股内收肌切断术+髋关节置换术治疗股骨头坏死患者的近期疗效

秦为

[摘要] 目的 探讨股内收肌切断术（HAA）+髋关节置换术（HA）治疗晚期股骨头坏死（ONFH）患者的近期疗效。 方法 回顾性分析2013年1月至2018年1月于我院接受诊治的晚期ONFH患者48例，按照手术方式不同，分为观察组（n=26）与对照组（n=22），观察组行HAA+HA，对照组行HA，比较两组一般情况、术前及术后1周髋关节Harris评分、髋关节外展活动度、股内收肌挛缩及手术并发症发生情况。 结果 两组手术时间、术中出血量、住院费用比较，差异无统计学意义（P>0.05）。观察组住院时间为（7.45±2.12）d，低于對照组的（9.14±2.36）d，差异有统计学意义（P<0.05）;术后1周，观察组髋关节Harris评分疼痛[（38.12±6.54）分]、功能[（39.15±7.74）分]、活动范围[（4.57±0.62）分]、畸形评分[（3.77±0.42）分]及总分[（85.57±9.18）分]均高于对照组的（33.51±5.72）分、（32.48±6.96）分、（4.12±0.59）分、（3.12±0.56）分、（74.46±8.95）分，差异均有统计学意义（P<0.05）;观察组术后髋关节外展活动度为（44.82±5.17）°，高于对照组的（36.65±5.82）°;术后股内肌挛缩评分为（6.76±1.75）分，低于对照组的（15.28±3.84）分，差异均有统计学意义（P<0.05）;观察组、对照组术后并发症总发生率分别为15.38%、18.19%，差异无统计学意义（P>0.05）。 结论 HAA联合HA术用于晚期ONFH患者，可以改善患者髋关节功能，提高髋关节外展活动度，降低股内肌挛缩程度，且不增加并发症发生率。

[关键词] 股骨头坏死;股内收肌切断术;髋关节置换术;近期疗效

[中图分类号] R658.3          [文献标识码] B          [文章编号] 1673-9701（2021）06-0096-04

Short-term curative effect of hip adductor amputation combined with hip arthroplasty in the treatment of osteonecrosis of the femoral head

QIN Wei

Second Department of Orthopedics， Qianjiang Central Hospital in Hubei Province， Qianjiang   433100， China

[Abstract] Objective To explore the short-term curative effect of hip adductor amputation（HAA） combined with hip arthroplasty（HA） in the treatment of advanced osteonecrosis of the femoral head（ONFH）. Methods A total of 48 patients with advanced ONFH who were diagnosed and treated in our hospital from January 2013 to January 2018 were retrospectively analyzed. According to the different surgical methods， they were divided into the observation group（n=26） and the control group（n=22）. The observation group received HAA+HA， and the control group received HA. The general hospitalization status， Harris score of the hip joint before and one week after the operation， hip abduction range， femoral adductor contracture， and surgical complications between the two groups were compared. Results There was no statistically significant difference in operation time， operative blood loss， and hospitalization expenditure between the two groups（P>0.05）. The hospitalization time of the observation group was（7.45±2.12）d， which was lower than（9.14±2.36） d of the control group， and the difference was statistically significant（P<0.05）. One week after surgery， the observation group′s hip joint Harris scores including pain（38.12±6.54） points， function was（39.15±7.74） points， range of motion was（4.57±0.62）points， deformity score was（3.77±0.42） and total score was（85.57±9.18） points points were higher than those （[33.51±5.72] points， [32.48±6.96]points， [4.12±0.59] points， [3.12±0.56]points， and [74.46±8.95] points） of the control group， and the difference was statistically significant（P<0.05）. The hip abduction range of the observation group was（44.82±5.17）°， higher than that of the control group（36.65±5.82）°. The intrathoracic muscle contracture score（6.76±1.75） points of the observation group was lower than that（15.28±3.84） points of the control group，and the difference was statistically significant（P<0.05）. The total incidence of postoperative complications in the observation group and the control group was 15.38% and 18.19%， respectively， with no significant difference（P>0.05）. Conclusion HAA combined with HA surgery for patients with advanced ONFH can improve the hip joint function，increase hip abduction range， reduce the degree of intrafemoral muscle contracture，and does not increase the incidence of complications.

[Key words] Femoral head necrosis; Hip adductor amputation; Hip arthroplasty; Short-term curative effect

股骨头坏死（Osteonecrosis of the femoral head，ONFH）又名股骨头缺血性或无菌性坏死，指因股骨头动脉血供受损或中断，静脉瘀滞导致的骨细胞、骨髓成分死亡及修复，继而引起股骨头结构变化乃至塌陷，最终使髋关节出现疼痛并功能障碍的病理过程[1-2]。髋关节置换术（Hip arthroplasty，HA）指采用外科手术切除病变髋关节，并以人工假体替代，从而维持髋关节结构及功能，目前在类风湿性髋关节炎、严重髋臼破坏及ONFH等疾病中均有应用[3-4]。股内收肌挛缩在ONFH患者中常见，可造成髋关节周围肌力失衡，严重影响髋关节功能，而股内收肌切断术（Hip adductor amputation，HAA）是改善股内收肌挛缩的手段，可促进关节外展、外旋等活动及稳定髋关节[5]。本研究采取HAA联合HA治疗ONFH患者，旨在观察其近期疗效，现报道如下。