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[1]洪志楠,宋雨珂,何曉銘,等.股骨頭前、外側(cè)保留角和聯(lián)合保留角在股骨頭壞死經(jīng)髖關(guān)節(jié)外科脫位打壓植骨支撐術(shù)適應(yīng)證選擇中的作用[J].中醫(yī)正骨,2024,36(09):69-75.
　HONG Zhinan,SONG Yuke,HE Xiaoming,et al.The role of anterior,lateral and combined preserved angles of femoral head in the selection of indications for impaction bone grafting through surgical hip dislocation approach for treating osteonecrosis of the femoral head[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2024,36(09):69-75.
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股骨頭前、外側(cè)保留角和聯(lián)合保留角在股骨頭壞死經(jīng)髖關(guān)節(jié)外科脫位打壓植骨支撐術(shù)適應(yīng)證選擇中的作用()
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《中醫(yī)正骨》[ISSN:1001-6015/CN:41-1162/R]

卷:
第36卷
期數(shù):
2024年09期
頁碼:
69-75
欄目:
臨床研究
出版日期:
2024-09-20

文章信息/Info

Title:
The role of anterior,lateral and combined preserved angles of femoral head in the selection of indications for impaction bone grafting through surgical hip dislocation approach for treating osteonecrosis of the femoral head
作者:
洪志楠; 宋雨珂; 何曉銘; 何偉; 魏秋實
(廣州中醫(yī)藥大學第三附屬醫(yī)院,廣東 廣州 510378)
Author(s):
HONG Zhinan; SONG Yuke; HE Xiaoming; HE Wei; WEI Qiushi
The Third Affiliated Hospital of Guangzhou University of Chinese Medicine,Guangzhou 510378,Guangdong,China
關(guān)鍵詞:
股骨頭壞死;  髖關(guān)節(jié);  脫位;  股骨頭前側(cè)保留角;  股骨頭外側(cè)保留角;  股骨頭聯(lián)合保留角;  骨移植;  適應(yīng)證
Keywords:
femur head necrosis;  hip joint;  dislocations;  anterior preserved angle of femoral head;  lateral preserved angle of femoral head;  combined preserved angle of femoral head;  bone transplantation;  indication
摘要:
目的:探討股骨頭前側(cè)保留角(anterior preserved angle,APA)、外側(cè)保留角(lateral preserved angle,LPA)和聯(lián)合保留角(combined preserved angle,CPA)在股骨頭壞死(osteonecrosis of the femoral head,ONFH)經(jīng)髖關(guān)節(jié)外科脫位打壓植骨支撐術(shù)適應(yīng)證選擇中的作用。方法:以2020年1月至2022年12月在廣州中醫(yī)藥大學第三附屬醫(yī)院接受經(jīng)髖關(guān)節(jié)外科脫位打壓植骨支撐術(shù)治療的ONFH患者為研究對象。收集患者的性別、年齡、ONFH分期和分型,以及手術(shù)前后、隨訪期間雙側(cè)髖關(guān)節(jié)蛙位和正位X線片等信息。在患者術(shù)前雙側(cè)髖關(guān)節(jié)蛙位和正位X線片上分別測量股骨頭APA和LPA,二角之和為股骨頭CPA。以行全髖關(guān)節(jié)置換術(shù)為終點事件,采用Kaplan-Meier法分析經(jīng)髖關(guān)節(jié)外科脫位打壓植骨支撐術(shù)后股骨頭生存情況; 采用受試者工作特征(receiver operating characteristic,ROC)曲線確定股骨頭APA、LPA和CPA預(yù)測經(jīng)髖關(guān)節(jié)外科脫位打壓植骨支撐術(shù)治療失敗的最佳臨界值,并根據(jù)此臨界值進行二分類后采用Kaplan-Meier法分析其對股骨頭生存情況的預(yù)測效果。結(jié)果:①一般情況。共納入109例患者,隨訪時間8～47個月,中位數(shù)25個月。患者術(shù)前股骨頭APA 43.71°±14.43°,LPA 53.08°±15.62°,CPA 96.79°±24.60°。隨訪期間,18髖改行全髖關(guān)節(jié)置換術(shù),其中17髖發(fā)生在經(jīng)髖關(guān)節(jié)外科脫位打壓植骨支撐術(shù)后2年內(nèi)。②經(jīng)髖關(guān)節(jié)外科脫位打壓植骨支撐術(shù)后股骨頭生存情況。術(shù)后1年、2年和3年股骨頭生存率分別為97.5%、86.1%和81.6%。③股骨頭APA、LPA和CPA對經(jīng)髖關(guān)節(jié)外科脫位打壓植骨支撐術(shù)治療失敗的預(yù)測價值評價結(jié)果。股骨頭APA、LPA和CPA預(yù)測經(jīng)髖關(guān)節(jié)外科脫位打壓植骨支撐術(shù)治療失敗的曲線下面積分別為0.835、0.765、0.854,敏感度分別為67.3%、75.2%、91.1%,特異度分別為88.9%、72.2%、72.2%,臨界值分別為39.5°、46.5°、75.0°。④股骨頭APA、LPA和CPA對經(jīng)髖關(guān)節(jié)外科脫位打壓植骨支撐術(shù)后股骨頭生存情況的預(yù)測結(jié)果。與術(shù)前股骨頭APA≤39.5°、LPA≤46.5°、CPA≤75.0°相比,術(shù)前股骨頭APA>39.5°、LPA>46.5°、CPA>75.0°時,股骨頭生存率更高。結(jié)論:股骨頭APA、LPA和CPA可用于指導ONFH經(jīng)髖關(guān)節(jié)外科脫位打壓植骨支撐術(shù)適應(yīng)證的選擇,且術(shù)前股骨頭APA>39.5°、LPA>46.5°、CPA>75.0°的患者有望獲得更好的手術(shù)療效。
Abstract:
Objective:To explore the role of anterior preserved angle(APA),lateral preserved angle(LPA)and combined preserved angle(CPA)of femoral head in the selection of indications for impaction bone grafting through surgical hip dislocation(SHD)approach for treating osteonecrosis of the femoral head(ONFH).Methods:The patients who underwent impaction bone grafting through SHD approach for ONFH in the Third Affiliated Hospital of Guangzhou University of Chinese Medicine from January 2020 to December 2022 were selected as the subjects,and their information,including gender,age,ONFH staging and typing,as well as the X-ray films of bilateral hip joints in normotopia and froglike position before and after the surgery and during follow-up period,was collected.The APA and LPA of the femoral head were measured on the presurgical X-ray films of bilateral hip joints in normotopia and froglike position,respectively,and the sum of the two angles was the CPA of femoral head.With total hip arthroplasty(THA)as the endpoint event,the survival of femoral head after the impaction bone grafting through SHD approach was analyzed by using Kaplan-Meier method.Furthermore,the optimal critical values of APA,LPA and CPA of femoral head in predicting the failure of impaction bone grafting through SHD approach in treating ONFH were determined by using the receiver operating characteristic(ROC)curve.The binary classification was performed on the APA,LPA and CPA of femoral head based on the critical values,and then the Kaplan-Meier method was used to analyze the predictive effects of APA,LPA and CPA of femoral head on the survival of the femoral head.Results:①General condition.One hundred and nine patients were included in the study,and they were followed up for 8-47 months with a median of 25 months.The preoperative femoral head APA,LPA and CPA were 43.71±14.43,53.08±15.62,and 96.79±24.60 degrees,respectively.During the follow-up period,18 hips were re-treated with THA,among which 17 ones experienced a re-operation within 2 years after impaction bone grafting through SHD approach.②The survival of femoral head after receiving impaction bone grafting through SHD approach.The results of analysis on the Kaplan-Meier curve showed that,the survival rates of femoral head were 97.5%, 86.1%,and 81.6% at postsurgical year 1,2, and 3,respectively.③The results of evaluation on the values of APA,LPA and CPA of femoral head in predicting the failure of impaction bone grafting through SHD approach in treating ONFH.The values of APA,LPA and CPA of femoral head in predicting the failure of impaction bone grafting through SHD approach in treating ONFH was evaluated and analyzed by using ROC curve,and the results showed that the areas under the ROC curves were 0.835,0.765 and 0.854; the sensitivities were 67.3%,75.2% and 91.1%; and the specificities were 88.9%,72.2%,and 72.2%; and the critical values were 39.5,46.5,and 75.0 degrees,respectively.④The prediction results of APA,LPA and CPA of femoral head on the survival of femoral head after receiving impaction bone grafting through SHD approach.Compared to the preoperative femoral head APA ≤39.5 degrees,LPA ≤46.5 degrees,and CPA ≤75.0 degrees,the survival rate of the femoral head was higher when the preoperative APA,LPA and CPA of femoral head were greater than 39.5,46.5,and 75.0 degrees,respectively.Conclusion:The APA,LPA,and CPA of femoral head can be used to guide the selection of indications for impaction bone grafting through SHD approach in treating ONFH,and the patients with presurgical APA,LPA and CPA of femoral head greater than 39.5,46.5,and 75.0 degrees,respectively,are expected to achieve better surgical outcomes.

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備注/Memo

備注/Memo:
基金項目:國家自然科學基金項目(82274544,82004392); 廣東省基礎(chǔ)與應(yīng)用基礎(chǔ)研究基金項目(2023A1515010551); 畢節(jié)市科學技術(shù)局2022年度“揭榜掛帥”項目[畢科合重大專項〔2022〕1號]; 廣東省中醫(yī)骨傷研究院開放課題重點項目(GYH202101-01,GYH202101-04)
通訊作者:魏秋實 E-mail:[email protected]
更新日期/Last Update: 1900-01-01