| 梁大伟,张蕾蕾,裴佳,等.比较髋关节外科脱位与慕尼黑骨外科入路打压植骨治疗塌陷前期股骨头坏死的临床疗效.骨科,2021,12(1): 45-50. |
| 比较髋关节外科脱位与慕尼黑骨外科入路打压植骨治疗塌陷前期股骨头坏死的临床疗效 |
| Comparison of clinical effectiveness of surgical hip dislocation vs. Orthopadische Chirurgie München approach with suppression of bone grafting in the treatment of pre-collapse osteonecrosis of the femoral head |
| 投稿时间：2020-04-06 |
| DOI：10.3969/j.issn.1674-8573.2021.01.009 |
| 中文关键词: 股骨头坏死 植骨 髋关节外科脱位 慕尼黑骨外科入路 |
| 英文关键词: Osteonecrosis of the femoral head Bone transplantation Surgical hip dislocation Orthopadische Chirurgie München approach |
| 基金项目:洛阳市科技计划医疗卫生项目（1603004A-8），河南省中医药学研究专项课题（20-21ZY2085） |
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| 中文摘要: |
| 目的 分析比较髋关节外科脱位（surgical hip dislocation，SHD）与慕尼黑骨外科（Orthopadische Chirurgie München，OCM）入路打压植骨治疗塌陷前期股骨头坏死（osteonecrosis of the femoral head，ONFH）的临床效果。方法 回顾性分析我院2015年3月至2017年8月采用死骨清除打压植骨术治疗的65例（65髋）ONFH病人的临床资料，其中男56例，女9例，年龄为（38.20±8.30）岁。按手术入路不同分为SHD组（28例）和OCM组（37例）。比较两组手术时间、术中出血量、术后并发症发生率；采用髋关节Harris评分、疼痛视觉模拟量表（visual analogue scale，VAS）评分评价髋关节功能及疼痛度。结果 OCM组手术时间、术中出血量、术后并发症发生率均优于SHD组，差异均有统计学意义（P均＜0.05）。末次随访时，OCM组Harris评分、VAS评分分别为（87.57±1.29）分、（2.14±0.35）分，SHD组为（87.07±1.69）分、（2.00±0.54）分，两组Harris评分、VAS评分均优于术前，差异均有统计学意义（P均＜0.05）；两组间Harris评分及VAS评分的差异均无统计学意义（P均＞0.05）。末次随访时OCM组6髋与SHD组3髋保髋失败，股骨头生存率分别为83.78%、89.28%，两组股骨头生存曲线分布的差异无统计学意义（P＞0.05）。结论 SHD入路与OCM入路打压植骨术均可用于治疗塌陷前期ONFH，可有效改善临床症状和影像学表现。ONFH病灶多位于前侧，因此OCM入路较SHD入路更为常用，完全肌间隙入路，创伤性更小，安全性更高；SHD入路视野完全，适合于偏内、偏后的病灶，但学习曲线更长。 |
| 英文摘要: |
| Objective To analyze and compare the clinical effect of surgical hip dislocation (SHD) vs. Orthopadische Chirurgie München (OCM) with suppression of bone grafting in the treatment of osteonecrosis of the femoral head (ONFH) at pre-collapse stage. Methods The clinical data of 65 patients (65 hips) with ONFH treated by debridement and bone grafting in our hospital from March 2015 to August 2017 were retrospectively analyzed. There were 56 males and 9 females with an average age of (38.20±8.30) years. The patients were divided into SHD group (28 cases) and OCM group (37 cases) according to the different surgical approaches. The operation time, intraoperative blood loss and incidence of postoperative complications were compared between the two groups. Harris hip score and visual analogue scale (VAS) were used to evaluate hip joint function and pain of patients. Results The operative time was shorter, intraoperative blood loss was less and postoperative complication rate was lower in OCM group than those in SHD group, with statistically significant difference (all P＜0.05). At the last follow-up, Harris score and VAS score in OCM group were 87.57±1.29 and 2.14±0.35, and those in SHD group were 87.07±1.69 and 2.00±0.54, respectively. The Harris score and VAS score in the two groups were better than those before operation, and the differences were statistically significant (all P＜0.05). There was no significant difference in Harris hip score and VAS score between the two groups (all P＞0.05). At the last follow-up, 6 hips in the OCM group and 3 hips in the SHD group failed to preserve hips. The femoral head survival rates were 83.78% and 89.28%, respectively. There was no significant difference in femoral head survival curve distribution between the two groups (P＞0.05). Conclusion Both SHD approach and OCM approach can be used for the treatment of pre-collapse ONFH, which can effectively improve clinical symptoms and imaging performance. The necrosis of the femoral head is mostly located in the anterior side, so the OCM approach is more common than the SHD approach. The complete intermuscular space approach is less invasive and safer. The SHD approach has a complete visual field and is suitable for internal and posterior lesions, but the learning curve is longer. |
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