【摘要】 背景:股骨头坏死是骨科难治性疾病,尤其激素性骨坏死,发病率高,易进展塌陷,增加对激素性股骨头坏死的认识将有助于早期识别、干预,选择合理的治疗措施,以改善预后。目的:探讨经头颈部开窗减压植骨治疗中日友好医院(CJFH)分型L1型患者中不同类型激素性股骨头坏死的临床效果及其影响因素。方法:临床观察分析采用经头颈部开窗减压治疗的82例(106髋)CJFH分型L1型激素性股骨头坏死患者的临床资料。临床效果评价由两部分组成,包括髋关节Harris评分系统、双髋关节正位及蛙式位片观察,临床失败定义为Harris评分为差(<70分),和/或股骨头进行性塌陷,伴随临床表现加重;单、多因素分析性别、年龄、病因、术前ARCO分期、发病时间及术前Harris评分对预后的影响。结果与结论:①全部患者均获得随访,随访时间3-51个月;②根据末次随访Harris评分结果,优4髋,良33髋,可50髋,差19髋,优良率为34.9%(37/106);末次随访Harris评分(83.1±14.3)分显著高于与术前(64.4±9.8)分,差异有显著性意义(P <0.05);③影像学观察股骨头塌陷进展15髋,单纯影像进展6髋;④临床失败26髋,单、多因素分析显示,术前Harris评分<70分是影响股骨头坏死预后的独立危险因素(P <0.05),不同类型激素性股骨头坏死组间差异无显著性意义;⑤提示经头颈部开窗减压治疗L1型激素性股骨头坏死可获得满意的中短期临床效果,但术前Harris评分<70分是影响保髋预后的危险因素。更多还原

【Abstract】 BACKGROUND: Osteonecrosis of the femoral head is a refractory disease in department of orthopedics. Especially with steroid-induced osteonecrosis, incidence rate is high, and it is easy to collapse. Increasing knowledge of hormone necrosis will help early identification and intervention, and choose reasonable treatment measures to improve prognosis. OBJECTIVE: To investigate the clinical effects and influencing factors in the treatment of different kinds of steroid-induced osteonecrosis of the femoral head of CJFH type L1 patients through femoral head and neck junction decompression by fenestration and bone grafting.METHODS: Clinical data of 82 patients(106 hips) with CJFH type L1 steroid-induced osteonecrosis of the femoral head, who underwent femoral head and neck junction decompression by fenestration in China-Japan Friendship Hospital, were analyzed. The clinical effect evaluation consisted of two parts: Harris hip score system, the observation of bilateral hip joint and frog position film. Clinical endpoint events were marked by poor Harris hip score < 70, progressive collapse of the femoral head with/without obvious clinical manifestation. Univariate and multivariate analyses were used to analyze the influence of gender, age, etiology, preoperative ARCO stage, onset time and preoperative Harris score on prognosis. RESULTS AND CONCLUSION:(1) All patients were followed up, and the mean duration was 3-51 months.(2) Based on Harris hip score of the last follow-up, the results were excellent in 4 hips, good in 33 hips, fair in 50 hips, and poor in 19 hips. The excellent and good rate was 34.9%(37/106). Harris hip score was higher in the final follow-up(83.1±14.3) than that before surgery(64.4±9.8)(P < 0.05).(3) Imaging results demonstrated that there were 15 hips with progressive collapse of the femoral head, and 6 hips without obvious clinical symptoms.(4) The 26 hips were classified as clinical failed. Univariate and multivariate analyses showed that preoperative Harris hip score < 70 was the independent risk factor for prognosis of osteonecrosis of the femoral head(P < 0.05). There was no significant difference among different types of steroid-induced osteonecrosis of the femoral head.(5) The method through femoral head and neck junction decompression by fenestration and bone grafting has a good effectiveness in patients with type L1 steroid-induced osteonecrosis of the femoral head in short and medium terms, but preoperative Harris hip score < 70 is a risk factor affecting the prognosis of hip preservation.更多还原