扇形减压异体腓骨支撑内固定治疗早期成人股骨头坏死

背景：传统的髓芯减压异体腓骨支撑可以减少股骨头内部的应力负荷，改善股骨头的力学性能。但不能为股骨头内部坏死后5个病理分区的稳定性提供支持。 目的：以传统异体腓骨植骨做对照，观察扇形减压异体腓骨支撑内固定对早期成人股骨头坏死的修复效果。 方法：纳入40例早期股骨头坏死患者，按随机数字表法分为2组，治疗组给予扇形减压、异体腓骨支撑内固定治疗；对照组给予传统减压异体腓骨植骨治疗，对比2组患者的治疗效果。治疗后复查双髋正蛙位片、髋关节功能Harris评分、X射线片ARCO分期评估塌陷程度和坏死修复程度。 结果与结论：末次随访时，治疗组患者Harris评分显著高于对照组(P < 0.05)，扇形减压异体腓骨支撑内固定组的修复治疗效果优于传统异体腓骨植骨组。在坏死修复方面，治疗组18髋修复良好(72%)，7髋修复迟缓或失败(28%)；对照组9髋修复良好(60%)，6髋修复迟缓或失败(40%)。提示与传统异体腓骨植骨治疗相比，扇形减压异体腓骨支撑内固定可使减压更彻底，异体腓骨在股骨头的稳定性增加，使支撑更加可靠。

Fan-shaped decompression and allograft fibula supporting internal fixation for treatment of early femoral head necrosis in adults

BACKGROUND:Traditional core decompression and allograft fibula supporting can reduce the stress load within femoral head and improve mechanical properties of femoral head. However, it cannot provide supports for maintaining the stability of five pathological areas following femoral head necrosis. OBJECTIVE:To observe the clinical effect of fan-shaped decompression and allograft fibula supporting internal fixation in treatment of early femoral head necrosis in adults, taking allograft fibula grants as the control. METHODS:Forty patients with early femoral head necrosis were randomly divided into treatment group and control group, receiving fan-shaped decompression plus allograft fibula supporting internal fixation and traditional decompression plus allograft fibula grafting, respectively. The therapeutic effects in two groups were observed and compared. After treatment, patients were detected by bilateral hip anteroposterior films, Harris scoring and X-ray ARCO staging to evaluate the collapse severity and restoration of necrosis. RESULTS AND CONCLUSION:At the last follow-up, Harris scores in the treatment group were significantly higher and the repairing effect was better than control group (P < 0.05). In treatment group, 18 hips restored well (72%) and 7 hips delayed or failed to restore (28%); in control group, 9 hips restored well (60%) and 6 hips delayed or failed to restore (40%). Our findings indicate that, fan-shaped decompression plus allograft fibula supporting internal fixation yields a more complete decompression, a higher stability of femoral head and a more reliable supporting, compared with traditional decompression plus allograft fibula grafting.