围塌陷期股骨头坏死保髋疗法的前瞻性研究

发布时间：2018-03-17 23:37

  本文选题：股骨头坏死　切入点：前瞻性　出处：《西南医科大学》2016年硕士论文　论文类型：学位论文

【摘要】：目的:观察并对比介入灌注术联合中药与髓芯减压植骨术联合中药在围塌陷期(ARCOⅡ-Ⅲa期)股骨头坏死治疗中的疗效,寻求围塌陷期股骨头坏死有效、可行的保髋疗法。方法:筛选2010年1月至2014年12月在西南医科大学附属中医医院就诊的ARCO(Ⅱ-Ⅲa)期股骨头缺血性坏死患者70例(80髋),依据治疗方式的不同,将行介入灌注术联合骨蚀一号方治疗者设为介入组(35例40髋),行髓芯减压植骨术联合骨蚀一号方治疗者设为减压组(35例40髋),经1年以上的随访,记录患者的围手术期指标(住院时间、手术时间、术中出血量、住院总花费)、Harris功能评分及影像学评定结果,然后用SPSS17.0进行统计学分析。结果:病例随访12~23个月,平均随访时间13.6个月。在80髋中,有4髋于随访期间病情加重接受了人工髋关节置换术,1髋失访,共计75髋,总结为如下四个方面:1.围手术期指标:两组患者住院时间的差异无统计学意义(t=2.514,P0.05);介入组手术时间较减压组短;介入组术中出血量较减压组少;介入组住院总花费方面较减压组少,且差异显著(t=15.224,P0.05;t=13.247,P0.05;t=10.329,P0.05)。2.疗效显示,Harris功能评价:优47髋,优秀率62.67%,良14髋,良好率18.67%,可6髋,尚可率8.00%,差8髋,无效率10.67%,总优良率为81.33%;影像学评价:稳定56髋,稳定率74.67%,加重19髋,加重率25.33%。3.组间分期比较:(1)在ARCOⅡ期中:介入组术后12个月髋关节Harris评分优良率高于减压组,差异显著(x~2=5.249,P=0.033),而介入组术后12个月影像稳定率与减压组的差异无统计学意义(x~2=1.687,P=0.073);(2)在ARCOⅢa期中:介入组术后12个月髋关节Harris评分优良率与减压组的差异无统计学意义(x~2=1.541,P=0.077),而介入组术后12个月的影像稳定率低于减压组,且差异有统计学意义(x~2=2.416,P=0.044)。4.组内分期比较:(1)在介入组中:ARCOⅡ期术后12个月髋关节Harris评分优良率高于ARCOⅢa期,差异显著(x~2=6.337,P=0.035),ARCOⅡ期术后12个月影像稳定率高于ARCOⅢa期,差异显著(x~2=9.247,P=0.034);(2)在减压组中:ARCOⅡ期术后12个月髋关节Harris评分优良率与ARCOⅢa期的差异无统计学意义(x~2=2.006,P=0.057),而ARCOⅡ期术后12个月影像稳定率高于ARCOⅢa期,且差异显著(x~2=6.478,P=0.031)。结论:1.在围塌陷期,介入灌注联合中药疗法与髓芯减压植骨术联合中药疗法均能改善ONFH的临床症状、体征,稳定影像学表现;2.本研究初步显示介入灌注联合中药疗法与髓芯减压植骨术联合中药疗法的近期疗效相当,但介入灌注联合中药疗法在改善患者疼痛及关节功能方面优于髓芯减压植骨术联合中药疗法;3.选择恰当的时效性分期节点、运用合理的保髋疗法,可以获得满意的疗效,本研究显示介入灌注疗法对于ARCOⅡ期患者具有较好的近期疗效,而髓芯减压植骨术对于ARCOⅢa期患者具有较好的近期疗效;4.结合Harris功能评价及影像学评价进行保髋治疗的疗效评价可能更加的客观、并且评价效能更加全面;5.介入灌注疗法具有经济方便、安全微创、迅速改善股骨头内外血运障碍的优点;而髓芯减压植骨术疗法有改善股骨头内血运障碍,并可纠正股骨头生物力学不稳定的优势。
[Abstract]:Objective: To compare the interventional therapy combined with Chinese medicine with core decompression and bone grafting combined with traditional Chinese medicine in pericollapse stage were observed (ARCO II - III a) curative effect of the treatment of femoral head necrosis, for pericollapse stage femoral head necrosis, hip preserving therapy feasible. Methods: from January 2010 to December 2014 in the medical screening of Southwest Hospital of traditional Chinese medicine Medical University Affiliated ARCO (a II - III) avascular necrosis of the femoral head in 70 cases (80 hips), according to different treatment methods, the Interventional Perfusion Combined with bone erosion a prescription treatment as the intervention group (35 cases, 40 hips) underwent core decompression and bone graft combined with bone erosion a no treatment as the decompression group (35 cases, 40 hips) after 1 years of follow-up, record the patient's perioperative indicators (hospitalization time, operation time, blood loss, intraoperative total hospitalization costs), the evaluation result of Harris score and imaging, then were analyzed by SPSS17.0. 缁撴灉:鐥呬緥闅忚��12~23涓�鏈�,骞冲潎闅忚�挎椂闂�13.6涓�鏈�.鍦，

本文编号：1627031