摘要
[目的]探讨双侧不同质塌陷股骨头坏死一期换髋与保髋治疗的临床疗效。[方法] 2018年10月—2019年6月,对28例双侧非同质股骨头坏死患者,均实施一期换髋与保髋治疗,比较两侧围手术期、随访和影像资料。[结果]所有患者顺利完成手术。随时间推移,两侧术后VAS评分均显著降低(P<0.05),而髋屈-伸ROM、内-外旋ROM、Harris评分显著增加(P<0.05)。术后6个月及末次随访时两侧VAS评分及Harris评分差异无统计学意义(P>0.05),换髋侧髋屈-伸ROM、内-外旋ROM优于保髋侧(P<0.05)。影像方面,末次随访时,与术前相比,换髋侧PDIT、FO显著增加(P<0.05),保髋侧无显著变化(P>0.05),术后两侧PDIT、FO差异均无统计学意义(P>0.05)。[结论]一期换髋与保髋治疗双侧不同质塌陷股骨头坏死,保髋侧可以获得与换髋侧相当的近期临床效果,能够延缓甚至避免关节置换。
[Objective] To investigate the clinical efficacy of one-stage hip replacement and hip preservation for bilateral femoral head necrosis with different heal collapse. [Methods] From October 2018 to June 2019, 28 patients underwent one-stage hip replacement for the severe collapse side and hip preservation by neck-head fenestration and bone grafting for the slight collapse side for bilateral femoral head necrosis in our hospital. The perioperative period, follow-up and imaging data of both sides were compared. [Results] All patients had operation completed successfully. The VAS scores decreased significantly(P<0.05), while the hip flexor-extension range of motion(ROM), internal-external rotation ROM and Harris scores significantly increased on both sides over time(P<0.05). Although there was no significant difference in VAS scores and Harris scores between the two sides at 6 months after surgery and the latest follow-up(P>0.05), the replacement side was significantly superior to the preservation side in terms of flexor-extension ROM and the internal-external rotation ROM postoperatively(P<0.05). Radiographically, the perpendicular distance between ischial tuberosity connecting line and the tip of the lesser trochanter(PDIT) and femoral offset(FO) significantly increased in the hip replacement side(P<0.05) at the latest follow-up, while which remained unchanged in the preservation side postoperatively compared with those preoperatively(P>0.05). There were no significant differences in PDIT and FO between the two sides at the latest follow-up(P>0.05). [Conclusion] One-stage hip replacement and hip preservation in the treatment of bilateral femoral head necrosis with different head collapse does achieve the comparable clinical outcomes on both side, which might delay or even avoid joint replacement on the side with slight head collapes.
作者
王上增
华茂奇
董晓坤
刘湘源
王倩倩
WANG Shang-zeng;HUA Mao-qi;DONG Xiao-kun;LIU Xiang-yuan;WANG Qian-qian(Osteopathy Schoo,Henan University of Chinese Medicine,Zhengzhou,450016,China;Henan Uniersity of Chinese Medicine,Zhengzhou,450003,China)
出处
《中国矫形外科杂志》
CAS
CSCD
北大核心
2022年第23期2180-2184,共5页
Orthopedic Journal of China
基金
河南省教育厅科学技术研究重点项目(编号:14A360023)
河南中医药大学科研苗圃工程项目(编号:MP2020-8)。
关键词
股骨头坏死
股骨头塌陷
全髋关节置换术
股骨头颈开窗植骨
femoral head necrosis
femoral head collapse
total hip arthroplasty
femoral head-neck fenestration and bone grafting
作者简介
王上增,主任医师,研究方向:关节外科、运动医学,(电话)13838527504,(电子信箱)wangsz74@163.com;通信作者:华茂奇,(电话)17398970997,(电子信箱)1018952434@qq.com。
