Liu Dehuai, Chen Qianfen, Chen Yuan, Liu Yun
Department of Orthopedics, National Hospital of Guangxi Zhuang Autonomous Region, Nanning Guangxi 530001, PR China.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2012 Oct;26(10):1165-8.
To evaluate the long-term effectiveness of treating early-middle stage avascular necrosis of the femoral head (ANFH) with core decompression and bone grafting.
Between January 2000 and December 2006, 87 ANFH patients (114 hips) were treated with core decompression and bone grafting, including 54 cases (62.1%) of alcohol-induced ANFH, 26 cases (29.9%) of steroid-induced ANFH, and 7 cases (8.0%) of idiopathic ANFH. There were 74 males (97 hips) and 13 females (17 hips), aged 20-56 years (mean, 38 years). The disease duration was 3-46 months (mean, 18 months). According to Ficat staging, 16 hips were at stage I, 68 hips at stage II, and 30 hips at stage III. The Harris score and Ficat stage were compared between pre- and post-operation to assess the outcomes clinically and radiologically. The hip survival was analyzed by the Kaplan-Meier method.
Eighty-seven patients were followed up 5 years to 11 years and 10 months (mean, 8 years and 9 months). The Harris hip score was significantly increased from 73.13 +/- 7.17 at preoperation to 81.59 +/- 13.23 at postoperation (t = -9.318, P = 0.000). The clinical success rate was 69.3% (79/114) and the radiological success rate was 54.4% (62/114). Kaplan-Meier survival analysis showed that the overall survival rate was 84.2% (96/114); the survival rates of Ficat stage I [100% (16/16)] and stage II [91.2% (62/68)] were higher than that of stage III [60.0%(18/30)] (P < 0.01); there was no significant difference between Ficat stage I and II (chi2 = 1.520, P = 0.218).
Core decompression with bone grafting is a safe and effective procedure for the treatment of Ficat stages I-II (early stage) ANFH, and the long-term effectiveness is satisfactory. But the long-term effectiveness is unsatisfactory for the patients at the Ficat stage III (middle stage).
评估髓芯减压联合植骨术治疗早中期股骨头缺血性坏死（ANFH）的长期疗效。
2000年1月至2006年12月，87例ANFH患者（114髋）接受髓芯减压联合植骨术治疗，其中酒精性ANFH 54例（62.1%），激素性ANFH 26例（29.9%），特发性ANFH 7例（8.0%）。男性74例（97髋），女性13例（17髋），年龄20 - 56岁（平均38岁）。病程3 - 46个月（平均18个月）。根据Ficat分期，Ⅰ期16髋，Ⅱ期68髋，Ⅲ期30髋。比较手术前后的Harris评分和Ficat分期，从临床和影像学方面评估疗效。采用Kaplan-Meier法分析髋关节生存率。
87例患者随访5年至11年10个月（平均8年9个月）。Harris髋关节评分从术前的73.13±7.17显著提高至术后的81.59±13.23（t = -9.318，P = 0.000）。临床成功率为69.3%（79/114），影像学成功率为54.4%（62/114）。Kaplan-Meier生存分析显示，总体生存率为84.2%（96/114）；FicatⅠ期[100%（16/16）]和Ⅱ期[91.2%（62/68）]的生存率高于Ⅲ期[60.0%（18/30）]（P < 0.01）；FicatⅠ期和Ⅱ期之间无显著差异（χ2 = 1.520，P = 0.218）。
髓芯减压联合植骨术治疗FicatⅠ - Ⅱ期（早期）ANFH安全有效，长期疗效满意。但对于FicatⅢ期（中期）患者，长期疗效不满意。
