髋关节外科脱位联合死骨刮除植骨治疗股骨头坏死的临床疗效观察

发布时间：2018-06-23 20:37

本文选题：股骨头坏死 + 髋关节外科脱位　；参考：《重庆医学》2017年36期

【摘要】：目的探讨髋关节外科脱位联合直视下死骨刮除植骨治疗股骨头早中期坏死的近期临床疗效。方法回顾性分析2014年10月至2016年12月江苏省连云港市第一人民医院收治的18例23髋FicatⅠ~Ⅲ期股骨头无菌坏死患者的资料。采用髋关节外科脱位死骨刮除打压植骨支撑固定治疗,术后观察股骨头塌陷,大粗隆截骨愈合情况,感染,异位骨化,神经损伤及深静脉血栓发生情况,手术前后Harris评分变化情况。结果 18例患者皆顺利完成手术,并得到随访,随访时间6~25个月,平均16.8个月。Harris评分由术前(52.68±6.86)分提高至术后(81.35±7.66)分,差异有统计学意义(t=17.256,P0.01)。术后疗效评定:优14例18髋;良3例4髋;差1例1髋。1例(1髋)术后18个月出现股骨头塌陷小于2mm,无疼痛且关节活动范围良好;大粗隆截骨无1例不愈合;1例(1髋)患者术后7d出现切口周围轻度红肿伴积液,给予充分引流,抗感染治疗治愈;1例(1髋)术后出现大腿前方麻木,无运动障碍,予以营养神经,6个月完全恢复。未出现异位骨化及深静脉血栓形成并发症。结论髋关节外科脱位联合直视下死骨刮除植骨治疗股骨头早中期坏死的近期临床疗效满意。
[Abstract]:Objective to explore the short-term clinical effect of hip joint surgical dislocation combined with dead bone scraping and bone grafting in the treatment of early and mid-term necrosis of the femoral head. Methods a retrospective analysis of 18 cases of 23 hip Ficat I ~ III patients with aseptic necrosis of the femoral head from October 2014 to December 2016 in Lianyungang First People's Hospital of Jiangsu province. Dislocated dead bone scraping and pressing bone graft support fixed treatment, after operation observation of femoral head collapse, large trochanter bone healing, infection, ectopic ossification, nerve injury and deep vein thrombosis, the changes of Harris score before and after operation. Results all 18 patients were successfully completed and followed up for a follow-up of 6~25 months with an average of 16.8 months. The monthly.Harris score was raised from preoperative (52.68 + 6.86) to postoperative (81.35 + 7.66) scores (t=17.256, P0.01). The postoperative curative effect was evaluated in 14 cases, 3 cases, 4 hips, 1 hips and 4 hips, 1 1 hips (1 hips), less than 2mm, no pain and good range of joint activity in 1 months after operation of 1 hips; (1 hips) after operation, 7d appeared mild swelling and effusion around the incision, given full drainage and anti infection cure; 1 cases (1 hips) appeared numbness in front of the thigh, no motor obstacle, nourishment nerve, 6 months completely recovered. No ectopic ossification and deep venous blood thrombus formed complications. Conclusion hip joint surgical dislocation combined with direct vision death. The clinical effect of bone curettage and bone grafting in the treatment of early and middle necrosis of femoral head is satisfactory.
【作者单位】：江苏省连云港市第一人民医院骨科;北京积水潭医院骨科;江苏省连云港市第一人民医院药剂科;
【基金】：国家科技部十一五支撑计划项目(2007BAI04B06)
【分类号】：R687.3

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