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[1]趙巖,沈計(jì)榮,張超,等.股骨頭壞死保髖手術(shù)治療現(xiàn)狀[J].中醫(yī)正骨,2020,32(01):47-50.
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股骨頭壞死保髖手術(shù)治療現(xiàn)狀()
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《中醫(yī)正骨》[ISSN:1001-6015/CN:41-1162/R]

卷:
第32卷
期數(shù):
2020年01期
頁碼:
47-50
欄目:
專家述評(píng)
出版日期:
2020-01-20

文章信息/Info

作者:
趙巖1沈計(jì)榮2張超2薛志鵬1陳衛(wèi)衡3
(1.中國中醫(yī)科學(xué)院望京醫(yī)院,北京 100102; 2.江蘇省中醫(yī)院,江蘇 南京 210029; 3.北京中醫(yī)藥大學(xué)第三附屬醫(yī)院,北京 100029)
關(guān)鍵詞:
股骨頭壞死 數(shù)據(jù)庫 外科手術(shù) 性別因素 年齡因素 職業(yè)因素 ARCO分期 中日友好醫(yī)院分型
摘要:
目的:基于中國股骨頭壞死數(shù)據(jù)庫(China osteonecrosis of the femoral head database,CONFHD)資料分析股骨頭壞死(Osteonecrosis of the femoral head,ONFH)保髖手術(shù)治療現(xiàn)狀。方法:篩選CONFHD中2016年7月至2018年12月收錄的病例資料,提取信息包括患者的性別、年齡、職業(yè)、ARCO分期、中日友好醫(yī)院(China-Japan Friendship Hospital,CJFH)分型及保髖手術(shù)方式。采用Excel2016處理數(shù)據(jù)。結(jié)果:共納入治療資料完整的ONFH患者1682例,其中采用保髖手術(shù)治療者484例(28.78%)。接受保髖手術(shù)治療的484例ONFH患者中,男350例(72.31%),女134例(27.69%); 年齡≤20歲16例(3.31%)、21~40歲174例(35.95%)、41~60歲242例(50.00%)、>60歲52例(10.74%); Ⅰ級(jí)體力勞動(dòng)者44例(9.09%)、Ⅱ級(jí)體力勞動(dòng)者130例(26.86%)、Ⅲ級(jí)體力勞動(dòng)者8例(1.65%)、Ⅳ級(jí)體力勞動(dòng)者235例(48.55%)、其他67例(13.84%)。保髖手術(shù)(484例636髖)包括動(dòng)脈灌注術(shù)(204髖)、髓芯減壓術(shù)(173髖)、病灶清除術(shù)(159髖)、植骨支撐術(shù)(50髖)、關(guān)節(jié)鏡術(shù)(43髖)、鉭棒植入術(shù)(7髖)。采用2種或2種以上術(shù)式聯(lián)合治療共128髖,其中髓芯減壓術(shù)聯(lián)合病灶清除術(shù)71髖(55.47%)、髓芯減壓術(shù)聯(lián)合病灶清除術(shù)及植骨支撐術(shù)36髖(28.13%)、病灶清除術(shù)聯(lián)合植骨支撐術(shù)10髖(7.81%)、髓芯減壓術(shù)聯(lián)合鉭棒植入術(shù)4髖(3.13%)、髓芯減壓術(shù)聯(lián)合植骨支撐術(shù)4髖(3.13%)、病灶清除術(shù)聯(lián)合鉭棒植入術(shù)3髖(2.34%)。接受保髖手術(shù)治療的患者中,ARCOⅠ期160髖、Ⅱ期216髖、Ⅲ期207髖、Ⅳ期53髖; Ⅰ期行動(dòng)脈灌注術(shù)69髖(43.13%),比例最高; Ⅱ期行動(dòng)脈灌注術(shù)69髖(31.94%),比例最高; Ⅲ期行病灶清除術(shù)67髖(32.37%),比例最高; Ⅳ期行髓芯減壓術(shù)18髖(33.96%),比例最高。CJFH分型C型152髖、M型94髖、L1型172髖、L2型90髖、L3型128髖; C型行動(dòng)脈灌注術(shù)55髖(36.18%),比例最高; M型行動(dòng)脈灌注術(shù)28髖(29.79%),比例最高; L1型行髓芯減壓術(shù)59髖(34.30%),比例最高; L2型行動(dòng)脈灌注術(shù)28髖(31.11%),比例最高; L3型行動(dòng)脈灌注術(shù)49髖(38.28%),比例最高。結(jié)論:CONFHD資料顯示,近1/3的ONFH患者接受了保髖手術(shù)治療,且多為早中期患者,其中男性多于女性、年齡以41~60歲居多、重度體力勞動(dòng)者多見,動(dòng)脈灌注術(shù)在單一保髖術(shù)式中占比較大、髓芯減壓術(shù)聯(lián)合病灶清除術(shù)在聯(lián)合保髖術(shù)式中占比較大,不同ARCO分期和不同CJFH分型的保髖手術(shù)方式不同,ARCO分期早中期患者行動(dòng)脈灌注術(shù)和病灶清除術(shù)的比例較高、晚期患者行髓芯減壓術(shù)的比例較高,CJFH分型中L1型行髓芯減壓術(shù)的比例較高、其他類型行動(dòng)脈灌注術(shù)的比例較高。

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備注/Memo

備注/Memo:
(收稿日期:2019-08-23 本文編輯:郭毅曼)基金項(xiàng)目:國家中醫(yī)藥管理局國家中醫(yī)臨床研究基地業(yè)務(wù)建設(shè)科研專項(xiàng)課題(JDZX2015272)通訊作者:陳衛(wèi)衡 E-mail:[email protected]
更新日期/Last Update: 2020-01-15