CAJ | 학술논문

目的评价经皮置管术介入治疗成人股骨头坏死的疗效.方法采用自制股骨头坏死介入治疗器械对1999至2011年解放军第一一七医院85例106髋成人股骨头坏死行经皮置管术介入治疗,其中Ficat Ⅰ期32例,40髋;Ⅱ期41例,50髋;Ⅲ期7例,9髋;Ⅳ期5例,7髋.入选病例必须具有坏死股骨头、颈部骨髓水肿或髋关节积液.采用X线平片随访2 ～10年,应用中华医学会骨科学分会保留股骨头的成人股骨头坏死疗效评价法(百分法％)进行疗效评价,与文献报道的髓芯减压术进行疗效比较,统计学分析采用x2检验.结果 Ficat Ⅰ期的显效率为88％(35/40),有效率7％(3/40),无效率5％ (2/40);FicatⅡ期的显效率为74％(37/50),有效率12％(6/50),无效率14％ (7/50);FicatⅢ期的显效率为22％(2/9),有效率22％ (2/9),无效率56％(5/9);FicatⅣ期的显效率为14％ (1/7),有效率14％(1/7),无效率72％(5/7).期别间显效率依次下降,无效率依次提高,除了Ficat Ⅰ、Ⅱ期差异无统计学意义(P＞0.05),Ficat Ⅰ期、Ⅱ期分别与FicatⅢ期和FicatⅣ期差异均有统计学意义(均P ＜0.01).结论经皮置管术可有效治疗成人Ficat Ⅰ、Ⅱ期股骨头坏死,对FicatⅢ期和Ⅳ期股骨头坏死也有一定的疗效.
목적 평개경피치관술개입치료성인고골두배사적료효.방법 채용자제고골두배사개입치료기계대1999지2011년해방군제일일칠의원85례106관성인고골두배사행경피치관술개입치료,기중Ficat Ⅰ기32례,40관;Ⅱ기41례,50관;Ⅲ기7례,9관;Ⅳ기5례,7관.입선병례필수구유배사고골두、경부골수수종혹관관절적액.채용X선평편수방2 ～10년,응용중화의학회골과학분회보류고골두적성인고골두배사료효평개법(백분법％)진행료효평개,여문헌보도적수심감압술진행료효비교,통계학분석채용x2검험.결과 Ficat Ⅰ기적현효솔위88％(35/40),유효솔7％(3/40),무효솔5％ (2/40);FicatⅡ기적현효솔위74％(37/50),유효솔12％(6/50),무효솔14％ (7/50);FicatⅢ기적현효솔위22％(2/9),유효솔22％ (2/9),무효솔56％(5/9);FicatⅣ기적현효솔위14％ (1/7),유효솔14％(1/7),무효솔72％(5/7).기별간현효솔의차하강,무효솔의차제고,제료Ficat Ⅰ、Ⅱ기차이무통계학의의(P＞0.05),Ficat Ⅰ기、Ⅱ기분별여FicatⅢ기화FicatⅣ기차이균유통계학의의(균P ＜0.01).결론 경피치관술가유효치료성인Ficat Ⅰ、Ⅱ기고골두배사,대FicatⅢ기화Ⅳ기고골두배사야유일정적료효.
Objective To evaluate the efficacies of treating osteonecrosis of the femoral head (ONFH) with percutaneous retaining catheterization.Methods A total of 85 patients (106 hips) of ONFH underwent percutaneous retaining catheterization with self-made instrument.There were stage Ⅰ (n =32,40 hips),stage Ⅱ (n =41,50 hips),stage Ⅲ (n =7,9 hips) and stage Ⅳ (n =5,7 hips) by Ficat and Arlet classification.The selection criteria include bone marrow edema (BME) of the femoral head and neck and joint fluid on magnetic resonance imaging (MRI).The percent method (％) of Orthopedics Branch of Association of Chinese Medical Association was used for evaluating the efficacies of ONFH with retained femoral head.A follow-up period of 2-10 years was conducted with plain radiograph.The standard was as follows:＞ 90,excellent; 75-89,good; 60-74,passable; ＜ 60,bad.The combination of excellent and good denoted obvious effect rate; passable for valid rate; bad for invalid rate.The historical core decompression was used as control group.And x2 test was used for statistical analysis (P ＜ 0.05).Results The obvious effect rate was 88％ (35/40),74％ (37/50),22％ (2/9),14％ (1/7),the valid rate 7％ (3/40),12％ (6/50),22％ (2/9),14％ (1/7)and the invalid rate 5％ (2/40),14％ (7/50),56％ (5/9),72％ (5/7)respectively in Ficat Ⅰ,Ⅱ,Ⅲ and Ⅳ stage.No statistically significant differences existed between Ficat Ⅰ and Ⅱ stage(P ＞ 0.05).But there were statistically significant differences in other groups (P ＜ 0.01).Conclusion Pcrcutaneous retaining catheterization is efficaciously treating ONFH in Ficat Ⅰ and Ⅱ stage and it may also be used for ONFH in Ficat Ⅲ and Ⅳ stage.