股骨头缺血性坏死对股骨近端骨组织的影响

背景股骨头缺血坏死可导致患者运动功能障碍,常用的治疗方法是全髋关节置换术,但手术失败原因目前尚不清楚.有作者认为是股骨近端骨组织异常所至,但是缺乏深入研究.目的探讨股骨头缺血坏死患者的股骨近端骨改变.设计以患者为研究对象,非随机化同期对照研究.单位青岛大学医学院附属医院创伤外科.对象1999-09/2003-05青岛大学医学院创伤外科收治的股骨头缺血坏死患者18例,男12例,女6例;平均年龄(50±5)岁.同期骨关节炎患者18例,男10例,女8例;平均年龄(62±3)岁.方法对18例股骨头缺血坏死行全髋关节置换术患者的股骨头和股骨近端松质骨标本进行组织学检查,并用18例髋关节骨关节炎患者作为对照组,所有标本采用双盲方式进行检查.主要观察指标两组患者股骨颈、大转子、小转子、股骨干的坏死评分和坏死阳性率.结果股骨头缺血坏死患者小转子下方4cm处存在广泛的骨坏死.股骨头缺血坏死组和对照组坏死评分总分分别为82分和16分;坏死阳性率分别为63.89%和19.44%,两组之间股骨近端的骨坏死程度相比较差异有非常显著性意义(P＜0.001).结论股骨近端的骨改变可能是股骨头缺血坏死行全髋关节置换早期失败的原因之一.

Ischemic osteonecrosis in the proximal femur tissue of patients with osteonecrosis of femoral head

BACKGROUND: Ischemic osteonecrosis of femoral head can cause dysfunction of the patients and the most frequently advocated treatment for advanced osteonecrosis of femoral head is total hip arthroplasty. But the reason is unknown. A potential cause in patients with osteonecrosis of femoral head is abnormal cancellous bone in the proximal femur which is short of further investigation.OBJECTIVE: To probe into proximal femoral change of patients with ischemic osteonecrosis of the femoral head.DESIGN: A non-randomized concurrent controlled study based on the patients.SETTING: Department of Traumatic Surgery, Affiliated Hospital of Medical College of Qingdao UniversityPARTICIPANTS: This study was done at the Department of Traumatic Surgery, Affiliated Hospital of Medical College of Qingdao University from September 1999 to May 2003. Eighteen patients with osteonecrosis of the femoral head including 12 males and 6 females with the average age of (50 ± 5) years and eighteen patients with osteoarthritis of the hip attended including 10 males and 8 female with the average age of(62 ±3)years were involved in this study.METHODS: Histological examination of the femoral heads and cancellous bone biopsies from four regions of the proximal femur in 18 patients with osteonecrosis of the femoral head following total hip arthroplasty was perforned. Eighteen patients with osteoarthritis were set as control group. All histological specimens were examined in a double-blinded fashion.MAIN OUTCOME MEASURES: The femoral neck, the greater trochanter, the lesser trochanter, the necrosis scoring and necrosis positive rate of shaft of femur of the patients in the two groups.RESULTS: Extensive osteonecrosis was found in the proximal femur up to 4 cm below the lesser trochanter in the group with osteonecrosis. The osteonecrosis scoring was 82 and 16 in the osteonecrosis group and control group respectively and the osteonecrotic positive rate was 63.89% and 19.44% respectively, There was an overall statistically significant difference in the extent of osteonecrosis death in the proximal femur between the two groups ( P ＜ 0. 001 ).CONCLUSION: Bone change of proximal femur might be one of the reasons for the early failure of total hip replacement reported in patients with osteonecrosis of the femoral head.