基于中日友好医院分型的股骨头坏死阶梯化保髋治疗经验总结

目的总结基于中日友好医院分型(CJFH分型)的股骨头坏死阶梯化保髋治疗经验,以供临床参考。方法广泛查阅相关文献,并结合本研究小组股骨头坏死保髋治疗28年临床经验,总结基于CJFH分型的股骨头坏死阶梯化保髋治疗方案。结果 CJFH分型将股骨头坏死分为M型、C型、L型,其中L型又分为L1、L2、L3亚型,本研究小组基于该分型标准制定了阶梯化保髋治疗方案。其中,M型一般坏死范围小、坏死部位在内侧非负重区,首选保守治疗。C型一般坏死范围小、坏死部位在外侧负重区,宜用微创死骨清除打压植骨异体腓骨棒支撑术。L型中,L1型髋关节外展位X线片显示正常骨范围未超过1/3者,优先考虑外科脱位头颈开窗死骨清理打压植骨术;正常骨范围超过1/3者,优先考虑经转子间弧形内翻截骨术;L2型可选择外科脱位股骨颈基底部旋转截骨术;L3型一般选择人工全髋关节置换术。结论基于CJFH分型的股骨头坏死阶梯化保髋治疗方案已取得一定疗效,远期效果有待进一步观察。

Hip preservation experience of avascular necrosis of femoral head according to China-Japan Friendship Hospital classification

Objective To sum up staging treatment experiences of hip preservation for avascular necrosis of the femoral head(ANFH) according to China-Japan Friendship Hospital Classification(CJFH Classification). Methods The literature about hip preservation of ANFH was extensively reviewed, and a staging treatment method for ANFH was set up base on CJFH Classification and the 28 years of clinical experience in this research group. Results According to CJFH Classification, the ANFH can be rated as types M, C, and L. And the type L is rated as L1, L2, and L3 subtypes. The staging treatment method for ANFH based on CJFH Classification is set up. Conservative treatment was selected for CJFH-M patients because the necrotic area is small and in the medial non-weight-bearing area. Minimally invasive sequestrum clearance, impacting bone graft, and supporting allogenic fibular graft is selected for CJFH-C patients because the necrotic area is also small and in the lateral non-weight-bearing area. If patients are in CJFH-L1, normal bone area is less than 1/3 on hip abduction radiograph, the sequestrum clearance and impacting bone graft via surgical hip dislocation approach can be selected. If patients are in CJFH-L1, normal bone area is more than 1/3 on hip abduction radiograph, the transtrochanteric curved varus osteotomy can be selected. The rotational osteotomy on the base of femoral neck via surgical hip dislocation approach is for CJFH-L2 patients. Total hip arthroplasty via direct anterior approach is for CJFHL3 patients. Conclusion The staging treatment method for ANFH according to CJFH Classification has good short-term effectiveness. But the long-term effectiveness needs further follow-up.