Chen Yan-Bai, Qin Wei-Kai, Yan Qi, Sun Ao-Lin, Zhang Hong-Mei
The First Department of Osteoarthropathy, Wangjing Hospital, China Academy of Chinese Medical Sciences, Beijing 100102, China.
Zhongguo Gu Shang. 2025 Jul 25;38(7):680-6. doi: 10.12200/j.issn.1003-0034.20250269.
To assess the mid-term clinical efficacy of the direct anterior approach for window decompression and bone grafting surgery in the treatment of early to mid-stage osteonecrosis of the femoral head (ONFH).
A retrospective analysis was performed on 40 patients (40 hips) diagnosed with osteonecrosis of the femoral head (ONFH), classified as types L1 and L2 according to the China-Japan Friendship Hospital (CJFH) classification system, and at stagesⅡ, ⅢA, and ⅢB based on the Association Research Circulation Osseous (ARCO) staging system. All patients underwent head-neck junction fenestration decompression and bone grafting via the direct anterior approach between January 2015 and May 2022, with complete follow-up data available for a minimum of three years. The ages of the patients ranged from 35 to 69 years old, with a mean of (49.13±6.14 ) years old;their body mass index (BMI) ranged from 20.02 to 27.94 kg·m, with a mean of (23.65±1.69) kg·m;the duration of the disease ranged from 13 to 36 months, with a mean of (24.55±4.14) months. Preoperative and 3-year postoperative X-ray parameters were collected, including the anterior preserved angle(APA), lateral preserved angle (LPA), and combined preserved angle (CPA). Additionally, hip joint disability and osteoarthritis outcome scores (HOOS) and Harris hip scores (HHS) were recorded.
Forty patients were followed up for a period ranging from 36 to 59 months, with a mean duration of (47.18±6.18) months. At 3 years postoperative, none of the patients underwent hip replacement surgery. The APA (73.15±19.35)°, LPA (75.35 ±21.48)°, and CPA (136.25±26.78)° at the 3-year postoperative significantly improved compared to preoperative measurements (61.93±20.54)°, (59.46±22.67)°, and (116.58±32.47)°, with statistical significance (<0.05). The HOOS (20.37±1.39) and HHS (89.74±3.28) scores at the 3-year postoperative were significantly improved from preoperative scores (12.36±1.58) and (50.27±6.15), respectively, with statistical significance (<0.05).
The direct anterior approach for window decompression and bone grafting surgery can relieve joint pain, improve joint function, and enhance X-ray preserved angles, effectively preventing femoral head collapse, making it an effective surgical method for treating ONFH classified as L1, L2 according to CJFH and stagesⅡ, ⅢA, ⅢB according to ARCO.
评估直接前路开窗减压植骨术治疗早中期股骨头坏死（ONFH）的中期临床疗效。
对40例（40髋）诊断为股骨头坏死（ONFH）的患者进行回顾性分析，根据中日友好医院（CJFH）分类系统分为L1和L2型，根据骨循环研究协会（ARCO）分期系统分为Ⅱ期、ⅢA期和ⅢB期。2015年1月至2022年5月期间，所有患者均通过直接前路行头颈交界处开窗减压植骨术，且有至少3年的完整随访数据。患者年龄35至69岁，平均（49.13±6.14）岁；体重指数（BMI）为20.02至27.94kg·m，平均（23.65±1.69）kg·m；病程13至36个月，平均（24.55±4.14）个月。收集术前及术后3年的X线参数，包括前保留角（APA）、侧保留角（LPA）和联合保留角（CPA）。此外，记录髋关节功能障碍和骨关节炎疗效评分（HOOS）及Harris髋关节评分（HHS）。
40例患者随访时间为36至59个月，平均（47.18±6.18）个月。术后3年，无患者接受髋关节置换手术。术后3年时的APA（73.15±19.35）°、LPA（75.35±21.48）°和CPA（136.25±26.78）°较术前测量值（61.93±20.54）°、（59.46±22.67）°和（116.58±32.47）°有显著改善，差异有统计学意义（<0.05）。术后3年时的HOOS（20.37±1.39）和HHS（89.74±3.28）评分较术前评分（12.36±1.58）和（50.27±6.15）也有显著改善，差异有统计学意义（<0.05）。
直接前路开窗减压植骨术可缓解关节疼痛，改善关节功能，提高X线保留角，有效防止股骨头塌陷，是治疗CJFH分类为L1、L2型及ARCO分期为Ⅱ期、ⅢA期、ⅢB期ONFH的有效手术方法。
