| 关节镜引导下髓芯减压植骨联合选择性动脉灌注治疗早期股骨头坏死 |
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投稿时间：2017-02-28
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| 作者 | Author | 单位 | Address | E-Mail |
| 郭浩山 |
GUO Hao-shan |
聊城市中医医院骨科, 山东 聊城 252000 |
Department of Orthopaedics, Liaocheng Hospital of Traditional Chinese Medicine, Liaocheng 252000, Shandong, China |
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| 田义军 |
TIAN Yi-jun |
聊城市中医医院骨科, 山东 聊城 252000 |
Department of Orthopaedics, Liaocheng Hospital of Traditional Chinese Medicine, Liaocheng 252000, Shandong, China |
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| 刘刚 |
LIU Gang |
聊城市中医医院骨科, 山东 聊城 252000 |
Department of Orthopaedics, Liaocheng Hospital of Traditional Chinese Medicine, Liaocheng 252000, Shandong, China |
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| 安龙 |
AN Long |
聊城市中医医院骨科, 山东 聊城 252000 |
Department of Orthopaedics, Liaocheng Hospital of Traditional Chinese Medicine, Liaocheng 252000, Shandong, China |
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| 周占国 |
ZHOU Zhan-guo |
聊城市中医医院骨科, 山东 聊城 252000 |
Department of Orthopaedics, Liaocheng Hospital of Traditional Chinese Medicine, Liaocheng 252000, Shandong, China |
13869568383@126.com |
| 刘焕珍 |
LIU Huan-zhen |
聊城市中医医院骨科, 山东 聊城 252000 |
Department of Orthopaedics, Liaocheng Hospital of Traditional Chinese Medicine, Liaocheng 252000, Shandong, China |
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| 期刊信息：《中国骨伤》2018年，第31卷，第1期，第56-61页 |
| DOI：10.3969/j.issn.1003-0034.2018.01.010 |
| 基金项目:国家中医临床研究基地业务建设第二批科研专项课题（编号：TDEX2015282）；中国中医科学院科技创新团队建设项目（编号：YS1304） |
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中文摘要:
目的：观察关节镜引导下髓芯减压植骨术联合选择性动脉灌注治疗早期股骨头坏死的疗效。
方法：自2010年1月至2014年12月，将76例76髋FicatⅡ期股骨头坏死患者分为试验组与对照组。试验组35例，男27例，女8例；年龄24~55（43.96±6.81）岁；行关节镜引导下髓芯减压植骨术，沿股骨颈方向钻直径8 mm骨隧道至坏死区，在关节镜监视下准确刮除死骨，取自体髂骨进行充分植骨，并联合选择性动脉灌注治疗。对照组41例，男29例，女12例；年龄26~56（44.62±7.33）岁；以直径3 mm的克氏针经皮行髓芯减压并联合选择性动脉灌注治疗。分别记录术前及术后随访时Harris评分，进行疗效比较，并判断影像学变化情况。
结果：所有患者获得随访，平均随访时间30个月。术后12个月随访时两组患者影像学差异有统计学意义（P<0.05），试验组优于对照组。参照Harris髋关节评分系统，末次随访时试验组（86.72±4.37）分，优6例，良24例，可4例，差1例；对照组（78.62±5.62）分，优2例，良20例，可15例，差4例；两组患者术后评分均高于术前（P<0.05），末次随访时两组患者Harris评分和疗效比较差异均有统计学意义（P<0.05）。
结论：两种手术方式对早期股骨头坏死的治疗均有效，关节镜引导下进行髓芯减压，可以更加准确定位死骨，有效进行死骨刮除，取得更加满意的疗效。 |
| 【关键词】股骨头坏死 关节镜 减压术,外科 血液灌注 |
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| Arthroscopy-guided core decompression and bone grafting combined with selective arterial infusion for treatment of early stage avascular necrosis of femoral head |
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ABSTRACT
Objective:To observe the clinical effects of arthroscopy-guided core decompression and bone grafting combined with selective arterial infusion for early stage avascular necrosis of femoral head.
Methods:From January 2010 to December 2014,76 patients(76 hips) diagnosed as FicatⅡstage avascular necrosis of femoral head were randomly divided into experimental group and control group. In the experimental group,there were 27 males and 8 females aged from 24 to 55 years old with an average of (43.96±6.81) years,treated with arthroscopic-guided core decompression and bone grafting combined with selective arterial infusion. Along the direction of the femoral neck,an 8 mm-diameter tunnel to necrotic areas was drilled,then curettage of necrotic bone was performed under arthroscope,and the iliac bone was grafted. In the control group,there were 29 males and 12 females aged from 26 to 56 years old with an average of (44.62±7.33) years,treated with percutaneous core decompression combined with selective arterial infusion. The preoperative and postoperative Harris scores were recorded and the changes of X-rays were analyzed.
Results:All the patients were followed up with an average of 30 months. Postoperative follow-up at 12 months showed that there was significant difference in imaging outcome between two groups(P<0.05),the experimental group was better than that of control group. According to Harris hip score system,at the final follow-up,Harris score of the experimental group was 86.72±4.37 on average,6 cases got excellent results,24 good,4 fair and 1 poor. Harris score of the control group was 78.62±5.62 on average,2 cases got excellent results,20 good,15 fair and 4 poor. After Ridit analysis,there was significant difference in the effect between the two groups(P<0.05). By pairing sample t test,there was significant difference between the preoperative and postoperative Harris score in the both groups(P<0.05). Between the two groups,there was no significant difference in preoperative Harris score(P>0.05),but there was significant difference in postoperative Harris score(P<0.05).
Conclusion:The two surgical procedures for early femoral head necrosis are effective. Using arthroscopic-guided core decompression method,the necrotic bone can be positioned and scraped more accurately,and can obtain better results. |
| KEY WORDS Femur head necrosis Arthroscopes Decompression,surgical Hemoperfusion |
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| 引用本文，请按以下格式著录参考文献： |
| 中文格式: | 郭浩山,田义军,刘刚,安龙,周占国,刘焕珍.关节镜引导下髓芯减压植骨联合选择性动脉灌注治疗早期股骨头坏死[J].中国骨伤,2018,31(1):56~61 |
| 英文格式: | GUO Hao-shan,TIAN Yi-jun,LIU Gang,AN Long,ZHOU Zhan-guo,LIU Huan-zhen.Arthroscopy-guided core decompression and bone grafting combined with selective arterial infusion for treatment of early stage avascular necrosis of femoral head[J].zhongguo gu shang / China J Orthop Trauma ,2018,31(1):56~61 |
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