髋关节镜联合多次小直径钻孔减压治疗早期股骨头缺血性坏死的临床疗效

Clinical efficacy of hip arthroscopy combined with multiple small-diameter drilling decompression in the treatment of early avascular necrosis of femoral head

摘要:

目的 探讨髋关节镜联合多次小直径钻孔减压治疗早期股骨头缺血性坏死的临床疗效。方法 选取2019年12月－2023年6月在该院接受治疗的早期股骨头缺血性坏死患者150例，根据治疗方法不同，将患者分为单独钻孔组（75例）和多次小直径钻孔组（75例）。其中，单独钻孔组脱落4例，多次小直径钻孔组脱落2例。最终，单独钻孔组纳入71例，多次小直径钻孔组纳入73例。单独钻孔组给予髋关节镜联合单独钻孔减压术，多次小直径钻孔组给予髋关节镜联合多次小直径钻孔减压术。两组患者术后均随访1年。比较两组患者手术相关指标、髋关节功能、疼痛程度（术前、术后3个月和术后1年）、肌力、生活质量（术前和术后1年）和骨代谢指标（术前和术后3个月）。结果 多次小直径钻孔组术中出血量明显少于单独钻孔组，差异有统计学意义（P < 0.05）。两组患者术后1年Harris评分明显高于术前和术后3个月，术后3个月明显高于术前；且多次小直径钻孔组术后1年Harris评分明显高于单独钻孔组，差异均有统计学意义（P < 0.05）。两组患者术后1年视觉模拟评分法（VAS）评分明显低于术前和术后3个月，术后3个月明显低于术前；且多次小直径钻孔组术后3个月和1年VAS评分明显低于单独钻孔组，差异均有统计学意义（P < 0.05）。两组患者术后1年肌力4级占比和健康调查量表36（SF-36）各项评分明显高于术前，且多次小直径钻孔组明显高于单独钻孔组，差异均有统计学意义（P < 0.05）。两组患者术后3个月血清骨形态发生蛋白-2（BMP-2）、25-羟胆钙化醇和胰岛素样生长因子-1（IGF-1）水平明显高于术前，且多次小直径钻孔组明显高于单独钻孔组，差异均有统计学意义（P < 0.05）；两组患者术后3个月血清Ⅱ型胶原C端肽（CTX-Ⅱ）水平明显低于术前，且多次小直径钻孔组明显低于单独钻孔组，差异均有统计学意义（P < 0.05）。结论 髋关节镜联合多次小直径钻孔减压治疗早期股骨头缺血性坏死，术中出血量相对较少，术后疼痛轻微，骨代谢指标和肌力的改善效果优于单独钻孔减压，可明显提高患者髋关节功能和生活质量。值得应用于临床。

Abstract:

Objective To explore the clinical efficacy of hip arthroscopy combined with multiple small-diameter drilling decompression in the treatment of early avascular necrosis of femoral head.Methods The study selected 150 patients with early avascular necrosis of femoral head who received treatment in our hospital from December 2019 to June 2023. According to the treatment method, they were divided into the individual drilling group (75 cases) and the multiple small-diameter drilling group (75 cases), with 4 cases in the individual drilling group and 2 cases in the multiple small-diameter drilling group. Finally, they were included in the individual drilling group (71 cases) and the multiple small-diameter drilling group (73 cases). The individual drilling group received hip arthroscopy combined with single drilling decompression, while the multiple small-diameter drilling group received hip arthroscopy combined with multiple small-diameter drilling decompression. Both groups were followed up for 1 year after surgery. The surgical related indicators, including hip joint function, pain degree (before surgery, 3 months after surgery, and 1 year after surgery), muscle strength, quality of life (before surgery and 1 year after surgery), and bone metabolism indicators (before surgery and 3 months after surgery) between the two groups were compared.Results Compared with the individual drilling group, the intraoperative bleeding in the multiple small-diameter drilling group was less, the difference was statistically significant (P < 0.05). 1 year after surgery, the Harris scores of both groups were higher than those before surgery and 3 months after surgery. At 3 months after surgery, the Harris scores of both groups were higher than those before surgery, and 1 year after surgery, the Harris score of multiple small-diameter drilling group was higher than that of individual drilling group, and the differences were statistically significant (P < 0.05). 1 year after surgery, the visual analogue scale (VAS) scores of the two groups were lower than those before surgery and 3 months after surgery, and lower than those before surgery at 3 months after surgery. Moreover, at 3 months and 1 year after surgery, VAS scores of the multiple small-diameter drilling group were significantly lower than those of the individual drilling group, and the differences were statistically significant (P < 0.05). Compared with before surgery, 1 year after surgery, the proportion of patients with muscle strength level 4 and scores of 36-Item Short Form Health Survey in both groups increased, and compared with the individual drilling group, those in the multiple small-diameter drilling group were higher, the differences were statistically significant (P < 0.05). Compared with before surgery, at 3 months after surgery, the levels of serum bone morphogenetic protein 2 (BMP-2), 25-hydroxycholecalciferol, and insulin-like growth factor-1 (IGF-1) in both groups increased, and compared with the individual drilling group, the multiple small-diameter drilling group was higher, the difference was statistically significant (P < 0.05); The levels of serum C-telopeptide of type II collagen (CTX-II) in both groups decreased, and compared with the individual drilling group, that in the multiple small-diameter drilling group was lower, the differences were statistically significant (P < 0.05).Conclusion The use of hip arthroscopy combined with multiple small-diameter drilling decompression for the treatment of early avascular necrosis of femoral head results in relatively less intraoperative bleeding, the degree of postoperative pain is mild, and the improvement effects of bone metabolism indicators and muscle strength are superior to those of decompression by individual drilling alone. It can significantly improve the hip joint function and quality of life of patients. It is a worthy clinical application.