关节镜辅助下髓芯减压联合钽棒置入治疗早期股骨头坏死的研究(1)
摘 要：目的 探讨关节镜辅助下髓芯减压联合钽棒植入对成人早期股骨头缺血坏死治疗的近期疗效。方法 选择2016年1月～2017年2月我院收治的早期股骨头坏死患者31例，髋国际骨循环研究协会分期，Ⅰ期13例、Ⅱ期18例，采用关节镜辅助下股骨头髓芯减压联合钽棒植入进行治疗，评估患者手术前后进行Harris评分及影像学表现。结果 28例患者获得随访，平均随访(20.50±2.12)个月，末次随访影像学检查5例发生了股骨头塌陷或关节间隙的变窄，余病例未见病变进展。髋关节Harris评分由术前的(52.60±5.50)分提高到术后的(84.40±9.90)分，差异具有统计学意义(P<0.05)。结论 关节镜辅助下股骨头髓芯减压联合钽棒植入治疗成人早期股骨坏死，可有效改善患者髋关节功能，近期疗效满意。
关键词：关节镜；髓芯减压；股骨头坏死；钽棒
中图分类号：R687.3 文献标识码：B DOI：10.3969/j.issn.1006-1959.2018.20.059
, 百拇医药
文章编号：1006-1959(2018)20-0186-03
Abstract：Objective To investigate the short-term effect of arthroscopic core decompression combined with tantalum rod implantation in the treatment of early avascular necrosis of femoral head in adults.Methods 31 patients with early femoral head necrosis admitted to our hospital from January 2016 to February 2017 were enrolled.The hip international bone circulation research association was staged， 13 cases in stage I and 18 cases in stage II.The femoral head core decompression combined with tantalum rod implantation was used to evaluate the Harris score and imaging findings before and after operation.Results 28 patients were followed up for a mean follow-up(20.50±2.12)months.In the last follow-up imaging examination，5 patients developed a femoral head collapse or a narrowing of the joint space.No lesion progression was observed in the remaining cases.The hip Harris score increased from preoperative(52.60±5.50)points to postoperative(84.40±9.90)points，the difference was statistically significant(P<0.05).Conclusion Arthroscopic core decompression of femoral head combined with tantalum rod implantation in the treatment of early femoral necrosis in adults can effectively improve the hip function of patients with satisfactory short-term results.
, 百拇医药
Key words：Arthroscopy；Core decompression；Femoral head necrosis；Tantalum rod
股骨頭缺血性坏死(avascular necrosis of femoral head，ANFH)在临床上发病率较高，常见的致病因素有长期酗酒、类固醇药物应用、创伤等。病变早期主要的病理改变是股骨头局部的血运障碍，进一步发展可导致股骨头塌陷[1]，影响患者患者的关节功能和生活质量。ANFH早期的治疗在于延缓或阻止病变的发展，避免股骨头塌陷。我科自2016年1月～2017年2月对31例早期股骨头坏死患者采用关节镜辅助下行股骨头髓芯减压植骨联合多孔钽棒植入治疗，28例患者获得随访，报道如下。
1 资料与方法
1.1一般资料 选择2016年1月～2017年2月遵义医科大学附属医院骨科收治的31例早期股骨头缺血坏死患者，所有患者均采用关节镜辅助下髓芯减压联合多孔钽棒植入进行治疗。患者年龄29～51岁，平均年龄(37.60±1.01)岁。髋国际骨循环研究协会(Association Research Circulation Osseous，ARCO)分期：ⅠB期5例，ⅠC期8例，ⅡA期9例，ⅡB期6例，ⅡC期3例。患者主要症状为髋关节局部疼痛，术前行Harris评分及髋关节影像学检查(图1)，术前Harris评分为(52.60±5.50)分。
1.2手术方法 麻醉生效后取平卧位，C臂透视下克氏针定位股骨头坏死区(图2)，使用10 mm空心钻沿克氏针钻孔至股骨头坏死区域减压。置入关节镜探查见正常骨壁渗血良好，死骨则呈现棕褐色、硬化骨呈苍白色、无血运，使用偏心铰刀匙刮除死骨和硬化骨，反复进入镜头监视直至病灶刮除彻底骨壁渗血良好(图3)。大量生理盐水冲洗后同种异体骨打压充分植骨，最后植入多孔钽棒再次C臂透视(图4)。, 百拇医药(仲鹤鹤 杨晋 刘毅)
关键词：关节镜；髓芯减压；股骨头坏死；钽棒
中图分类号：R687.3 文献标识码：B DOI：10.3969/j.issn.1006-1959.2018.20.059
, 百拇医药
文章编号：1006-1959(2018)20-0186-03
Abstract：Objective To investigate the short-term effect of arthroscopic core decompression combined with tantalum rod implantation in the treatment of early avascular necrosis of femoral head in adults.Methods 31 patients with early femoral head necrosis admitted to our hospital from January 2016 to February 2017 were enrolled.The hip international bone circulation research association was staged， 13 cases in stage I and 18 cases in stage II.The femoral head core decompression combined with tantalum rod implantation was used to evaluate the Harris score and imaging findings before and after operation.Results 28 patients were followed up for a mean follow-up(20.50±2.12)months.In the last follow-up imaging examination，5 patients developed a femoral head collapse or a narrowing of the joint space.No lesion progression was observed in the remaining cases.The hip Harris score increased from preoperative(52.60±5.50)points to postoperative(84.40±9.90)points，the difference was statistically significant(P<0.05).Conclusion Arthroscopic core decompression of femoral head combined with tantalum rod implantation in the treatment of early femoral necrosis in adults can effectively improve the hip function of patients with satisfactory short-term results.
, 百拇医药
Key words：Arthroscopy；Core decompression；Femoral head necrosis；Tantalum rod
股骨頭缺血性坏死(avascular necrosis of femoral head，ANFH)在临床上发病率较高，常见的致病因素有长期酗酒、类固醇药物应用、创伤等。病变早期主要的病理改变是股骨头局部的血运障碍，进一步发展可导致股骨头塌陷[1]，影响患者患者的关节功能和生活质量。ANFH早期的治疗在于延缓或阻止病变的发展，避免股骨头塌陷。我科自2016年1月～2017年2月对31例早期股骨头坏死患者采用关节镜辅助下行股骨头髓芯减压植骨联合多孔钽棒植入治疗，28例患者获得随访，报道如下。
1 资料与方法
1.1一般资料 选择2016年1月～2017年2月遵义医科大学附属医院骨科收治的31例早期股骨头缺血坏死患者，所有患者均采用关节镜辅助下髓芯减压联合多孔钽棒植入进行治疗。患者年龄29～51岁，平均年龄(37.60±1.01)岁。髋国际骨循环研究协会(Association Research Circulation Osseous，ARCO)分期：ⅠB期5例，ⅠC期8例，ⅡA期9例，ⅡB期6例，ⅡC期3例。患者主要症状为髋关节局部疼痛，术前行Harris评分及髋关节影像学检查(图1)，术前Harris评分为(52.60±5.50)分。
1.2手术方法 麻醉生效后取平卧位，C臂透视下克氏针定位股骨头坏死区(图2)，使用10 mm空心钻沿克氏针钻孔至股骨头坏死区域减压。置入关节镜探查见正常骨壁渗血良好，死骨则呈现棕褐色、硬化骨呈苍白色、无血运，使用偏心铰刀匙刮除死骨和硬化骨，反复进入镜头监视直至病灶刮除彻底骨壁渗血良好(图3)。大量生理盐水冲洗后同种异体骨打压充分植骨，最后植入多孔钽棒再次C臂透视(图4)。, 百拇医药(仲鹤鹤 杨晋 刘毅)