打压支撑植骨术治疗早期酒精性股骨头坏死的临床研究

目的 探讨打压支撑植骨术治疗早期酒精性股骨头坏死的近期疗效.方法 2004年1月至2007年12月采用打压支撑植骨术治疗163例男性酒精性股骨头坏死患者;获随访93例(123髋),随访时间18-52个月,平均36.4个月;年龄25-65岁,平均(41.0±8.5)岁;按ARCO分期:Ⅱ、ⅢA、ⅢB-C期分别为33、63、27髋;术前正位分型C1、C2型分别为24、99髋;术前蛙位分型C1、C2型分别为32、91髋;Harris评分平均为(80.6±6.4)分.随访时以ARCO分期、Harris评分及股骨头生存率作为疗效评价指标.结果 术后所有病例均无感染、神经损伤等并发症;术后ARCO分期:Ⅲ、Ⅳ期分别为36、87髋;术后Harris评分平均为(91.0±7.3)分;以髋关节置换为终点事件,末次随访时股骨头生存率为82.2%.25-35岁、36-45岁与46岁以上患者的股骨头生存率分别为100%、87.1%和63.3%.25-35岁、36-45岁年龄段的股骨头生存率高于46岁以上年龄段(P<0.05);而25-35岁与36-45岁年龄段之间的股骨头生存率差异无统计学意义.术前蛙位C1、C2的生存率分别为:100%、77.6%.术前蛙位分型为C1型的股骨头生存率高于蛙位分型为C2型的股骨头生存率.结论 打压支撑植骨术治疗早期酒精性股骨头坏死的近期疗效良好,治疗效果与患者年龄及蛙位分型有关,主要适用于年龄<45岁,蛙位分型坏死范围未超过髋臼外侧缘的股骨头坏死患者.

Clinical study of impacting bone graft in treating early alcohol-induced osteonecrosis of the femoral head

Objective To analyze the short-term outcome of impacting bone graft in treating early stage alcohol-induced osteonecrosis of the femoral head (AIONFH).Methods From January 2004 to Decem-ber 2007,163 adult male patients with AIONFH were treated with impacting bone graft,93 patients (123 hips) were followed up for average of 36.4 months (18-52 months),with the mean age of (41.0±8.5) years(25-65 years).According to the Association Research Circulation Osteous (ARCO) classification,33,63 and 27 hips were in stage Ⅱ,ⅢA and ⅢB-C;in the light of the preoperative anteroposterior radiographs typing,C1 an C2 were 24 and 99 hips;and based on the preoperative lateral radiographs typing,C1 and C2 were 32 and 91 hips.Harris score was average 80.6±6.4 preoperatively.And evaluating indicators during follow-up duration included ARCO classification.Harris score and the femoral head survival rate (FHSR).Results No infections,nerve damage and other complications were found in all patients.Postoperatively,ARCO classing:stage Ⅲ and Ⅳ were 36 and 87 hips;Harris score was average 91.0±7.3;as total hip arthroplasty (THA) for the endpoint,the FHSR was 82.2%.In 25-35,36-45 and over 46 years old groups,the FHSR were 100%、87.1% and 63.3%.respectively.And the FHSR of 25-35 and 36.45 group were higher than that of over 46 years old group(P<0.05);no significant difference was observed between the 25-35 and 36-45 years old group.The FHSR of preoperative lateral radiographs typing C1 and C2 was 100% and 77.6%.Conclusion The short-term outcome of impacting bone graft in treating early stage AIONFH is good,and is relative to the age and the lateral radiographs typing.Patients with early stage AIONFH,younger than 45 years,necrotic region not extended out side of the lateral acetabular rim can have better outcome.