CAJ | 학술논문

目的回顾性分析小孔径多通道髓芯钻孔减压技术治疗股骨头坏死.并探讨其疗效及适应证.方法 2000年3月至2004年12月,共55例(85髋)早期股骨头坏死患者行股骨头髓芯减压术.所有病例入院时均按宾夕法尼亚大学分期法分期并行患髋Harris评分.所有患者均在"C"型臂X线机透视下采用直径3.2 mm空心环钻经大转子下向股骨头外上钻孔,平行3个通道钻孔减压.术后1、2、3、6个月门诊随访,以后每年门诊随访至少1次.随访观察比较患髋Harris评分变化,影像学进展及是否行人工髋关节置换术.术后评价:股骨头塌陷视为钻孔减压失败,疼痛缓解、股骨头未塌陷视为有效.结果 49例(79髋)患者获得随访,术后平均随访4.8(3.5-9.2)年.Ⅰ C期11髋,Harris评分由术前平均75分提高到末次随访时85分,1例(1个股骨头)术后1年发生塌陷;Ⅱ A期15髋,Harris评分由术前平均75分提高到85分,3例(3个股骨头)分别于术后1、2年发生塌陷;Ⅱ B期24髋,Harris评分由术前平均72分提高到83分,5例(6个股骨头)分别于术后1、2、4年发生塌陷;Ⅱ C期29髋,Harris评分由术前平均73分提高到82分,7例(9个股骨头)分别于术后1、2、3年发生塌陷.所有患者术后1个月疼痛均明显缓解,无明显手术并发症发生.结论小孔径多通道髓芯钻孔减压技术治疗早中期、轻中度股骨头坏死,具有良好的近中期疗效,而且无明显手术并发症.
목적 회고성분석소공경다통도수심찬공감압기술치료고골두배사.병탐토기료효급괄응증.방법 2000년3월지2004년12월,공55례(85관)조기고골두배사환자행고골두수심감압술.소유병례입원시균안빈석법니아대학분기법분기병행환관Harris평분.소유환자균재"C"형비X선궤투시하채용직경3.2 mm공심배찬경대전자하향고골두외상찬공,평행3개통도찬공감압.술후1、2、3、6개월문진수방,이후매년문진수방지소1차.수방관찰비교환관Harris평분변화,영상학진전급시부행인공관관절치환술.술후평개:고골두탑함시위찬공감압실패,동통완해、고골두미탑함시위유효.결과 49례(79관)환자획득수방,술후평균수방4.8(3.5-9.2)년.Ⅰ C기11관,Harris평분유술전평균75분제고도말차수방시85분,1례(1개고골두)술후1년발생탑함;Ⅱ A기15관,Harris평분유술전평균75분제고도85분,3례(3개고골두)분별우술후1、2년발생탑함;Ⅱ B기24관,Harris평분유술전평균72분제고도83분,5례(6개고골두)분별우술후1、2、4년발생탑함;Ⅱ C기29관,Harris평분유술전평균73분제고도82분,7례(9개고골두)분별우술후1、2、3년발생탑함.소유환자술후1개월동통균명현완해,무명현수술병발증발생.결론 소공경다통도수심찬공감압기술치료조중기、경중도고골두배사,구유량호적근중기료효,이차무명현수술병발증.
Objective To retrospectively analyze the results of core decompression of the femoral head for osteonecrosis using multiple small-diameter drilling.Methods From March 2000 to December 2004,85 hips of 55 patients with symptomatic osteonecrosis of the femoral head underwent core decompression using multiple small-diameter drilling.Clinical stage was determined according to the University of Pennsylvania System of Classification and Staging,Harris hip scpre were used to evaluate postoperative functions of the daily life and work.Results Forty-nine patients (79 hips) were followed up for an average of 4.8 years.In 11 hips with stage IC,1 hip had collapsed one year after operation,the mean Harris hip score increased from 75 points to 85 points.In 15 hips with stage ⅡA,1 hip and the other 2 hips had collapsed in the first year and in the second year postoperatively.All had undergone total hip replacement,the change of the Harris hip score was similar to stage Ⅰ.In 24 hips with stage ⅡB,2 hips had collapsed in the first year,3 hips in the second year and Ⅰ in the forth year,3 hips had undergone total hip replacement,the mean Harris hip score increased from 72 to 83 points postoperatively.In 29 hips with stage ⅡC,4 hips had collapsed one year after operation,3 two years and 2 three years;the mean Harris hip score increased from 73 to 82 points.The pain significantly relieved one month after the procedure in all patients.Conclusion Core decompression using multiple small-diameter drilling is associated with better clinical results with no surgical complica-tions.