不同粗细通道髓芯减压治疗早期股骨头坏死的疗效比较

目的：比较8mm与3mm直径通道髓芯减压治疗早期股骨头坏死的疗效。方法选择髓芯减压的早期股骨头坏死患者83例，共91髋，其中48髋行8mm粗通道髓芯减压（粗通道组），43髋行3mm细通道髓芯减压（细通道组），术后2周开始口服利塞膦酸钠（5mg/d，服用1年）。随访比较两组患者术前、术后24个月Har-ris评分和MRI坏死指数，并比较同组不同ARCO分期患者疗效。结果两组患者术前Harris评分均＜70分，粗通道组和细通道组术后2个月治疗有效率（Harris评分≥70分）分别为75.00%和81.40%，Harris评分和MRI坏死指数均显著优于术前,差异有统计学意义（P<0.05），但两组术后24个月疗效对比无明显统计学差异（P>0.05），其中粗通道组2髋术后发生股骨颈骨折，积极处理后恢复良好。两组患者随着ARCO分期的增加，治疗有效的百分率逐渐下降。结论8mm粗通道及3mm细通道髓芯减压联合口服利塞膦酸钠均是治疗早期股骨头坏死的有效方法，两组术后24个月疗效无明显统计学差异，但3mm细通道术后并发症更少。并且随着ARCO分期越高，疗效越差。

Curative Effect Comparison between Marrow Core Depressions with Passages of Different Diameters in the Treatment of Early Osteonecrosis of Femoral Head

Objective To compare the effects between marrow core depressions with the passage diameter of 8mm and that of 3mm on early osteonectosis of femoral head (ONFH). Methods 83 cases with early ONFH (in total 91 hips) were selected;marrow core de-pression with the passage diameter of 8mm was made to 48 hips (thick passage group) while that of 3mm was made to 43 hips (thin pas-sage group);all the cases was given oral administration of risedronate sodium 2 weeks after the depression (5mg a day) and the cause lasted for 1 year;follow-up was made and the Harris scores and the index of necrosis on MRI films of the cases in the 2 group before op-eration and 24 months after operation were compared;the curative effects of the cases in the same group but with different ARCO stages were compared. Results The Harris scores of the cases in the 2 groups before operation were lower than 70 and 2 months after opera-tion, the curative effect (Harris scores≥70) in thick passage group was 75.00%while that in thin passage group was 81.40%, and the Harris scores and the index of necrosis on MRI films of the cases in both group were superior to those before operation and the differ-ence was of statistical significance (P<0.05);24 months after operation, the curative effect comparison between the 2 group was of no statistical significance (P>0.05), 2 hips occurred femoral neck fracture(FFNF) in thick passage group and recovered well after effective treatment;for all the cases, with the ARCO stage upgrading, the percentage of curative effect was getting lower. Conclusions Marrow core decompression with the passage diameter of 8mm or of 3mm plus oral administration of risedronate sodium is effective on early ONFH; though the curative effects of the 2 groups 24 months after operation were of no statistical difference, less complications oc-curred in thin group;with the ARCO stage upgrading, the curative effect is getting poorer.