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小直径多孔道髓芯减压联合髋关节镜清理治疗早期股骨头缺血性坏死的疗效观察

发布时间:2019-01-11 15:36  文章来源:笔耕文化传播
【摘要】:目的通过与单纯髓芯减压比较,探讨小直径多孔道髓芯减压联合髋关节镜清理治疗早期股骨头缺血性坏死的疗效。方法回顾分析2010年3月—2013年12月收治并符合选择标准的91例早期股骨头缺血性坏死患者临床资料。其中,39例(53髋)采用小直径多孔道髓芯减压联合髋关节镜清理治疗(A组),52例(74髋)采用单纯小直径多孔道髓芯减压治疗(B组)。两组患者术前均有明显髋关节疼痛、活动受限等症状。两组患者性别、年龄、病因、侧别、骨坏死分期及术前Harris评分等一般资料比较,差异均无统计学意义(P0.05),具有可比性。结果两组手术均顺利完成。A组手术时间为(73.3±10.6)min,较B组(41.5±7.2)min明显延长(t=8.726,P=0.000)。术后切口均Ⅰ期愈合。A组术后2例出现牵引造成的暂时性坐骨神经失用,其余患者均无相关并发症发生。两组患者均获随访,A组随访时间24~52个月,平均39.3个月;B组随访时间24~48个月,平均34.6个月。末次随访时,两组Harris评分均较术前明显提高(t= 10.327,P=0.001;t= 8.216,P=0.008);且A组评分高于B组(t= 4.247,P=0.029)。X线片复查示,随访期间A组FicatⅠ期1髋、Ⅱ期5髋发生股骨头塌陷,手术总有效率为88.68%(47/53);B组FicatⅠ期4髋、Ⅱ期12髋发生股骨头塌陷,手术总有效率为78.38%(58/74);两组手术总有效率比较,差异有统计学意义(χ2=5.241,P=0.041)。两组发生股骨头塌陷患者均行人工髋关节置换术。结论小直径多孔道髓芯减压联合髋关节镜清理治疗早期股骨头缺血性坏死能有效缓解患者关节疼痛,改善关节功能,延缓股骨头缺血性坏死进程。
[Abstract]:Objective to investigate the effect of small diameter multiple channel core decompression combined with hip arthroscopy in the treatment of early avascular necrosis of femoral head by comparing with simple core decompression. Methods the clinical data of 91 patients with early avascular necrosis of femoral head admitted from March 2010 to December 2013 were retrospectively analyzed. Among them, 39 cases (53 hips) were treated with small diameter perforated core decompression combined with hip arthroscopy (group A), 52 cases (74 hips) were treated with small diameter multi-channel core decompression (group B). The patients in both groups had obvious hip pain and limited movement before operation. Gender, age, etiology, side, osteonecrosis stage and preoperative Harris score were not significantly different between the two groups (P0.05). Results the operation time of group A was (73.3 卤10.6) min, longer than that of group B (41.5 卤7.2) min. In group A, temporary sciatic nerve loss caused by traction was found in 2 cases, and no related complications occurred in other patients. The follow-up time was 24 ~ 52 months (mean 39.3 months) in group A and 34. 6 months in group B (24 ~ 48 months). At the last follow-up, the Harris scores in both groups were significantly higher than those before operation (t = 10.327g / kg, 0.001t = 8.216m / P0. 008). The score of group A was higher than that of group B (t = 4.247). X). During the follow-up period, 1 hip of Ficat stage 鈪,

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