摘要
[目的]探讨关节镜下清理结合术后冲击波治疗股骨头坏死的临床疗效.[方法]回顾性分析2010年1月—2018年1月,本院收治的成人股骨头坏死422例(642髋)患者的临床资料,所有患者均接受髋关节镜探查清理,股骨头钻孔减压手术治疗,术后早期开始冲击波治疗.[结果]422例患者(642髋)均顺利手术,术中无严重并发症.ESW治疗期无明显不良反应.422例患者随访24个月以上.随访过程中,16例(18髋)于术后8~24个月,平均(14.33±6.21)个月,因股骨头塌陷行全髋关节置换术,占2.84%.术前至术后12个月,患者静息状态VAS评分、行走时VAS评分均显著下降(P<0.05),而屈伸ROM、内旋-外旋ROM、内收-外展ROM以及Harris评分均显著增加(P<0.05);但是,与术后12个月相比,末次随访时上述指标的改善均有所丢失,各指标两时间点间差异均无统计学意义(P>0.05).影像方面,术前至术后12个月,642髋的ARCO分级、股骨头骨水肿和关节积液均显著改善(P<0.05),而髋关节T?nnis分期无显著变化(P>0.05).与术后12个月相比,末次随访时上述各影像指标无显著变化(P>0.05).[结论]关节镜下清理结合术后冲击波治疗能够在一定程度上逆转或延缓股骨头坏死的进展,临床疗效满意.
[Objective]To explore the clinical efficacy of arthroscopic debridement and drilling decompression combined with postoperative extracorporeal shock wave therapy for early-stage femoral head necrosis.[Methods]A retrospective study was done on a total of 422 adult patients(642 hips)who received treatment for early-stage femoral head necrosis in our hospital from January 2010 to January 2018.All the patients underwent hip arthroscopic debridement and drilling decompression of the femoral head,and then extracorporeal shockwave therapy postoperatively.[Results]All the 422 patients(642 hips)were successfully operated on without serious complications during perioperative period,and with no obvious adverse reactions during ESW treatment.The follow-up period lasted for more than 24 months.Of them,16 patients(18 hips)turned to receive total hip arthroplasty due to femoral head collapse in 8~24 months after primary op-eration,with an average of(14.33±6.21)months,accounting for 2.84%.From time point preoperatively to 12 months postoperatively,the VAS scores in resting state and during walking were significantly decreased(P<0.05),while flexion-extension ROM,internal-external rotation ROM and adduction-abduction ROM,as well as Harris score significantly increased(P<0.05).However,the improvements in the above item had slight loss at the latest follow-up compared with those at 12 months postoperatively,whereas which were not statistically significant(P>0.05).Radiographically,significant improvements were noticed in terms of ARCO classification,femoral head bone edema,and intraarticular effusion from the time preoperatively to 12 months postoperatively(P<0.05),whereas the Tonnis classification remained unchanged(P>0.05).However,there were no significant changes in these imaging parameters at the latest follow-up compared with those at 12 months postoperatively(P>0.05).[Conclusion]The arthroscopic debridement and drilling decompression combined with postoperative shock wave therapy might reverse in some extent,or delay the progression of femoral head necrosis,do achieve satisfactory clinical outcomes.
作者
王耀霆
安佰京
王龙
宋立琨
赵斌
李春宝
王明新
刘玉杰
WANG Yao-ting;AN Bai-jing;WANG Long;SONG Li-kun;ZHAO Bin;LI Chun-bao;WANG Ming-xin;LIU Yu-jie(Department of Orthopedics,The Forth Medical Center,General Hospital of CPLA,Beijing 100039,China)
出处
《中国矫形外科杂志》
CAS
CSCD
北大核心
2022年第5期421-425,共5页
Orthopedic Journal of China
基金
解放军总医院临床科研扶持基金(为军服务)项目(编号:2018FC-WJFWZX-1-06)。
关键词
股骨头坏死
髋关节镜术
钻孔减压
体外冲击波
osteonecrosis of the femoral head(ONFH)
hip arthroscopy
drilling decompression
extracorporeal shock wave
