from 20.02 to 27.94 kg·m^(-2),with a mean of(23.65±1.69)kg·m^(-1);the duration of the disease ranged from 13 to 36 months,with a mean of(24.55±4.14)months.Preoperative and 3-year postoperative X-ray parameters were collected,including the anterior preserved angle(APA),lateral preserved angle(LPA),and combined preserved angle(CPA).Additionally,hip joint disability and osteoarthritis outcome scores(HOOS)and Harris hip scores(HHS)were recorded.Results Forty patients were followed up for a period ranging from 36 to 59 months,with a mean duration of(47.18±6.18)months.At 3 years postoperative,none of the patients underwent hip replacement surgery.The APA(73.15±19.35)°,LPA(75.35±21.48)°,and CPA(136.25±26.78)°at the 3-year postoperative significantly improved compared to preoperative measurements(61.93±20.54)°,(59.46±22.67)°,and(116.58±32.47)°,with statistica significance(P<0.05).The HOOS(20.37±1.39)and HHS(89.74±3.28)scores at the 3-year postoperative were significantly improved from preoperative scores(12.36±1.58)and(50.27±6.15),respectively,with statistical significance(P<0.05).Conclusion The direct anterior approach for window decompression and bone grafting surgery can relieve joint pain,improve joint function,and enhance X-ray preserved angles,effectively preventing femoral head collapse,making it an effective surgical method for treating ONFH classified as L1,L2 according to CJFH and stagesⅡ,ⅢA,ⅢB according to ARCO.
作者
陈彦百
秦伟凯
闫奇
孙奥林
张洪美
CHEN Yan-bai;QIN Wei-kai;YAN Qi;SUN Ao-lin;ZHANG Hong-mei(The First Department of Osteoarthropathy,Wangjing Hospital,China Academy of Chinese Medical Sciences,Beijing 100102,China)
出处
《中国骨伤》
2025年第7期680-686,共7页
China Journal of Orthopaedics and Traumatology
基金
中国中医科学院望京医院自主选题项目(编号:WJYY-ZZXT-2025-23)。
关键词
股骨头坏死
直接前方入路
头颈交界开窗减压
植骨
Osteonecrosis of the femoral head
Direct anterior approach
Fenestration and decompression at the femoral head-neck junction
Bone grafting
