CAJ | 학술논문

背景：传统的髓芯减压异体腓骨支撑可以减少股骨头内部的应力负荷，改善股骨头的力学性能。但不能为股骨头内部坏死后5个病理分区的稳定性提供支持。目的：以传统异体腓骨植骨做对照，观察扇形减压异体腓骨支撑内固定对早期成人股骨头坏死的修复效果。方法：纳入40例早期股骨头坏死患者，按随机数字表法分为2组，治疗组给予扇形减压、异体腓骨支撑内固定治疗；对照组给予传统减压异体腓骨植骨治疗，对比2组患者的治疗效果。治疗后复查双髋正蛙位片、髋关节功能Harris评分、X射线片ARCO分期评估塌陷程度和坏死修复程度。结果与结论：末次随访时，治疗组患者Harris评分显著高于对照组(P<0.05)，扇形减压异体腓骨支撑内固定组的修复治疗效果优于传统异体腓骨植骨组。在坏死修复方面，治疗组18髋修复良好(72%)，7髋修复迟缓或失败(28%)；对照组9髋修复良好(60%)，6髋修复迟缓或失败(40%)。提示与传统异体腓骨植骨治疗相比，扇形减压异体腓骨支撑内固定可使减压更彻底，异体腓骨在股骨头的稳定性增加，使支撑更加可靠。
배경：전통적수심감압이체비골지탱가이감소고골두내부적응력부하，개선고골두적역학성능。단불능위고골두내부배사후5개병리분구적은정성제공지지。목적：이전통이체비골식골주대조，관찰선형감압이체비골지탱내고정대조기성인고골두배사적수복효과。방법：납입40례조기고골두배사환자，안수궤수자표법분위2조，치료조급여선형감압、이체비골지탱내고정치료；대조조급여전통감압이체비골식골치료，대비2조환자적치료효과。치료후복사쌍관정와위편、관관절공능Harris평분、X사선편ARCO분기평고탑함정도화배사수복정도。결과여결론：말차수방시，치료조환자Harris평분현저고우대조조(P<0.05)，선형감압이체비골지탱내고정조적수복치료효과우우전통이체비골식골조。재배사수복방면，치료조18관수복량호(72%)，7관수복지완혹실패(28%)；대조조9관수복량호(60%)，6관수복지완혹실패(40%)。제시여전통이체비골식골치료상비，선형감압이체비골지탱내고정가사감압경철저，이체비골재고골두적은정성증가，사지탱경가가고。
BACKGROUND:Traditional core decompression and al ograft fibula supporting can reduce the stress load within femoral head and improve mechanical properties of femoral head. However, it cannot provide supports for maintaining the stability of five pathological areas fol owing femoral head necrosis. OBJECTIVE:To observe the clinical effect of fan-shaped decompression and al ograft fibula supporting internal fixation in treatment of early femoral head necrosis in adults, taking al ograft fibula grants as the control. METHODS:Forty patients with early femoral head necrosis were randomly divided into treatment group and control group, receiving fan-shaped decompression plus al ograft fibula supporting internal fixation and traditional decompression plus al ograft fibula grafting, respectively. The therapeutic effects in two groups were observed and compared. After treatment, patients were detected by bilateral hip anteroposterior films, Harris scoring and X-ray ARCO staging to evaluate the col apse severity and restoration of necrosis. RESULTS AND CONCLUSION:At the last fol ow-up, Harris scores in the treatment group were significantly higher and the repairing effect was better than control group (P<0.05). In treatment group, 18 hips restored wel (72%) and 7 hips delayed or failed to restore (28%);in control group, 9 hips restored wel (60%) and 6 hips delayed or failed to restore (40%). Our findings indicate that, fan-shaped decompression plus al ograft fibula supporting internal fixation yields a more complete decompression, a higher stability of femoral head and a more reliable supporting, compared with traditional decompression plus al ograft fibula grafting.