CAJ | 학술논문

目的：探讨髓芯减压病灶清除打压植骨术治疗股骨头坏死的动态临床效果。方法根据纳入与排除标准，收集经髓芯减压病灶清除打压植骨术治疗并获得3年以上随访的股骨头坏死患者临床资料共41例50髋，分别将术前、术后3个月，术后1年及术后3年不同随访时点的X线和临床材料进行动态观察，以Harris评分、X线稳定率、股骨头形态、囊变面积、骨关节炎发生为评价指标，分析统计随访结果。结果 Harris评分术后3年的优良率为84.00％，明显高于治疗前66.00％（Z＝16.08，P＝0.00）；X线稳定率术后1年达到80％以上，而3年与1年比较差异无统计学意义，其中L1型91.66％优于L3型的75.00％；股骨头塌陷程度无论在术后1年或3年，总体、L1型与治疗前比较均无统计学差异（P＞0.05），而L3型则存在统计学意义的差异（P＜0.05）；股骨头囊变面积在任何随访时点，总体、L1型和L3型与治疗前比较，均存在统计学差异（ P＜0.01）；骨关节炎程度，无论是总体、L1型，还是L3型，术后3月、1年与治疗前比较无统计学差异（ P＞0.05），而在3年时，L1型骨关节炎的程度亦无统计学差异（P＞0.05），而总体、L3型骨关节炎的程度则与治疗前比较有统计学差异（ P＜0.01）。结论髓芯减压病灶清除植骨术治疗股骨头坏死在不同分期均有良好的疗效，且保留外侧柱的效果好于全股骨头坏死；动态观察治疗过程中的股骨头塌陷程度、囊变面积及骨关节炎等相关指标，有利于了解疗效特点和病情状态，及时调整治疗和康复的方案。
목적：탐토수심감압병조청제타압식골술치료고골두배사적동태림상효과。방법근거납입여배제표준，수집경수심감압병조청제타압식골술치료병획득3년이상수방적고골두배사환자림상자료공41례50관，분별장술전、술후3개월，술후1년급술후3년불동수방시점적X선화림상재료진행동태관찰，이Harris평분、X선은정솔、고골두형태、낭변면적、골관절염발생위평개지표，분석통계수방결과。결과 Harris평분술후3년적우량솔위84.00％，명현고우치료전66.00％（Z＝16.08，P＝0.00）；X선은정솔술후1년체도80％이상，이3년여1년비교차이무통계학의의，기중L1형91.66％우우L3형적75.00％；고골두탑함정도무론재술후1년혹3년，총체、L1형여치료전비교균무통계학차이（P＞0.05），이L3형칙존재통계학의의적차이（P＜0.05）；고골두낭변면적재임하수방시점，총체、L1형화L3형여치료전비교，균존재통계학차이（ P＜0.01）；골관절염정도，무론시총체、L1형，환시L3형，술후3월、1년여치료전비교무통계학차이（ P＞0.05），이재3년시，L1형골관절염적정도역무통계학차이（P＞0.05），이총체、L3형골관절염적정도칙여치료전비교유통계학차이（ P＜0.01）。결론수심감압병조청제식골술치료고골두배사재불동분기균유량호적료효，차보류외측주적효과호우전고골두배사；동태관찰치료과정중적고골두탑함정도、낭변면적급골관절염등상관지표，유리우료해료효특점화병정상태，급시조정치료화강복적방안。
Objective To investigate the clinical effects of the core decompression and the focal lesion debridement combining the bone grafting on the osteonecrosis of the femoral head ( ONFH ) . Methods The clinical information of 41 cases ( 50 hips ) with ONFH were collected according to the including criteria.All these patients were treated by the core decompression and focal lesion debridement combining the bone grafting surgery, and followed up for more than three years.The data such as radiographic images and clinical records in different time points ( before the surgery, three months, one year and three years after the surgery) were adopted for this investigation.Harris Hip Score ( HHS) , the stability rate in the X-ray image, the morphology of the femoral head, the area of the cystic lesion, and the morbidity of osteoarthritis were used as indicators for the assessment.Results The HHS excellent rate in the third year was 84.00%which was higher than that in the first year (66.00%, Z=16.08, P=0.00). The stability rate in the X-ray image was 80%and did not changed significantly in the following two years. The L1 type (91.66%) received better results than the L3 type (75.00%).The change of the collapse degree of the femoral head was not statistically significant in L1 type ( P>0.05 ) , but it had significant difference in L3 type (P<0.05).For L1 and L3, the cystic lesion area varied dramatically in each single time point (P<0.01).Compared with the preoperative data, the osteoarthritis degree showed no statistical difference after the surgery in L1 group ( P >0.05 ) , while there was a significant difference in the osteoarthritis degree of the L3 group after the treatment ( P<0.01) .Conclusion The core decompression and the focal lesion debridement combining the bone grafting surgery possesses favorable effects in the treatment of ONFH in different stages.It has better outcome in the lateral lesion type than the diffusive lesion of the whole femoral head.The observation of the collapse degree, the cystic lesion area and the osteoarthritis degree is beneficial for understanding the curative effects and can provide useful informations for adjusting the treatment and rehabilitation regimen.