多孔髓芯减压并关节清理治疗早期股骨头缺血性坏死

目的:探讨多孔髓芯减压并关节清理治疗早期股骨头缺血性坏死的疗效。方法:自1999年3月~2003年9月应用股骨头髓芯减压并髋关节镜清理术治疗股骨头缺血性坏死41例(46髋)。Ficat分期0期3髋,I期25髋,II期16髋,III期2髋。行患髋关节清理术,多孔道髓芯减压术。Harris评分术前平均47分,术后平均82分。按术后≥80分定义为临床成功,术后分期稳定定义为影像学成功。结果:临床成功率为86.9%,影像学成功率为82.6%。结论:髓芯减压结合关节镜关节清理术治疗股骨头坏死可有效进行骨内减压,改善关节内环境,从而有效减轻疼痛、预防股骨头塌陷,延迟患者需全髋关节置换的时间。髋关节镜微创技术的应用为股骨头坏死的诊断和治疗开辟了一新的方法。该方法适用于早期(0期、I期、II期)病变。

Clinical evaluation of core decompression of femoral head assisted with arthroscopy debridement for avascular necrosis of femoral head

Objective:To explore the value of multi-hole decompression of femoral head assisted with arthroscopy debridement for avascular necrosis. Methods: Forty-one cases(forty-six hips) had been treated by multi-hole decompression assisted with arthroscopy debridement from Mar, 1999 to Sep, 2003. Among them, 44 hips belonged to Ficat 0-II stage, 3 hips belonged to Ficat III stage. Core decompression of femoral head was carried out by several small diameter holes drilled by K-pin directed by fluoroscopy and arthroscopy and the hip joint was examined and debrided by hip arthroscopy.Results:According to Harris scores, average preoperative and postoperative score was 47 points and 82 points differently, postoperative Harris hip score improved significantly, the clinical successful rate was 86.9%,radiological successful1 rate was 82.6% in relation to the stage of necrosis according to the classification system of Ficat and Alert.Conclusion:This method can decrease intraosseous hypertension and improve the intraarticular environment efficiently, and can prevent the femoral head from collapsing earlier, delay the need for total hip replacement in yong patients with ischaemic necrosis. Hip arthroscopy offers a direct, minimally invasive technique to improve overall diagnostic accuracy and serves as a direct means of treatment or adjunct to application of more traditional techniques in avascular necrosis management.This method can be applied to avascular necrosis at early stage(stage 0, I, II).