关节镜下微创综合治疗早期股骨头缺血性坏死

目的通过与单纯闭合髓芯减压术比较,探讨关节镜下髓芯减压结合自体松质骨复合BMP植骨治疗早期股骨头缺血性坏死的疗效。方法回顾分析2007年1月-2010年3月收治的28例33髋早期股骨头缺血性坏死患者临床资料,其中采用关节镜下髓芯减压结合自体松质骨复合BMP植骨治疗18例21髋(试验组);单纯闭合髓芯减压术治疗10例12髋(对照组)。两组患者性别、年龄、病程、病因及骨坏死分期等一般资料比较,差异均无统计学意义(P>0.05),具有可比性。结果术后两组切口均Ⅰ期愈合,无感染等并发症发生。两组患者均获随访,随访时间1～3年,平均2.5年。术后患者疼痛均明显缓解,髋关节功能改善。末次随访时,试验组Harris评分为(85.67±4.78)分,对照组为(81.33±7.03)分,差异有统计学意义(t=—2.10,P=0.04)。试验组FicatⅡ期1髋,对照组FicatⅠ期2髋、Ⅱ期2髋发生股骨头塌陷,行人工髋关节置换术;两组手术总有效率分别为95.24%及66.67%,比较差异有统计学意义(χ2=4.85,P=0.03)。结论与单纯闭合髓芯减压术比较,关节镜下髓芯减压结合自体松质骨复合BMP植骨治疗早期股骨头缺血性坏死具有定位准确、清除坏死骨彻底,能有效缓解疼痛,改善关节功能,延缓股骨头坏死进程的优点。

COMPREHENSIVE MANAGEMENT OF EARLY STAGE AVASCULAR NECROSIS OF FEMORAL HEAD BY ARTHROSCOPIC MINIMALLY INVASIVE SURGERY

Objective To evaluate the effectiveness of comprehensive management for early stage avascularnecrosis of the femoral head(ANFH) by arthroscopic minimally invasive surgery by comparing with closed coredecompression.Methods Between January 2007 and March 2010,28 patients(33 hips) with early stage ANFH weretreated with the procedure of arthroscopic core decompression combined with autogenous cancellous bone graft and bonemorphogenetic protein(BMP) in 18 cases(21 hips,trial group) or with simple closed core decompression in 10 cases(12 hips,control group).No significant diff erence was found in gender,age,disease duration,etiology,and staging between 2 groups(P >0.05).Results Incision healed primarily in all patients,and no infection occurred.All patients were followed up 2.5 years onaverage(range,1-3 years).Pain relief and improvement of hip function were obtained in all patients at 6 months after operation.Atlast follow-up,the Harris scores were 85.67 ± 4.78 in trial group and 81.33 ± 7.03 in control group,showing significant diff erencebetween 2 groups(t= —2.10,P=0.04).Collapse of the femoral head was observed in 1 hip(Ficat stage II) of trial group,and in 2hips(Ficat stage I) and 2 hips(Ficat stage II) of control group;hip arthroplasty was performed.Significant diff erence in totaleffective rate was found between trial group and control group(95.24% vs.66.67%;χ2=4.85,P=0.03).Conclusion Arthroscopiccore decompression combined with autogenous cancellous bone graft and BMP is more effective than traditional closed coredecompression for treatment of early stage ANFH in pain relief,improvement of hip function,slowing-down the process of femoralhead necrosis,reduction of hip joint replacement by accurate location of the lesions,and thoroughly debridement of necrotic bone.